A cystocele is a herniation of the posterior bladder wall and trigone through the anterior wall of the vagina. It is caused by weakening of the pelvic floor during childbirth. Patients complain of vaginal bulging or fullness. Symptoms are worsened by Valsalva maneuvers and improved with positioning (recumbent). Cystoceles are often associated with urinary incontinence and incomplete emptying of the bladder. Rectoceles, uterine prolapse, and soft tissue tumors should also be considered.
Management and Disposition
ED management is reassurance and outpatient referral to a gynecologist. Advise the patient to avoid heavy lifting or straining. Definitive treatment for larger cystoceles or those associated with significant urinary symptoms, pain, or bothersome bulging may require pessary placement or surgery.
Cystocele. Cystocele with bulging of the posterior bladder wall into the vagina. (Photo contributor: Matthew Backer, Jr., MD.)
Most cystoceles are asymptomatic and are detected incidentally at the time of pelvic examination.
Cystocele. Cystocele worsening with Valsalva. (Photo contributor: Matthew Backer, Jr., MD.)