When to worry about a vaginal bulge with cystocele

A cystocele happens when the front wall of the vagina loses support and the bladder presses downward. You may notice pressure, a dragging feeling, a visible lump, or symptoms that become more noticeable after standing, lifting, coughing, or straining. Some people also have trouble starting urine, a weak stream, or the feeling that the bladder has not emptied. The size of the bulge and the intensity of symptoms can change from day to day.

Arrange a routine appointment if the bulge is new, is becoming more noticeable, or interferes with walking, exercise, sex, or passing urine. Until you are assessed, avoid heavy lifting and prolonged straining, keep bowel movements soft with fluids and fibre if suitable for you, and record when the bulge appears. Do not push a painful or injured area back inside. A clinician can examine the vaginal walls, check bladder emptying, and discuss pelvic-floor therapy, a support device, or other options.

Seek urgent medical help if you cannot pass urine, have severe pelvic pain, heavy bleeding, fever, vomiting, or a bulge that is stuck outside and becoming swollen, dark, dry, or ulcerated. Contact a clinician promptly for blood in the urine, repeated urinary infections, new loss of bladder control, or rapidly worsening pressure. These signs need examination because they may indicate irritation, infection, or impaired bladder function.

Ask whether the bulge is affecting bladder emptying, whether pelvic-floor physiotherapy or a pessary could help, and which activities should be limited while symptoms settle. Tell the clinician about urinary leakage, constipation, pain, bleeding, previous births, and any change in the bulge.