Cystocele (Bladder Prolapse): Symptoms, Treatment & Support

What Is a Cystocele or Front Wall Prolapse?

A cystocele, also known as a front wall prolapse or anterior prolapse, happens when the bladder drops from its usual position and bulges into the front wall of the vagina. This can occur when the pelvic floor muscles and supportive tissues become weakened or stretched.

Pelvic organ prolapse can affect different organs within the pelvis, including the bladder, uterus, bowel or rectum. The pelvic floor muscles act like a supportive hammock, helping to hold these organs in place. When these muscles weaken, one or more pelvic organs can begin to shift or prolapse.

Although a cystocele can feel uncomfortable, distressing or embarrassing, it’s important to remember that it’s very common — especially after pregnancy, childbirth and during or after the menopause. Many women experience symptoms such as bladder leaks when coughing, exercising, jumping or running around with children, even if they don’t openly talk about it.

The good news is that pelvic floor exercises can help strengthen and support the pelvic floor muscles, which may help prevent symptoms from worsening and improve mild prolapse symptoms over time.

Like many pelvic health conditions, early support and treatment are important. Leaving a prolapse untreated for long periods may lead to further weakening of the pelvic floor muscles and surrounding nerves, increasing the likelihood of symptoms worsening or returning in the future. If you notice symptoms or have any concerns, it’s always best to speak to your GP or healthcare professional for advice and support.

Front Wall vs Back Wall Prolapse: What’s the Difference?

A cystocele is now more commonly referred to as a Front Wall Prolapse (Fig. 1), while a rectocele is known as a Back Wall Prolapse (Fig. 2). Both conditions happen when the pelvic floor muscles and supportive tissues become weakened and are no longer able to properly support the pelvic organs.

A Front Wall Prolapse occurs when the bladder bulges into the front wall of the vagina (anterior vaginal wall). A Back Wall Prolapse or Back Vaginal Wall Prolapse occurs when the rectum pushes into the back wall of the vagina (posterior vaginal wall).

Because the pelvic floor supports all of the organs within the pelvis, weakened pelvic floor muscles can increase the likelihood of developing more than one type of prolapse at the same time. If you have a Front Wall Prolapse, you may also be more likely to develop a Back Wall Prolapse — and vice versa.

It is very common for front and back wall prolapses to occur together. Strengthening the pelvic floor muscles can help improve support for the pelvic organs and may help manage symptoms of both conditions. The Kegel8 Prolapse Condition Guide is a 12 week programme designed to help strengthen and support the pelvic floor muscles, helping to treat multiple prolapse symptoms together where needed.

What Are the Stages of a Front Wall Prolapse (Cystocele)?

A Front Wall Prolapse, also known as a cystocele or bladder prolapse, can vary in severity. Healthcare professionals usually classify the condition into three stages, depending on how far the bladder has moved into the vaginal wall. Your GP or specialist will be able to diagnose the stage of your prolapse during an examination.

Stage 1 – Mild Prolapse

The bladder has dropped only slightly into the vaginal wall. Symptoms are usually mild and may include a feeling of pressure, discomfort or occasional bladder leaks.

Stage 2 – Moderate Prolapse

The bladder has dropped further and has reached the opening of the vagina. In some cases, the prolapse may become visible temporarily when coughing, straining or lifting.

Stage 3 – Severe Prolapse

The bladder has significantly dropped and is visibly bulging outside the vaginal opening more permanently. Symptoms may feel more noticeable and can affect daily comfort and bladder function.

The earlier a prolapse is identified, the sooner steps can be taken to help manage symptoms and support pelvic floor health. Pelvic floor exercises and specialist support may help improve mild to moderate prolapse symptoms and prevent the condition from worsening.

Could You Have a Front Wall Prolapse (Cystocele)? Symptoms to Look Out For

If you think you may be developing a Front Wall Prolapse (cystocele), or you have already been diagnosed with one, you may experience some or several of the following symptoms. Every woman’s experience can be different, and symptoms may range from mild discomfort to more noticeable bladder and pelvic symptoms.

One of the most common symptoms associated with a Front Wall Prolapse is recurrent bladder or urinary tract infections (cystitis).

Other symptoms can include:

• frequent bladder or urinary tract infections (UTIs/cystitis)
• leaking urine when coughing, sneezing, laughing, running, jumping or lifting
• difficulty controlling the bladder during everyday activities
• needing to pass urine more often than usual
• a sudden or urgent need to pass urine
• difficulty emptying the bladder fully
• discomfort, stinging or pain when passing urine
• feeling that the bladder has not emptied properly after using the toilet
• lower back, pelvic or vaginal discomfort
• pain or discomfort during sex
• a feeling of heaviness, dragging or pressure inside the vagina
• the sensation that something is bulging or falling down inside the vagina
• tissue bulging at the vaginal opening, especially when coughing or straining
• unusual vaginal bleeding not related to your period

Because different types of prolapse can happen close together within the pelvis, symptoms can sometimes overlap and feel confusing. That’s why it’s important to speak to your GP or healthcare professional if you have any concerns. A proper diagnosis can help you understand what’s causing your symptoms and which treatment or pelvic floor support options may help you most.

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What Causes a Front Wall Prolapse (Cystocele)?

A Front Wall Prolapse (cystocele) happens when the pelvic floor muscles and supportive tissues become weakened, allowing the bladder to drop into the vaginal wall.

Several factors can increase the risk of developing a prolapse, including pregnancy, childbirth, menopause and ageing. Being overweight, repeated heavy lifting or anything that places ongoing pressure on the pelvic floor can also contribute.

Common causes and risk factors include:

• Pregnancy and childbirth – carrying and delivering a baby places extra strain on the pelvic floor muscles, especially after multiple or difficult vaginal births.
• Menopause and ageing – lower oestrogen levels and natural muscle loss can weaken pelvic floor support over time.
• Persistent coughing – ongoing coughing from smoking, asthma or bronchitis increases pressure on the pelvic floor.
• Constipation and straining – repeated straining on the toilet can weaken the pelvic floor muscles.
• Being overweight – excess weight places additional pressure on the pelvic organs and pelvic floor.
• Heavy lifting or high-impact exercise – repeated strain from lifting, running or jumping can affect pelvic floor strength.
• Previous pelvic surgery – including hysterectomy or previous prolapse surgery.
• Genetics – some women may naturally have weaker connective tissues, increasing their risk of prolapse.

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Can You Prevent a Front Wall Prolapse?

A prolapse is not always preventable, but there are steps you can take to support your pelvic floor health and reduce your risk.

Strengthen your pelvic floor

Daily pelvic floor exercises (Kegel exercises) help strengthen and support the muscles that hold the pelvic organs in place. Many women also choose to use a pelvic floor toner to help improve exercise results.

Maintain a healthy weight

Keeping to a healthy weight can reduce unnecessary pressure on the pelvic floor muscles.

Avoid constipation and straining

Eating a fibre-rich diet, drinking plenty of water and avoiding straining on the toilet by using a toilet stool can help protect the pelvic floor from excess pressure.

Lift carefully

Avoid repeated heavy lifting where possible and always use correct lifting techniques to reduce strain on the pelvic floor.

Support your pelvic floor

Specialist prolapse support garments, such as SRC Restore compression shorts, may help provide additional support and comfort for women living with mild prolapse symptoms or stress urinary incontinence.

Vaginal Pessaries for prolapse and incontinence can help.

What Treatments Are Available for a Front Wall Prolapse (Cystocele)?

Treatment for a Front Wall Prolapse (cystocele) will depend on how severe your symptoms are and how much they affect your daily life. Many women with mild or moderate prolapse symptoms can successfully manage their condition without surgery.

Non-surgical treatments are usually recommended first, especially if you may want children in the future or would prefer to avoid surgery.

Pelvic Floor Exercises (Kegel Exercises)

Daily pelvic floor exercises can help strengthen the muscles that support the bladder and pelvic organs. For some women, this may be enough to improve symptoms and prevent the prolapse from worsening.

Many women find pelvic floor exercises more effective when combined with an electronic pelvic toner, such as the Kegel8 Ultra 20. The Kegel8 Prolapse Condition Guide, created by women’s health physiotherapist Amanda Savage, is designed to help strengthen weakened pelvic floor muscles and support prolapse recovery.

Lifestyle Changes

Simple lifestyle changes can help reduce pressure on the pelvic floor and improve symptoms, including:

• maintaining a healthy weight
• avoiding constipation and straining
• reducing heavy lifting where possible
• managing long-term coughing

Hormone Treatment

For some women, particularly during or after menopause, topical oestrogen creams or hormone treatment may help improve the strength and health of vaginal tissues and pelvic floor support.

Vaginal Pessaries

A vaginal pessary is a small device placed inside the vagina to help support the bladder and vaginal walls. Pessaries are commonly used to relieve prolapse symptoms and may also help with bladder leaks.

There are different types of pessaries available depending on your symptoms and anatomy. Your GP or specialist can help fit the most suitable option and advise how often it should be changed.

Surgery for Front Wall Prolapse

If symptoms remain severe and non-surgical treatments have not helped enough, surgery may be recommended.

Front Wall Prolapse surgery aims to lift and support the bladder while repairing and strengthening the vaginal wall tissues. However, surgery does not strengthen the pelvic floor muscles themselves, which is why pelvic floor exercises remain important after recovery to help reduce the risk of prolapse returning.

Your specialist will discuss the most suitable treatment options for your individual symptoms, lifestyle and future plans.

How Long Does It Take to Recover From Front Wall Prolapse (Cystocele) Surgery?

Recovery after Front Wall Prolapse (cystocele) surgery can vary from woman to woman, but most people begin returning to normal daily activities within four to six weeks.

Immediately after surgery, you may have a catheter and vaginal dressing in place overnight to help support healing. Follow-up appointments are usually arranged by your surgeon to monitor your recovery over the following months.

Most women are advised to:

• avoid heavy lifting for around 3 months
• avoid high-impact exercise during recovery
• wait around 6 weeks before resuming sex
• gradually return to normal activities as advised by their healthcare team

Are There Any Risks or Complications?

As with any surgery, there are potential risks and complications. Your surgeon will discuss these with you before treatment so you can make an informed decision.

Some women may experience:

• ongoing pelvic discomfort or pain
• recurrence of prolapse symptoms over time
• discomfort during sex
• bladder or bowel symptoms after surgery

In some cases, surgical mesh may be used, although its use is now more limited and carefully considered due to concerns about long-term complications in some patients.

Can Pelvic Floor Exercises Help After Surgery?

Yes. Surgery can help repair and support a prolapse, but it does not strengthen the pelvic floor muscles themselves. This means pelvic floor rehabilitation remains an important part of recovery and long-term prolapse management.

Pelvic floor exercises are recommended after surgery to help support the pelvic organs, improve recovery and reduce the risk of the prolapse returning. In fact, around 20% of prolapse repairs may require further surgery in the future, so ongoing pelvic floor care and lifestyle changes are essential.

How the Kegel8 Ultra 20 Can Help Support Front Wall Prolapse (Cystocele)

Many women benefit from support from a women’s health physiotherapist or a structured pelvic floor rehabilitation programme after surgery. Women’s health physiotherapist Amanda Savage has created a 12-week Rehabilitation Guide designed to support recovery after gynaecological and prolapse surgery using the Kegel8 Ultra 20 , helping women safely rebuild pelvic floor strength and confidence step-by-step.

Recovery from prolapse surgery should not be seen as a quick or easy fix. Long-term success often depends on continuing pelvic floor exercises, avoiding unnecessary strain, maintaining a healthy weight and protecting the pelvic floor during everyday life.

At Kegel8, we’re with you every step of the way with trusted pelvic health support, expert guidance and easy-to-follow rehabilitation advice.

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Royal College of Obstetricians and Gynaecologists. (2022). Information for you, Pelvic organ prolapse [online] Royal College of Obstetricians and Gynaecologists, 2022 [viewed 24/10/2024]. Available from: https://www.rcog.org.uk/for-the-public/browse-our-patient-information/pelvic-organ-prolapse/

Women's Health Concern. (2021). Prolapse: Uterine and vaginal [online] Women's Health Concern, 2021 [viewed viewed 24/10/2024]. Available from: https://www.womens-health-concern.org/wp-content/uploads/2022/12/21-WHC-FACTSHEET-Prolapse-NOV2022-B.pdf