From the Guidelines
Treatment for a slipped bladder, or cystocele, should prioritize conservative management for mild cases, including pelvic floor muscle exercises and lifestyle modifications, while symptomatic moderate to severe cases may require surgical repair, such as anterior colporrhaphy, with considerations for mesh augmentation and estrogen therapy in postmenopausal women. When considering treatment options, it's essential to evaluate the severity of symptoms and the overall health of the patient. Conservative approaches are generally recommended for mild cases, with a focus on strengthening the pelvic floor muscles through exercises like Kegel exercises, performed in 3 sets of 10 contractions daily 1. Additional lifestyle modifications can include:
- Weight loss for overweight patients
- Avoiding heavy lifting (nothing over 10-15 pounds)
- Treating chronic cough
- Preventing constipation through increased fiber intake and adequate hydration These measures can help alleviate symptoms and improve the patient's quality of life. For patients who are poor surgical candidates or prefer non-surgical options, a pessary device can provide mechanical support to reduce prolapse symptoms. In cases of symptomatic moderate to severe cystoceles, surgical intervention may be necessary, with procedures such as anterior colporrhaphy aiming to reinforce weakened vaginal tissues to support the bladder 1. However, the use of mesh augmentation should be carefully considered due to the potential risks of complications. Estrogen therapy, such as vaginal estrogen cream applied nightly for 2 weeks, then 2-3 times weekly, may be recommended for postmenopausal women to improve tissue quality before other treatments. Ultimately, the choice of treatment depends on the patient's age, symptom severity, overall health, and personal preferences, with the primary goal of relieving symptoms and improving quality of life.
From the Research
Treatment Options for Cystocele (Bladder Prolapse)
- Pelvic floor muscle exercise (PFME) is a recommended treatment for urinary incontinence, which can be a symptom of cystocele 2
- PFME strengthens the pelvic floor muscles to provide urethral support and prevent urine leakage 2
- This exercise has been recommended as first-line treatment for stress urinary incontinence, particularly in postmenopausal women 3
- Studies have shown that PFME can improve pelvic floor muscle strength, quality of life, and reduce the severity of urinary incontinence in postmenopausal women 3
- The specific factors such as dose-response relationships and standardized methods for measuring effects of PFME need to be established through further research 3
Non-Surgical Treatment
- PFME can be used as a conservative treatment for urinary incontinence, which can be a symptom of cystocele 2, 3
- Clinicians and physical therapists should understand pelvic floor muscle anatomy, evaluation, and regimen to instruct patients on how to train the muscles properly 2