When is pelvic floor repair surgery recommended for cystocele?

A cystocele, also called bladder prolapse or anterior wall prolapse, happens when the support between the bladder and the front wall of the vagina becomes weaker. The bladder can then bulge into the vagina. Some cystoceles cause no symptoms and can be monitored, while others cause pressure, a vaginal bulge, discomfort with activity or sex, urinary leakage, or difficulty starting or completing urination.

Surgery is not chosen from the appearance of the prolapse alone. A clinician considers your symptoms, examination findings, bladder function, general health, plans for pregnancy, and the effect on daily activities. Repair aims to restore support and improve the problem being treated; it may not address every urinary or pelvic symptom.

Arrange a gynaecology or uro-gynaecology assessment if a bulge, pressure, or urinary change is affecting you. Depending on the findings, options may include pelvic floor muscle training, treating constipation, adjusting activities that increase pressure, or a vaginal pessary. These approaches can be useful when symptoms are mild, when surgery is not wanted, or while you consider an operation.

Keep a brief record of urinary leakage, difficulty emptying your bladder, discomfort, bowel symptoms, and activities that make the bulge more noticeable. Take this to the appointment. If surgery is discussed, ask what repair is proposed, how recovery may affect work and lifting, and whether any urinary symptoms need separate treatment.

Seek prompt medical care if you cannot pass urine, have severe or rapidly increasing pelvic pain, notice heavy bleeding, or develop fever with feeling unwell. A new vaginal bulge with marked difficulty emptying the bladder also needs timely assessment. These symptoms do not by themselves establish the cause, but they should not be managed by waiting for a routine review.

Ask: How severe is my cystocele, and does it explain my symptoms? What non-surgical options suit me? What would surgery be expected to improve? Could urinary leakage or difficulty emptying continue after repair? What restrictions and follow-up should I expect during recovery?