Cystocele (Bladder Prolapse) Treatment in Turkey: Solving Bladder Issues at the Source
What is a cystocele? Learn about symptoms like urinary incontinence, frequent urination, and vaginal fullness. Explore non-surgical and surgical treatments (anterior repair) in Istanbul with Dr. Cengiz Andan.
Could Your Bladder Be Out of Place?
In women, the bladder is located just in front of the vagina, held in place by strong muscles and connective tissues. However, over time, this “support wall” can weaken. When the support fails, gravity takes over, causing the bladder to sag and herniate into the vagina.
Medically known as Cystocele, and commonly called Bladder Prolapse, this is one of the most quality-of-life-reducing pelvic floor disorders.
Many women mistake their frequent urination or leakage for “signs of aging” or “infection.” In reality, the underlying cause is often a purely mechanical “prolapse” problem. At Dr. Cengiz Andan’s Clinic, we identify this anatomical defect and restore the bladder to its original position, resolving urinary issues and restoring vaginal comfort.
- Why Does Cystocele Happen? Who is at Risk?
A cystocele occurs due to the weakening of the pelvic floor muscles (the hammock holding the vagina and organs).
Most Common Causes:
- Vaginal Births: Especially difficult labors, large babies, or multiple births can tear or stretch the anterior vaginal wall.
- Menopause: Estrogen gives tissues elasticity. As estrogen drops with menopause, tissues sag.
- Increased Abdominal Pressure: Chronic coughing (asthma/smoking), chronic constipation (straining), or jobs/sports requiring heavy lifting.
- Genetics: Some women naturally have weaker connective tissue.
- Hysterectomy: Reduced support tissue after uterus removal.
- Symptoms: Not Just a Urinary Problem
Symptoms vary by the degree of prolapse. Mild cases may go unnoticed, while advanced stages make life difficult.
- Palpable Bulge: A soft swelling at the vaginal opening or a feeling that “a ball is coming out.”
- Difficulty Urinating: When the bladder sags, the urethra (urine tube) bends. Patients struggle to start urinating or feel like they “cannot empty completely.” Sometimes, they must push the bulge up with their fingers to urinate.
- Frequent Urination: Since the bladder doesn’t empty fully, the urge to go returns quickly.
- Incontinence: Leaking when coughing, laughing, or lifting (Stress Incontinence) may accompany prolapse.
- Recurrent Infections: Retained (residual) urine creates a breeding ground for bacteria, causing frequent cystitis (UTIs).
- Sexual Discomfort: A feeling of fullness or pain in the vagina.
- Diagnosis and Grading
Diagnosis requires a simple gynecological exam. Your doctor will ask you to strain to determine the severity.
- Grade 1 (Mild): Slight sag into the vagina.
- Grade 2 (Moderate): Reaches the vaginal opening.
- Grade 3 (Severe): Protrudes outside the vaginal opening.
If needed, Urodynamics testing measures bladder function, or an ultrasound checks the kidneys.
- Treatment Methods: Is Surgery Necessary?
The treatment plan depends on the grade of prolapse, symptoms, and patient age.
- Non-Surgical Methods (Mild to Moderate Cases):
- Kegel Exercises: Strengthening pelvic floor muscles can stop the progression of mild prolapse.
- Pessary Use: Silicone rings inserted into the vagina to hold the bladder up mechanically. Ideal for elderly patients unfit for surgery or during pregnancy.
- Estrogen Therapy: Local creams can strengthen tissue in menopausal women.
- Surgical Treatment (Vaginal Repair / Anterior Colporrhaphy):For advanced prolapse or significant symptoms, surgery is the definitive solution.
- The Procedure: Performed through the vagina (no abdominal cuts). The loose, sagging excess tissue of the anterior vaginal wall is removed. The underlying weakened fascia (connective tissue) is tightened with stitches, lifting the bladder back up.
- Extra Procedure: If urinary incontinence is present, a bladder neck sling (TOT) can be applied in the same session.
- Duration: Takes about 30-45 minutes. Patients go home the next day.
- Prevention: Stopping Recurrence
Whether you have surgery or not, protecting your pelvic floor is key:
- Avoid Constipation: Straining is the enemy. Eat fiber.
- Weight Control: Excess weight increases abdominal pressure.
- Quit Smoking: Chronic coughing tears tissues.
- Proper Exercise: Avoid heavy lifting; choose pelvic-floor-friendly exercises.
Frequently Asked Questions (Cystocele)
- Will my urinary leakage stop after cystocele surgery?Answer:Cystocele repair (anterior repair) alone may not fix leakage. Sometimes, it can even unmask “hidden incontinence.” Therefore, we test for incontinence before surgery and, if needed, add a TOT sling procedure to the operation. This solves both problems at once.
- Can this surgery be done without removing the uterus?Answer:Yes. If only the bladder is prolapsed, we can perform a vaginal repair without touching the uterus. However, if the uterus is also prolapsed, your doctor might recommend suspension or removal.
- How will surgery affect my sex life?Answer:Positively. The sensation of fullness and pain from the sagging bladder disappears. Also, since the anterior vaginal wall is tightened during surgery, vaginal tone improves, increasing sexual pleasure.
- Is using a pessary difficult?Answer:No, patients can insert/remove it themselves, or a doctor can clean/change it periodically. However, it is not a permanent cure, just a mechanical support. Long-term use requires regular checks to prevent vaginal irritation.
- Will there be a visible scar?Answer:No. The entire procedure is performed inside the vagina, so there are no visible external scars.
Dr. Cengiz Andan restores your quality of life by using combined surgical approaches to correct both the anatomical defect and urinary function in cystocele treatment.
