Can a cystocele cause bladder spasms?

Cystocele and Bladder Spasms: The Connection

Cystocele can cause urinary urge symptoms including bladder spasms, with approximately 52% of patients with cystocele experiencing urge symptoms that are cured in about 88% of cases following cystocele repair. 1

Relationship Between Cystocele and Bladder Function

• Cystocele is defined as a herniation or prolapse of the bladder through the anterior vaginal wall, which can lead to various urinary symptoms 2, 3
• Urinary dysfunction, including bladder spasms, can be caused by anatomic abnormalities such as cystocele without urethral rotation, resulting in urethral kinking 2
• Imaging studies show that cystocele can lead to changes in bladder-neck morphology and urethrovesical angle, which may contribute to bladder dysfunction 2

Clinical Manifestations

• Patients with cystocele commonly present with urge symptoms (52.02%), which can include bladder spasms 1
• The severity of urge symptoms does not necessarily correlate with the grade of cystocele, as improvement rates after repair are similar across different grades of cystocele 1
• Bladder wall thickness may be increased in the setting of detrusor muscle instability, which can be associated with cystocele 4

Diagnostic Considerations

• Clinical examination is the cornerstone of diagnosis for cystocele, with imaging reserved for complex cases 3
• Voiding Cystourethrography (VCUG) defines cystocele as extension of the opacified urinary bladder below the pubic symphysis 3
• MR Defecography can provide comprehensive evaluation of cystocele and associated pelvic floor abnormalities 2
• Transperineal Ultrasound is a non-invasive option for evaluating cystocele and related functional issues 3

Treatment Impact on Bladder Spasms

• Surgical repair of cystocele results in resolution of urge symptoms (including bladder spasms) in 88.62% of patients 1
• Despite successful anatomical correction, approximately 11.4% of patients may continue to experience persistent urge symptoms after cystocele repair 1
• About 5.84% of patients may develop de novo urge symptoms following cystocele repair 1

Important Clinical Considerations

• The presence of bladder spasms in patients with cystocele may be due to the anatomical distortion causing urethral kinking or changes in bladder-neck morphology 2
• Patients with larger cystoceles (grade 3) may have increased bladder capacity compared to those with lesser degrees of prolapse 5
• Detrusor hyperactivity can coexist with cystocele but is not necessarily directly caused by the cystocele itself 5
• When evaluating patients with bladder spasms and cystocele, it's important to consider other potential causes of detrusor instability 4

Treatment Approach

• Surgical repair of cystocele should be considered for patients with bothersome urge symptoms that are likely related to the anatomical defect 1
• Pubovaginal sling procedures combined with anterior colporrhaphy have shown effectiveness in treating both stress incontinence and reducing cystocele 6
• Patients should be counseled about the possibility of persistent symptoms or development of new urge symptoms despite successful anatomical correction 1