Is Cystocele Repair a Major Surgery?

Cystocele means a prolapsed or dropped/fallen bladder (urine pouch). It is the bulging or dropping of the bladder into the woman’s vagina (the tube that connects the womb to outside the woman’s body).

It mostly occurs when the wall between a woman’s bladder and her vagina weakens due to

• Constant straining during defecation.
• Chronic constipation.
• Chronic or violent coughing.
• Heavy weight-lifting.
• Excessive weight gain.
• Straining during childbirth.
• Weakened vaginal muscles during menopause.

Mild prolapse often may not show any symptoms. However, if you have severe bladder prolapse, then you may experience

• A bulge in the vagina.
• Heaviness or fullness in the pelvic (groin) area.
• Difficulty starting a urine stream.
• Frequent or urgent urination.
• Urine leakage during sneezing or coughing.
• Incomplete emptying of the bladder.
• Discomfort while walking and standing for a long time.

Mild bladder prolapse can be treated with conservative therapies such as

• Dietary changes and laxatives.
• Physical therapy with Kegel exercises (pelvic floor muscle exercises).
• Pessary (insertion of a device into the vagina).

Surgery is the last option for women who are bothered by prolapse.

Cystocele repair is a surgical procedure that is performed to repair the sinking of the vaginal wall or bulging of the bladder into the vagina.

The surgery may help to restore the normal position of your bladder and may reduce the pressure caused due to the bulging bladder onto your vagina. These surgeries are generally recommended in severe prolapse cases when physical therapy and medications do not resolve the condition. Surgery is generally done by taking a cut on the vagina or belly with basic three methods:

• Anterior colporrhaphy: In this, the prolapsed bladder is repaired by making a cut on the vaginal surface and stitching the internal surface to strengthen the area.
• Paravaginal repair: It repairs the prolapsed bladder by attaching it to the pelvic sidewalls.
• Anterior colporrhaphy with graft: In this, a tissue graft is placed (if the tissue lining is very thin) along with stitches on the internal surface of the vagina.

Before the surgery,

• Your gynecologist (women’s specialist)/urologist (urine specialist) will examine your condition and identify the fallen bladder.
• They may discuss the symptoms to confirm the exact reason and may order some additional tests to assess any more damage to the urinary system.

During the surgery,

• Under general anesthesia, an incision is made in the vaginal wall.
• The tissue between the bladder wall and the vaginal wall is tightened with stitches to allow the strengthening of the muscles and ligaments.
• Sometimes, extra tissue may be removed, or tissue grafts are used (if the tissue lining is very thin).

• You may be required to stay in the hospital for one to two days.
• You will be discharged with a catheter in place for some time.
• You will be able to pee normally after two to six weeks.
• You can resume your normal activities in about six weeks.
• You may be able to resume sexual intercourse in less than six weeks.
• You will be informed to
  • Avoid strenuous activities such as lifting heavy weights and standing for long periods for at least the first three months.
  • Increase your activity level gradually.
  • Avoid straining during defecation.

• Bladder infection
• Bladder injury
• Leakage of urine
• Inability to pass urine
• Painful sex
• Formation of an opening between the vagina and bladder
• Surgery failure