Cystocele - it gryzhepodobnoe protrusion of the bottom of the bladder into the cavity of the vagina (or beyond) as a result of displacement of the front wall.It occurs most often after 40 years and the highest number of cases of cystocele account for old age (60 - 70 years).
Cystocele often accompanied by prolapse of the urethra - urethrocele.
Cystocele is not an independent disease, but a diagnosis of cystocele represents a deviation in the normal anatomical position of the bladder, which can occur either almost asymptomatic or accompanied by a bright clinical manifestations.
Cystocele is the result of pathological changes in the properties and / or structure of muscular and ligamentous apparatus of the pelvic floor.
The bladder is a muscle, "bag" with a capacity of 750 cc located in the pelvic cavity.In front of the bladder are the pubic bone, and behind - the uterus and the upper part of the vagina.It recovered the body, the tip, bottom and neck, which passes into the ureth
pelvic muscles and ligaments ensure the normal anatomic location of the pelvic organs (such as the uterus, bladder and rectum).The pelvic muscle apparatus is represented by three powerful muscle layers, which are reinforced fibers of the connective tissue - fascias and the uterus is held in place by a round and broad ligaments.Changes in the normal position of the bladder is a consequence of the displacement of the uterus towards vagina, i.e. downwards.Due to violations of the tone of the pelvic muscles and weakening uterine ligaments, the anterior wall of the vagina weakens, the uterus begins to shift, pulling the bladder.
In the case of uterine prolapse is accompanied by the omission of the rear wall of the vagina, there is a shift of the rectum - rectocele.Meets combination of cystocele and rectocele simultaneously.The assertion that the cystocele and rectocele are signs express omission of the uterus and vagina.
degree of displacement of the bladder depends on the degree of support of the pelvic muscles and ligaments, and directly related to the degree of uterine prolapse.
cystocele Treatment depends on the degree of bladder dysfunction.A slight shift of it can not disturb the patient and does not require medical or surgical correction.
Prevention cystocele is to strengthen the muscles of the pelvis by a properly sized complex exercise.
Some patients use the wrong term cystocele bladder to indicate their status.The word "cystocele" is derived from the Greek term «cystis» - mochevoy bubble and «cele» - com, hernia, tumor, that is, the phrase "bladder" it is already present, and cystocele bladder does not exist.
Since the bladder "rush" after moves down the uterus, cystocele causes almost always similar reasons, the omission of the uterus and vagina, namely:
- Injuries to the pelvic muscles and / or ligaments.
- Multiple births, leading to hyperinflation pelvic muscles and reduce their flexibility.An important role in the formation of cystocele after childbirth plays a weakening of connective tissue structures located between the uterus, bladder and pelvis lonnymi.
- Obstructed labor, accompanied by extracting fetal buttocks, forceps and so on.
- Surgery on the genitals.While surgery is sometimes necessary to cut, and then stitches to the muscle layer.Formed in muscle tissue scars alter its elasticity and contractility.
- The deep gaps in the crotch area of any etiology (including delivery).
- increased long-term intra-abdominal pressure that accompanies some extragenital diseases or chronic severe constipation.
- Underdevelopment pelvic muscles innate nature.
- hernia, prolapse of internal organs associated with connective tissue disorders.
- Heavy physical work or exercise properly organized.
- Atrophic changes and loss of elasticity of the pelvic floor muscles due to age-related natural causes.Cystocele diagnosed most often in older patients.Estrogen deficiency in this category of women exacerbates the process of displacement of the genitals and can lead to cystocele.
omission of the front wall of the vagina is almost always, in varying degrees, accompanied by formation of cystocele and is the most obvious contributing factor of its appearance.
Symptoms of cystocele
bright clinical picture is accompanied by only expression of the displacement of the bladder.In some cases, the woman is not experiencing any discomfort, and cystocele she found during a pelvic examination.
processes offset genitals tend to worsen, so over time the disease can appear clinic complaints dysuria, discomfort and feeling of pressure (foreign body) in the vagina, pain in the abdomen and sacrum.If cystocele accompanied by uterine prolapse (full or partial), the patient complained of bias genitals beyond gender gap, which they found themselves.For cystocele characterized by frequent cystitis to the damage of normal blood circulation in the pelvis and stagnation of urine in the bladder.
micturition disorders occur dysuria (painful and frequent urination), difficulty urinating, or urinary incontinence.Often patients complain of residual urine - urine that remains in the bladder after emptying.
micturition disorders may accompany many other diseases, so a reliable method of diagnosis is a cystocele gynecological examination.During the inspection revealed prolapse (protrusion) of the front wall of the vagina, exacerbated by tension anterior abdominal wall (woman offers tighter during the inspection).In advanced cases, the protrusion beyond the genital slit can be detected in a woman even in a vertical position.In this case, a segment looks slimy dropped out injured, with multiple bruises and even ulcers.
specific clinical picture when cystocele causes diagnostic difficulties, but in some cases it can be similar to symptoms of urinary bladder diverticula or urethra.Diverticulitis is called congenital or acquired protrusion of the body wall.Unlike cystocele bladder remains in place, and moves only a diverticulum.The final diagnosis is made after examination of a urologist.To clarify the diagnosis can be assigned to an ultrasound and X-ray examination.
Cystocele often accompanied by inflammation in the bladder and vagina.To clarify the nature of inflammation research is conducted urine tests and vaginal swabs.
process of displacement of the bladder depends on a combination of many factors.Common to all scenarios of cystocele did not exist.
For example, in some patients there is a shift only the front part of the vaginal wall with the expanded urethra (urethrocele), whereby the bladder remains at the proper place.
significant impact on the nature of cystocele have an individual anatomical features, age of the patient, obstetrical history, the presence of concomitant pathology neginekologicheskoy.
Depending on the topography of the bladder are three degrees of cystocele:
- Cystocele first degree - the most favorable, mild displacement of the bladder, usually does not cause women discomfort and detected during a pelvic exam after straining.
- Moderate, second degree cystocele during the inspection revealed without the need for women to strain the abdominal wall.Found the front protrusion of the vaginal wall, are not beyond the boundaries of the genital slit.
- Third degree cystocele is the most severe.Flexing the vaginal wall across borders genital slit (partially or completely), it is found even in a state of complete physical rest.
degree cystocele characterizes the stage of development of pathological displacement of the bladder, and also serves as a decisive criterion in the choice of therapy.
spontaneous cure prolapse of the vaginal walls does not occur, but if diagnosed in a timely manner, an adequate range of therapeutic and preventive measures will help to stop the process and prevent its further progression.
Some patients diagnosed with cystocele perceived as a verdict, which is absolutely wrong, because the process can be eliminated.
When choosing a method of treatment of cystocele is necessary to consider the situation and the clinical stage of the disease.Mild cystocele not require serious medical intervention, and severe degree necessarily implies surgical treatment.
good effect in the treatment of non-severe bias genitals (and cystocele in particular) has a physiotherapy method Kegel providing alternate tension and relaxation of the muscles of the pelvis.Women with risk of developing cystocele, Kegel exercises prescribed as a preventive.
Along with physiotherapy is recommended to change the nature of physical activity: in order to avoid unwanted tension in the muscles of the pelvic floor is prohibited to lift weights, if the patient has constipation, it is necessary to adjust the diet to during bowel movements do not have to make an effort too.
In postmenopausal women with marked atrophy of the processes and metabolic disorders used pills and ointments with estrogens to improve the elasticity of the muscles.Lubrication of the vaginal mucosa hormonal ointments reduce the degree of atrophy and improve the condition of patients.
in elderly patients is not always possible to perform the surgery, and some of them are contraindicated in hormone therapy.In these instances, the rubber rings - pessaries, selected individually by size.Pessary inserted into the vagina and uterus, and prevents vaginal walls move.Some women have a negative attitude to such a therapeutic method because of the need to frequently change the ring and regular douche with solutions of herbs and antibacterial agents, for the prevention of inflammation.
indications for surgical treatment are severe cases of cystocele.Surgical treatment is prescribed after failed attempts to rectify the situation by other means.
Operation during cystocele
The aim of surgical treatment of cystocele is to return the bladder to its original position.Surgical treatment is performed by surgeons - urologists.
access to the bladder (the place where it is planned to carry out cross-section) determined by the degree of cystocele.If the bladder is significantly protrudes into the vaginal cavity, performed a vaginal access, in other cases, the surgical field is localized to the anterior abdominal wall.Also, the operation can be carried out via laparoscopy.
most common operation for cystocele is a front colporrhaphy.After determining the place of bulging bladder all pathologically changed (stretched or diverged) underlying tissues are strengthened by means of sutures or special materials, resembling a fine mesh.If cystocele surrounding tissue severely damaged, they are removed, and the edges of healthy tissue are sewn.
sometimes require additional fixation of the bladder and strengthen the pelvic muscles.The surgeon can carry out a two-stage operation, combining several methods, and may appoint a consistent series of operations.It depends on the particular clinical situation.
correctly performed surgical reconstruction of the location of the bladder and adequate postoperative care allows patients to return to a habitual rhythm of life one month after surgery.
cystocele recurrence probability varies from 5% to 23%.