From the Guidelines
Heavy lifting and physical labor can worsen a cystocele (bladder prolapse) and should be avoided or modified by women with this condition. Women with cystocele should limit lifting to no more than 10-15 pounds and use proper lifting techniques when necessary, keeping the load close to the body and engaging core muscles rather than straining 1. For those whose jobs require physical labor, workplace accommodations or temporary reassignment to lighter duties should be considered.
Key Recommendations
- Pelvic floor physical therapy is strongly recommended as it can strengthen the supporting muscles and potentially reduce symptoms.
- When lifting cannot be avoided, wearing a supportive pessary (if prescribed) can provide temporary additional support.
- The reason these precautions are necessary is that increased intra-abdominal pressure from heavy lifting or straining pushes downward on the bladder and weakened pelvic floor tissues, potentially stretching them further and worsening the prolapse 1.
Additional Measures
- Women should also practice daily pelvic floor exercises (Kegels) to help manage their condition and prevent progression.
- Maintaining a healthy weight, avoiding constipation, and quitting smoking are also essential in managing cystocele and preventing its progression 1.
Diagnostic Considerations
- Transperineal US (TPUS) or translabial US can be used for anatomic and functional evaluation of the pelvic floor, including evaluation of a protruding or bulging vaginal mass or clinically suspected POP 1.
- Fluoroscopy Voiding Cystourethrography (VCUG) can be used as an objective measure of change in cystocele height and urethral angle after surgical repair 1.
- Cystocolpoproctography (CCP) can be used to assess for presence and size of rectocele and to evaluate for contrast material retention within rectoceles 1.
From the Research
Risks of Worsening Cystocele
- Physical labor and heavy lifting can exacerbate cystocele, a condition where the bladder bulges into the vagina 2
- Conservative management approaches, such as pelvic floor exercises and use of vaginal pessaries, can help manage mild prolapse and prevent worsening symptoms 2, 3
- Avoidance of exertional activities, including heavy lifting, is recommended to prevent progression of the condition 2
Nonsurgical Treatment Options
- Pelvic floor muscle training and pessary use are effective options for conservative treatment of pelvic organ prolapse, including cystocele 3
- These nonsurgical options can help improve symptoms and quality of life, and may be preferred by women for whom surgery is contraindicated or not desired 3
Importance of Lifestyle Changes
- Lifestyle changes, such as avoiding heavy lifting and exertional activities, are necessary to prevent worsening of cystocele and other pelvic organ prolapses 2
- Comprehensive evaluation of bladder and urethral function should be done before any surgical repair is undertaken, and reconstructive surgery can provide definitive therapy if all anatomic defects are addressed and necessary lifestyle changes are instituted 2