Medical expert of the article
New publications
Cystocele, urethrocele and rectocele
Last reviewed: 07.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Cystocele, urethrocele and rectocele are protrusions of the bladder, urethra and rectum respectively into the vaginal canal. The symptoms of this pathology are urinary incontinence and a feeling of pressure. The diagnosis is based on clinical data. Treatment includes the insertion of uterine rings into the vagina, therapeutic exercises to strengthen the pelvic floor muscles and surgical treatment.
Cystocele, urethrocele and rectocele are most often found together. Bladder hernia (cystocele) and urethrocele usually develop when there is a failure of the pubocervical vesical fascia. There are several degrees of cystocele depending on the level of prolapse: to the upper part of the vagina (grade I), to the entrance to the vagina (grade II), beyond the genital slit (grade III). Rectocele is the result of a rupture of the muscles that lift the anus and is classified similarly to a bladder hernia.
[ 1 ]
Symptoms of Cystocele, Urethrocele and Rectocele
Common symptoms include prolapse of the vaginal walls and pelvic organs, a feeling of pressure and tension. The organs may bulge into the vagina or toward its entrance, especially with straining or coughing. Cystocele and urethrocele are often accompanied by stress urinary incontinence. Rectocele causes constipation and incomplete defecation. Patients must press on the back wall of the vagina to defecate.
Diagnosis of cystocele, urethrocele and rectocele
The diagnosis is confirmed by examination. Cystocele or urethrocele is diagnosed by inserting a speculum along the posterior wall of the vagina in the lithotomy position. Straining of the patient on request makes bladder hernias or urethroceles clearly visible and palpable as soft reducible tumors protruding the vaginal wall. Inflamed paraurethral glands are palpated in front and on the sides of the urethra, they are painful on palpation, and pus is released from them. Enlarged Bartholin's glands can be palpated because they are located in the middle and lower third of the labia majora; when infected, these glands are soft. Rectoceles are also determined by lifting the anterior vaginal wall with a speculum while the patient is in the lithotomy position, with the patient straining, which makes the rectocele visible and palpable during a rectovaginal examination.
Treatment of cystocele, urethrocele and rectocele
Initial treatment may consist of inserting a pessary and Kegel exercises. A pessary is a prosthesis inserted into the vagina to support the prolapsed organs. Uterine rubber rings come in different shapes and sizes; if they are not properly fitted, they can cause ulcers on the vaginal walls and increase discharge. Kegel exercises are aimed at isometric contractions of the pubococcygeus muscle. Its contraction is difficult (about 50% of patients cannot do it), but it is necessary. The Valsalva maneuver is harmful, and contraction of the buttocks or thighs is of no use. Contraction of the muscle is best initiated by asking the patient to simulate an attempt to hold in urine. It is recommended to perform such exercises 8-10 times a day. The recommended initial duration of the exercise is 12 seconds, increasing to 10 seconds at each opportunity. Exercises can be made easier with weighted vaginal cones, which help patients focus on contracting the desired muscle. Biofeedback or electrical stimulation can be used to force the muscle to contract.
If the symptoms of the disease are very severe and are not eliminated by conservative treatment, surgical correction (anterior and posterior colporrhaphy) is prescribed. If necessary, surgical shortening and suturing of the perineum (perineorrhaphy) is performed. Colporrhaphy is usually postponed until the woman has fulfilled her reproductive function, because subsequent vaginal delivery can again lead to rupture. Surgical correction of urinary incontinence can be performed simultaneously with colporrhaphy. After surgical treatment, patients should avoid lifting heavy objects for 2 months. After surgical correction of cystocele or urethrocele, a urethral catheter is used for 24 hours after surgery and, less often, for several days.