Photo from commons.wikimedia.org
Anterior vaginal prolapse, also known as a cystocele or a prolapsed bladder, occurs when the bladder moves from its normal position in the pelvic and presses against the vaginal wall.
The pelvic floor muscles and connective tissues normally hold the pelvic organs in place, including the bladder, uterus, and intestines. Anterior prolapse happens when the pelvic floor gets weak or when too much pressure is placed on it. This might develop gradually, as as during vaginal childbirth, prolonged constipation, forceful coughing, or hard lifting.
Anterior prolapse can be treated. Nonsurgical treatment is frequently helpful for mild to severe prolapse. Surgery may be required in more severe cases to retain the vagina and other pelvic organs in their normal locations.
WHAT ARE THE SYMPTOMS OF ANTERIOR VAGINAL PROLAPSE?
You may not notice any indications or symptoms of anterior prolapse in moderate situations. When symptoms emerge, they may include the following:
- A sensation of fullness or pressure in your pelvis and vagina
- In some circumstances, you may notice or feel a protrusion of tissue in your vagina.
- When you strain, cough, bear down, or raise, your pelvic pressure rises.
- Urinary problems, such as difficulties commencing an urine stream, the feeling that you haven't entirely emptied your bladder after urinating, a frequent need to urinate, or urine leakage (urinary incontinence)
Signs and symptoms are often more visible after prolonged standing and may disappear when you lie down.
WHAT ARE THE CAUSES OF ANTERIOR VAGINAL PROLAPSE?
The muscles, ligaments, and connective tissues of your pelvic floor support your bladder and other pelvic organs. The connections between your pelvic organs and ligaments might deteriorate with time, as a result of birthing trauma or continuous straining. When this occurs, your bladder may fall lower than usual and bulge into your vagina (anterior prolapse).
Some of the reasons of pelvic floor stress are as follows:
- Pregnancy and vaginal delivery
- Obesity or being overweight
- Repetitive heavy lifting
- Constraint in bowel motions
- A persistent cough or bronchitis
WHAT ARE THE RISK FACTORS FOR ANTERIOR VAGINAL PROLAPSE?
The following variables may enhance your chances of anterior prolapse:
- Childbirth and pregnancy: Women who have had a vaginal or instrument-assisted delivery, many pregnancies, or infants with a high birth weight are more likely to experience anterior prolapse.
- Hysterectomy: The removal of your uterus may contribute to pelvic floor weakness, however this is not always the case.
- Genetics: Some women have poorer connective fibers after birth, rendering them more prone to anterior prolapse.
- Obesity: Women who are overweight or obese are more likely to experience anterior prolapse.
- Aging: As you become older, your chances of having anterior prolapse rise. This is especially true after menopause, when your body's production of estrogen, which aids in the strength of the pelvic floor, drops.
HOW IS ANTERIOR VAGINAL PROLAPSE DIAGNOSED?
Anterior prolapse diagnosis may include:
- A pelvic examination: You may be examined while lying down as well as standing. Your provider will search for a tissue bulge into your vagina during the exam, which indicates pelvic organ prolapse. You will almost certainly be asked to bear down as if having a bowel movement to assess how much this alters the degree of prolapse. You'll be instructed to contract your pelvic floor muscles as if you're trying to stop the flow of urine to assess their strength.
- Filling a questionnaire: You may be asked to complete a form that will assist your provider in assessing your medical history, the severity of your prolapse, and how much it impacts your quality of life. This information is also useful in guiding treatment selections.
- Urine and bladder tests: If you have substantial prolapse, your bladder may be checked to assess how well and thoroughly it empties. If you appear to be retaining more pee in your bladder than is typical after urinating, your provider may run a test on a urine sample to search for symptoms of a bladder infection.
WHAT ARE THE TREATMENTS FOR ANTERIOR VAGINAL PROLAPSE?
Treatment is determined by whether you have symptoms, the severity of your anterior prolapse, and whether you have any associated diseases, such as urine incontinence or several types of pelvic organ prolapse.
Mild instances, with few or no visible symptoms, usually do not necessitate therapy. Your clinician may advise you to wait and see, with periodic visits to monitor your prolapse.
If you have symptoms of anterior prolapse, your first line of treatment should include:
- Exercises for the pelvic floor muscles: These exercises, also known as Kegels, aim to strengthen your pelvic floor muscles, allowing them to better support your bladder and other pelvic organs. Your physician or a physical therapist can show you how to conduct these exercises and help you assess if you're doing them correctly.
Kegel exercises may be most effective at alleviating symptoms when taught by a physical therapist and reinforced with biofeedback. Biofeedback involves the use of monitoring equipment to ensure that you are contracting the right muscles at the right intensity and length of time. These exercises may help alleviate your symptoms, but they may not reduce the amount of the prolapse.
- A supplementary device (pessary): A vaginal pessary is a plastic or rubber ring that is put into your vagina to provide bladder support. A pessary does not correct or cure the prolapse, but the additional support it provides can help reduce discomfort. Your doctor or other health care provider fits you for the device and instructs you on how to clean and reinsert it on your own. Pessaries are used by many women as a temporary alternative to surgery, and some use them when surgery is too hazardous.
When surgery is required
If you continue to have visible, painful symptoms despite the preceding treatment choices, you may require surgery to correct the prolapse.
- How it's done: The operation is frequently performed vaginally and entails stitching the prolapsed bladder back into position and removing any extra vaginal tissue. If your vaginal tissues appear to be very thin, your doctor may use a unique type of tissue graft to augment them and enhance support.
- If you have a uterine prolapse: Your doctor may propose removing the uterus (hysterectomy) in addition to treating the injured pelvic floor muscles, ligaments, and other tissues if anterior prolapse is combined with a prolapsed uterus.
- If incontinence is a problem for you: If your anterior prolapse is accompanied with stress incontinence (leaking pee during vigorous exercise), your doctor may also suggest one of many treatments to support the urethra (urethral suspension) and alleviate your incontinence symptoms.
If you are pregnant or planning to become pregnant, you may need to postpone surgery until after you have finished having children. In the meanwhile, pelvic floor exercises or a pessary may assist reduce your problems. The benefits of surgery can persist for many years, but there is a chance that prolapse can occur again, necessitating further surgery at some point.
HOME REMEDIES FOR ANTERIOR VAGINAL PROLAPSE
Kegel exercises are at-home workouts that strengthen your pelvic floor muscles. A stronger pelvic floor supports your pelvic organs and alleviates symptoms associated with anterior prolapse.
Follow these steps to conduct Kegel exercises:
- Tighten (contract) the muscles in your pelvic floor that you utilize to halt urinating.
- Hold the contraction for five seconds, followed by five seconds of relaxation. (If this is too difficult, start with two seconds of holding and three seconds of relaxing.)
- Extend the contraction for 10 seconds at a time.
- Every day, perform three sets of ten repetitions of the exercises.
Inquire with your doctor about how to properly perform a Kegel and whether you're using the right muscles. Once you've mastered the appropriate technique, you can perform Kegel exercises almost anywhere, whether you're sitting at your computer or lounging on the couch.
You can also try the following lifestyle changes to assist prevent an anterior prolapse from progressing:
- Constipation should be treated and avoided: High-fiber diets can be beneficial.
- Lift correctly and avoid heavy lifting: Lift with your legs rather than your waist or back.
- Coughing must be controlled: Don't smoke and seek therapy for a chronic cough or bronchitis.
- Maintain a healthy weight: Consult your doctor to assess your target weight and, if necessary, weight-loss programs.