Share this page

Health Library

Cystocele/Rectocele(Pelvic Relaxation; Bladder Prolapse; Fallen Bladder/Rectocoele; Protruding Rectum)

Pronounced: SIS-tuh-seal/REK-tuh-seal

Definition

Connective tissue separates the pelvic organs. The tissue, called fascia, is attached to nearby muscles. The fascia and muscles support the bladder, vagina, and rectum. Defects in the fascia can cause cystoceles and rectoceles.

In a cystocele, there is a defect in the fascia between the bladder and vagina. This allows a part of the bladder wall to bulge into the vagina. There are three grades of cystocele:

  • Grade 1: mildest form, where the bladder drops only partway into the vagina
  • Grade 2: moderate form, where the bladder has sunken far enough to reach the opening of the vagina
  • Grade 3: most severe form, where the bladder sags through the opening of the vagina

Cystocele

si55551974_96472_1

Copyright © Nucleus Medical Media, Inc.

In a rectocele, there is a defect in the fascia between the rectum and the vagina. This allows part of the wall of the rectum to bulge into the vagina.

Rectocele

si55551976_96472_1

Copyright © Nucleus Medical Media, Inc.

The sooner that a cystocele or rectocele is treated, the better the outcome. If you suspect you have this condition, contact your doctor.

Causes

The walls between the vagina and bladder or rectum can be damaged by one or more of the following factors:

  • Difficult vaginal births:
    • Multiple births
    • The use of forceps to assist delivery
    • Perineal tears during delivery
    • Episiotomy during birth
  • Strain from lifting heavy objects
  • Chronic cough
  • Chronic constipation
  • Weakening of vaginal muscles caused by a lack of estrogen after menopause
Risk Factors

Factors that increase your risk for a cystocele or rectocele include:

  • Age: postmenopausal
  • History of difficult vaginal births
  • History of straining during bowel movements
  • Obesity
  • Smoking
Symptoms

Many cases are mild and do not have symptoms.

In more serious cases, the symptoms of cystocele include:

  • Urine leakage while laughing, sneezing, or coughing
  • Incomplete bladder emptying after urination
  • Pain or pressure in the pelvis
  • Pain during sexual intercourse
  • Feeling of tissue bulging out of vagina

Symptoms of rectocele include:

  • Pain or pressure in the vagina
  • Pain during sexual intercourse
  • Pain or pressure in the rectum
  • Difficult passage of stool
  • Needing to apply pressure on vagina to pass stool
  • Feelings of incomplete stool passage
  • Feeling of tissue bulging out of vagina

If you have any of these symptoms, do not assume it is due to cystocele or rectocele. These symptoms may be caused by other, less or more serious health conditions.

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may also have a vaginal and rectal exam. Tests for cystocele may include the following:

  • You may need to have images taken of your urine and bowel activity. This can be done with:
    • Voiding cystourethrogram
    • Defecogram
  • Your bodily fluid may need to be tested. This can be done with urine tests.
Treatment

Talk with your doctor about the best plan for you. For the mildest cases of cystocele and rectocele, no treatment is needed. For more serious cases, treatment options include the following:

Activity Modification
  • Your doctor may suggest that you avoid heavy lifting.
  • Kegel exercises, which involve squeezing the pelvic floor muscles, may help to strengthen the muscles around the vagina and bladder.
  • A diet that allows for easy passage of stools may help with a rectocele. The diet should include fiber, liquids, and a stool softener if necessary.
Pessary

A pessary is a device that is inserted into the vagina. It can provide support to keep the bladder and/or rectum in place.

Estrogen Replacement Therapy

Adding estrogen may help strengthen the walls of the vagina after menopause. It may be delivered in the form of pills, creams, or patches.

Surgery

For severe cases, surgery may be needed to move the bladder or rectum back into place.

Prevention

To help reduce your chances of getting cystocele and rectocele, take the following steps:

  • Avoid heavy lifting.
  • Perform Kegel exercises regularly.
  • Treat constipation.
  • Quit smoking.
  • Maintain a healthy weight.

RESOURCES:

American Society of Colon and Rectal Surgeons
http://www.fascrs.org

Urology Care Foundation
http://www.urologyhealth.org

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

Women's Health Matters
http://www.womenshealthmatters.ca

References:

Cystocele (fallen bladder). National Kidney and Urologic Diseases Information Clearinghouse website. Available at: http://www.kidney.niddk.nih.gov/kudiseases/pubs/cystocele. Updated June 29, 2012. Accessed March 1, 2013.

Cystocoele, rectocele, and pelvic support surgery. Society of Gynecologic Surgeons website. Available at: http://www.sgsonline.org/sgsinc/patiented/educate_articles/edpro002.htm. Accessed March 1, 2013.

A healthy pregnancy for women with diabetes. The American College of Obstetricians and Gynecologists website. Available at: http://www.acog.org/~/media/For%20Patients/faq176.pdf?dmc=1&ts=20130301T1642555353. Accessed March 1, 2013.

Pelvic organ prolapse. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 22, 2013. Accessed March 1, 2013.

Rectocele. American Society of Colon and Rectal Surgeons website. Available at: http://www.fascrs.org/patients/conditions/rectocele. Updated October 2012. Accessed March 1, 2013.



Last reviewed December 2013 by Adrienne Carmack, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

Baptist Flame

Healthy Life Podcasts

Find A Doctor

Services

Locations

Baptist Medical Clinic

Patients & Visitors

Learn

Contact Us

Physician Tools

Careers at Baptist

Employee Links

Online Services

At Baptist Health Systems

At Baptist Medical Center

close ×