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​Understanding a prolapse of the bladder

A cystocele, also called an anterior vaginal wall prolapse, occurs when the tissues supporting the front wall of the vagina become weakened or stretched. This can allow the bladder and sometimes the urethra to bulge into the vagina.

A cystocele is one of the most common types of pelvic organ prolapse. Some women have a very mild prolapse and may have no symptoms at all, while others may experience bladder, vaginal or sexual symptoms that affect everyday life.

Having a prolapse does not mean that something is “falling out” or that you have done anything wrong. Pelvic organ prolapse is common and can develop for many different reasons, including pregnancy and childbirth, changes in the supporting tissues, ageing, hormonal changes, chronic constipation or straining, persistent coughing and other factors.

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What might a cystocele feel like?

Symptoms vary from woman to woman and do not always correspond to the apparent size or stage of the prolapse.

You may notice:

• A feeling of pressure, heaviness, dragging or fullness in the vagina

• A sensation of a bulge inside the vagina or at the vaginal opening

• A bulge that becomes more noticeable after standing, walking, exercising or being active

• Needing to pass urine more frequently

• A sudden or difficult-to-control urge to urinate

• Stress urinary incontinence, such as leaking when coughing, sneezing, laughing, exercising or lifting

• Difficulty starting the flow of urine

• A weak, slow or intermittent urinary stream

• A feeling that your bladder has not emptied completely

• Needing to change position or return to the toilet to empty your bladder

• Recurrent urinary tract infections in some women

• Changes in sexual sensation or discomfort during sexual activity

 

Because the bladder and urethra work together, a change in the position and support of the anterior vaginal wall can sometimes affect how the bladder stores and empties urine.

It is also possible to have a cystocele without experiencing any urinary symptoms at all.

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Does the stage of prolapse matter?

Healthcare professionals may describe prolapse using a staging system, such as the POP-Q (Pelvic Organ Prolapse Quantification) or the Baden Walker system.

​Rather than thinking of prolapse simply as “mild, moderate or severe”, it is more useful to consider:

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• What is prolapsing?

• How far does it descend?

• What symptoms are you experiencing? 

• How is it affecting your bladder, bowel, sexual function and quality of life?

A small prolapse can sometimes cause troublesome symptoms, while a more noticeable prolapse may cause surprisingly few problems.

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Your symptoms and your individual circumstances are therefore just as important as the stage of your prolapse.

 

What can you do?

​You do not necessarily need surgery for a cystocele.

Management depends on your symptoms, the type and extent of prolapse, your general health, your preferences and what you would like to achieve.

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Options may include:

Pelvic floor muscle training

A properly assessed and supervised pelvic floor muscle training programme can be helpful, particularly for women with earlier-stage symptomatic prolapse.

Pelvic floor muscles need to be able to contract, relax and respond appropriately to different activities and changes in pressure, not simply be kept permanently tight.

 

Lifestyle and symptom management

Your healthcare professional may discuss strategies such as managing constipation and avoiding persistent straining, maintaining a healthy weight where appropriate, and adapting activities that consistently aggravate your symptoms.

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This does not mean that you have to stop exercising or avoid everything that involves lifting. Your activity should be individualised to you and your symptoms.

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Vaginal pessary

A pessary is a removable medical device placed inside the vagina to provide mechanical support to the vaginal walls and prolapsed tissues. Pessaries come in different shapes, sizes and designs, including ring, ring-with-support, Gellhorn and cube pessaries.

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Finding the right pessary can sometimes involve assessment and trialling different types or sizes. A pessary that works beautifully for one woman may not be suitable for another.

A well-fitted pessary may help reduce the sensation of pressure or bulging and can also improve some bladder symptoms associated with prolapse.

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Importantly, supporting a prolapse with a pessary can sometimes change urinary symptoms. For example, some women may develop or notice stress urinary leakage after the prolapse is supported. This is something that can be assessed and managed rather than a reason to give up on pessary treatment.

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Pessary care matters

Pessaries are generally made from medical-grade materials such as silicone and are designed to be used safely when appropriately fitted and monitored.

The care a pessary requires depends on the type of pessary, how it is being used and whether you are able to remove and replace it yourself.

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Some women can learn to remove, clean and replace their own pessary. Others prefer or need regular clinical appointments for pessary care.

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Regular review is important because, although pessaries are generally safe, problems can occur if they are neglected. These can include vaginal irritation, bleeding, discharge, ulceration or, rarely, more serious complications.

A pessary should never be painful.

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If you experience pain, bleeding, difficulty passing urine, recurrent infections, offensive discharge, or a pessary that repeatedly falls out or feels uncomfortable, seek advice rather than simply putting up with it.

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You have choices

Being diagnosed with a cystocele can feel worrying, particularly if you have been told that surgery is your only option.

It isn't necessarily.

There are several approaches to managing pelvic organ prolapse, and your treatment should be based on your symptoms, your body, your lifestyle and your goals.

You are also entitled to ask questions and seek a second opinion if you are unsure about your options.

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Could a pessary help you?

Pessary fitting is not simply about choosing a size from a box.

The shape and position of your prolapse, the condition of the vaginal tissues, your bladder and bowel symptoms, your activities, your anatomy and your ability to manage the pessary can all influence which device may work best for you.

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At Pelvic Angel, I provide specialist pessary education, assessment and support to help women understand their options and become more confident in managing their prolapse.

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If you have been told that you have a cystocele, are struggling with bladder symptoms, have tried a pessary that did not work for you, or simply want to understand your options, you do not have to navigate this alone.

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Understand your prolapse. Understand your options. Feel confident in your care.

 

Professional pessary training and support available.

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Page reviewed and updated August 2026