Grades of cystocele and rectocele. When is it used? Surgery is done to relieve bulging into the vagina that Feb 1, 2022 · Moreover, among patients with cystocele grade 3 the frequency of apical compartment prolapse is higher than in cases of grade 2 (r = 0. All It is possible to treat cystocele, but treatment options vary based on the grade and severity of your prolapse. More flexible silicone Shelf pessaries have recently been manufactured. This approach has been proven safe and effective, but there may not be any benefit over other types of rectocele repair. Anterior prolapse repair is done through a cut, called in incision, in the wall of the vagina. Pb: perineal body length. This allows part of the wall of the rectum to bulge into the vagina. ACOG: What happened when you saw your health care team? Lauren: When I went to see my midwife and ob-gyn, they said I had a grade-one rectocele and a grade-one cystocele, which means my bladder also had dropped down. Sep 4, 2015 · Introduction and hypothesis We updated anatomic theories of pelvic organ support to determine pathophysiology in various forms of cystocele. Rectocele is caused by prolonged pressure on the pelvic floor. Diseases & Conditions Rectocele; 20021848562-overview. Rectocele, C. OUTCOMES OF SURGICAL REPAIR Suitable for use with uterine, cystocele, rectocele, small bowel and/or rectum. Apr 26, 2024 · The most common site of prolapse is the front, also called anterior, vaginal wall. There are multiple underlying causes for the development of cystocele resulting in weakness of the muscles and the connective tissue surrounding the bladder and vagina. (Reproduced from Bhatia NN. Rectocele—The rectum bulges into the vagina. With more severe (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina. A symptomatic rectocele is best diagnosed if evacuation is aided by supporting the rectocele. The small bowel may also bulge into the back wall of the vagina, this is called an enterocele. Grade 4 - Descent is as far as possible past the hymen. A rectocele can also be repaired through the abdomen, either laparoscopically, robotically or open. Grade 2 (moderate). 86; p It is a common finding that is largely asymptomatic and rarely needs surgical repair. It is held on the anterior wall to examine for a rectocele, and the posterior wall for a cystocele. Enterocele, D. Massive eversion of the vagina with cystocele, enterocele, and rectocele. Am I wrong thinking that, considering the prolapse is clearly at the opening of the vagina as described as moderate, grade 2, and not the minor A cystocele is mild (grade 1) when the bladder droops only a short way into the vagina. The tissue between the rectum and the vagina is known as the rectovaginal septum and this structure can become thin and weak over time, resulting in a rectocele. Surgery is usually used only after you have tried other treatments such as: Doing muscle-strengthening exercises, called Kegel exercises. This includes pressing the rectocele back into the rectum through the vagina during evacuation, or pressing between the rectum and the vagina in order to aid evacuation. Mickey M. This disorder is called a cystocele. Rectocele repair is also sometimes called posterior colporrhaphy. Methods PubMed/MEDLINE, ScienceDirect, Cochrane Library, and Web of Science databases were searched using the terms pelvic floor, cystocele, anatomy, connective tissue, endopelvic fascia, and pelvic mobility. 0% of all studied diagnostic groups were managed by cystocele/rectocele repair alone. Diagnosis of anterior prolapse may involve: A pelvic exam. Here we are in agreement with the majority of the studies that showed a strong correlation between the anterior compartment (point Ba in the POP-Q classification) and apex (point C) (r = 0. Nov 18, 2019 · Grade 1 - Descent halfway to the hymen. When the wall between a woman's bladder and the vagina weakens, the bladder may drop or sag into the vagina. Sep 7, 2022 · - Cystocele and rectocele; RELATED TOPICS. Once the fascia is detached from the tendinous arch, a paravaginal fascial repair is added 3. Cystocele, B. Grade 3 includes full prolapse and bulging into the vagina. Mar 6, 2013 · In terms of rectocele, the existence of which had a significant relationship with urge urinary incontinence, the present work showed no relationship between rectocele grade and intensity of incontinence; on the other hand, despite the relationship between stress urinary incontinence and cystocele, no relationship was found between cystocele Grade 1 is the mildest form of the condition, and grades 3 and 4 are the most serious. Cystocele is a hernia of the bladder wall into the vagina, causing a soft anterior fullness. It "drops" and bulges into the vagina when the supportive tissues between the bladder and vagina weaken and stretch. Or, both the urethra and the bladder can prolapse into the vagina at the same time. The most common symptom was incomplete evacuation (85%), followed by straining (74%), sensation of obstructed defecation (66%), anal incontinence (63% Diagrammatic representation of the various types of pelvic organ prolapse. Once all measurements have been made the stage of the prolapse can be identified in relation to hymen; Stage 0: No prolapse is observed (points Aa, Ba, C, D, Ap and Bp are all < / = -3cm). Aug 10, 2022 · A posterior vaginal prolapse, also known as a rectocele, occurs when the wall of tissue that separates the rectum from the vagina weakens or tears. The bladder droops only a short way into the vagina. Bladder training. I hadn’t Colporrhaphy is a surgery used to repair weaknesses in your vaginal walls that are causing unpleasant symptoms. It can be the womb (uterus), bowel, bladder or top of the vagina. Shelf Pessary The Shelf pessary is a rigid type of pessary suited to more advanced prolapse. Posterior vaginal wall prolapse: when the rectum (lower part of the large bowel) bulges into the back wall of the vagina, also called a rectocele. Aug 10, 2022 · Treatment depends on how severe your prolapse is. What to Expect when you have a Cystocele and Rectocele Repair When is it used? Surgery is done to relieve bulging into the vagina that may be caused by a cystocele and rectocele. The women can be asked to cough or “bear down” to assess the full descent of the prolapse. The rectocele is depressed in the midline with the surgeon’s finger to reveal the margin of the puborectalis portion of the levator ani muscle. A stapled transanal rectal resection (STARR) procedure involves stapling the rectocele tissue Pelvic organ prolapse is when 1 or more of the organs in the pelvis slip down from their normal position and bulge into the vagina. Women may or may not present with symptoms of rectocele at the time. Jul 29, 2024 · Rectocele refers to a The clinical examination may reveal a rectocele and other pelvic organ prolapses such as a cystocele, and to grade the severity of the Cystocele. May 16, 2019 · Defecatory dysfunction is common in women with a symptomatic rectocele. Anterior Colporrhaphy (Cystocele Repair) is the surgical repair of a defect in the vaginal wall, including a cystocele (when the bladder protrudes into the vagina) and a rectocele (when the rectum protrudes into the vagina). Weight loss. The medical term for this is a cystourethrocele. 2 There is frequently an association with other anatomic support defects such as an enterocele or a cystocele. The approach will depend on the size of the rectocele and the symptoms associated with the rectocele. Mar 22, 2022 · Both rectocele and cystocele are conditions that involve pelvic organs shifting out of place because of a weakened pelvic floor. Enterocele—The small intestine bulges into the vagina. Posterior compartment containing either the small bowel loops (enterocele) or rectum (rectocele) POP is a gynecological condition that is very common among multiparous women and mostly postmenopausal women [1] over 50 (affects approximately 50% of women over age 50). Unfortunately, their surgical choices remain largely rooted in an older paradigm. We retrieved 612 articles, of which 61 matched Nov 27, 2013 · Grade of cystocele • Divided into 4 grade 7. Losing weight may reduce symptoms. Chronic diseases include diabetes, hypertension, hepatic or renal failure, and cancer . This pessary can relieve symptoms of cystocele and rectocele prolapses but is also difficult to Treatment for Cystocele Treatment for a cystocele includes cystocele repair surgery, surgery to place a urethral sling, or both. The following remedies for mild or moderate cystocele include: Activity changes : Avoid certain strenuous activities, such as heavy lifting or straining during bowel movements, which can exacerbate the condition. In this Apr 5, 2022 · Cystocele and rectocele recur in the mid-vaginal plane were the most important outcome factors [3,4]. You may be examined while lying down and possibly while standing up. Grade 1: This is also called mild cystocele. Grade 2 includes dropping into the vaginal opening. Treatment might involve: Observation. Cystocele characterizes anterior wall herniation, rectocele refers to the posterior vaginal wall descent, and vaginal vault prolapse characterizes the descent of the uterus, cervix, or apex of the May 1, 2010 · Older terms describing pelvic organ prolapse (e. This type of prolapse is called a cystocele. In taking her health history, which of the following would the nurse expect to find? A) Sporadic vaginal bleeding accompanied by chronic pelvic pain B) Heavy leukorrhea with vulvar pruritus C) Menstrual irregularities and hirsutism on the Furthermore, 87. Risk factors for rectocele may include: Pregnancy and childbirth, especially repeated vaginal deliveries and/or tearing or episiotomy during delivery; Aging; Chronic constipation; Obesity; Chronic cough or bronchitis; Rectocele Symptoms Rectal Pressure A large, exteriorized rectocele places the patient at risk for vaginal mucosal erosion and ulceration, and accelerates progression of the rectocele due to further weakening of the posterior vaginal wall. Most medical experts rank cystoceles and rectoceles on a graded system. The grading system shown in Table I Secondary prolapses, specifically rectocele prolapse (sagging of the connective tissue between the vagina and rectum) or cystocele prolapse (sagging of the connective tissue between the vagina and the bladder). Other types of prolapse are: anterior vaginal wall prolapse, or cystocele, where The back wall of the vagina: Prolapse of the rectum (rectocele) or small intestine (enterocele) The front wall of the vagina: Prolapse of the bladder (cystocele) or urethra (urethrocele) The top of the vagina: Vaginal (apical) prolapse. The treatment for rectocele, like most other forms of prolapse falls into one of two categories; conservative (non-surgical) and invasive (surgical). Jan 8, 2024 · Invasive Rectocele and Cystocele Repairs. Your bladder drops only a short way into your vagina. Grades of Uterine Prolapse Cystocele—The bladder drops into the vagina. Treatment for a cystocele includes cystocele repair surgery, surgery to place a urethral sling, or both. Karram. In a woman, the rectum bulges into the back wall of the vagina. Grade 3 (severe). B. Pelvic organ prolapse (POP) is subcategorized according to the compartment of descent. 4% rectocele, and 13. Other organs can also prolapse into the vagina, including the uterus, the small intestine, and the rectum (rectocele). Like most symptoms of pelvic floor dysfunction, the treatment for cystocele falls into one of two categories; conservative (non-surgical) and invasive (surgical). Cystoceles are grouped into grades: Grade 1. Rectocele includes an additional grade. Grade 4 Cystocele: is the extrusion of the bladder base beyond the vaginal opening at rest to maximum possible descent. 64; p < 0. Grade 1 is mild, with only slight bulging or movement out of position. Mild. Rectocele: When the rectum (the last part of the large bowel) bulges into the vagina, it is called rectocele. In taking her health history, which of the following would the nurse expect to find? A)Sporadic vaginal bleeding accompanied by chronic pelvic pain B)Heavy leukorrhea with vulvar pruritus C)Menstrual irregularities and hirsutism on the chin D What is a cystocele and rectocele repair? A cystocele and rectocele repair is an operation that lifts and tightens the tissue around the bladder and rectum so these organs no longer push against the vagina. Yes, this means your bladder is able to all but exit the body through the vaginal opening. During the 5-year time period, the majority of women (9,251, 55. ) at the end of the case Pescatori et al liken the presence of a rectocele in ODS to an iceberg, in which the rectocele is only the tip visible above the water, while larger “underwater rocks” may be present and affect the outcome of surgery. ) familiar with these techniques. Pain or discomfort during sexual intercourse; Difficulty using tampons How is a cystocele treated? Treatment depends on the grade of the cystocele and may include: Activity changes. If the exam reveals bulging of the bladder or rectum but the uterus is not significantly prolapsed, a vaginal prolapse repair may be the best treatment option. Cystocele may be accompanied by urethrocele, which is not a hernia but a sagging of the urethra due to detachment from the pubic symphysis usually during childbirth Dec 30, 2022 · Grade 3 is severe cystocele, and the bladder is so low that it bulges through the vaginal introitus; Tests are then performed to assess the intensity of other symptoms and look for other signs Jul 1, 1998 · Grade 4: Maximum possible descent for each site Notes for using the grading system: Prolapse is graded at each site (cystocele, uterine prolapse, vault prolapse, rectocele, enterocele) with At baseline, 40. The former is divided into anterior compartment prolapse (usually a cystocele or bladder prolapse), uterine prolapse (which is termed ‘procidentia’ if complete) and posterior compartment prolapse, which may be a rectocele (a diverticulum of the rectal ampulla herniating into the vagina) and/or an enterocele (a herniation of the small bowel Oct 3, 2022 · Pelvic organ prolapse is the descent of pelvic structures into the vagina due to ligament or muscular weakness. 7% Aug 3, 2022 · There can be prolapse of the bladder into the vagina. After all the sutures have been placed, they are tied. Your bladder drops to the opening or slightly outside of your vagina. Effect of pregnancy and childbirth on urinary incontinence and pelvic organ prolapse; Etiology and evaluation of chronic constipation in adults; Fecal incontinence in adults: Etiology and evaluation; Female urinary incontinence: Evaluation; Management of chronic constipation in adults Jul 1, 1998 · Fluorourodynamic view of grade 4 cystocele with characteristic "dumbbell" shape. prolapse beyond the H-line. Grade 2 - Descent to the hymen. The most advanced-grade 3-cystocele occurs when the bladder bulges out through the opening of the vagina. This can occur along with vaginal vault prolapse. Investigation • • • • • Pelvic examination Voiding cystourethrogram Urodynamics Cystoscopy Fluoroscopy. More severe. ) Cystoscopy done after indigo carmine was administered,(Indigo carmine is a dye injected during urogynecologic procedures for better visualization of structures/fluids etc. Anterior vaginal wall prolapse, or cystocele, is defined as pathologic descent of the anterior vaginal wall and overlying bladder base. Suits mild to severe prolapse depending on the type of prolapse. Jul 1, 1998 · Diagnosing and Treating a Rectocele A rectocele is a bulge into the vagina caused by the rectum prolapsing through an attenuated rectovaginal septum (Fig. Cystocele. TVL: total vaginal length after reducing the prolapse. Surgical options are generally only advised for severe cystocele (grade 3 or 4). Grade 3 - Descent halfway past the hymen. forceps delivery, vacuum delivery, tearing with a vaginal delivery, and episiotomy Dec 31, 2018 · Introduction. She said it sounded like a rectocele – a kind of prolapse where the rectum drops down and bulges into the vagina. Basically, the bladder’s supportive tissue stretches or detaches and sinks against the front (or anterior) vaginal Feb 2, 2011 · The terminology avoids assigning a specific label, such as cystocele or rectocele, to the prolapsing part of the vagina, acknowledging that the actual organ(s) above the prolapse frequently cannot be determined by physical examination. [1] The bladder bulges through the anterior wall of the vagina, with which it is anatomically associated. This procedure is also known as an Anterior and Posterior Repair. Oct 17, 2022 · A cystocele, otherwise known as a protrusion of the bladder, occurs when the bladder descends into the vagina. How is a cystocele treated? Treatment depends on the grade of the cystocele and may include: Activity changes. She has nine living children. When this happens, tissues or structures just behind the vaginal wall — in this case, the rectum — can bulge into the vagina. With a more severe-grade 2-cystocele, the bladder sinks far enough to reach the opening of the vagina. , cystocele, urethrocele, rectocele) have been replaced because they imply an unrealistic certainty about the structures on the other side of the There are three grades of cystocele: Grade 1: The mildest grade of cystocele, characterized by the bladder dropping only a little into the vagina ; Grade 2: More moderate grade characterized by the bladder having dropped far enough into the vagina to reach the vaginal opening ; Grade 3: Most advanced of all the stages, characterized by the Rectocele Causes. Oct 2, 2019 · Grade 3—most severe form, where the bladder sags through the opening of the vagina; Cystocele. g. During your consultation with the surgeon, they will perform a thorough history to determine the exact issues you would like addressed. described in a prospective evaluation of 160 women undergoing rectocele repair that preoperatively, 87% had bowel symptoms. Female patients over the age of 30 who were having cystocele and rectocele repair surgery, treatment, or oral contraceptive pills were included in the study. Pros and Cons Mar 21, 2018 · The anterior rectal wall bulge in rectoceles should be reported as pathological from grade °II, as a grade °I rectocele can be observed in nearly 78–99% of parous women, while rarely in men [7, 15, 16]: °0 = no outpouching, °I = outpouching up to 2 cm, °II = outpouching between 2 and 4 cm, and °III = outpouching at least 4 cm . A rectocele can also be repaired through the abdomen, either laparoscopically or open. May 3, 2023 · There are three grades of cystocele: Grade 1 (mild). All MRI images and cine loops were obtained and interpreted by a single radiologist (Z. This is the most common type of pelvic organ prolapse. It occurs when the supportive wall between your vagina and large intestine weakens, allowing tissue from the rectum to push against the back wall of Whether or not a hysterectomy is recommended at the time of prolapse repair depends on each patient’s symptoms and physical exam. Urethral Cystocele and rectocele. Enterocele. 4% uterine prolapse (Table 1). A woman is admitted for repair of cystocele and rectocele. Grade 3 is a cystocele that protrudes halfway beyond the introitus; and if it occurs with an everted vaginal cuff or cervix, it is called a “procidentia,” complete pelvic floor collapse, or grade 4 cystocele. Prevalence of isolated and combined pelvic support defects at baseline, year 1, and year 5 of evaluation in WHI E+P participants is presented in Table 2. Differential diagnosis. he sooner that a cystocele or rectocele is treated, the better the outcome. Calling it minor (as in grade 1, where it doesn't protrude out of the vagina) seems like the severity is being downplayed. There are many things which can lead to weakening of the pelvic floor, including advanced age, multiple vaginal deliveries and birthing trauma during vaginal delivery (e. (All of these problems are addressed in the body of the note below. With the rectocele still depressed, a No. A prolapsed bladder sinks into the anterior wall of the vagina. 9% of women had POP (grades 1-3); 34. Jan 5, 2024 · A cystocele alone can be treated with a retropubic (Burch) colposuspension, which comprises the suspension of the lateral aspects of the bladder from the pelvic sidewalls. The approach will depend on the size of the rectocele and the symptoms associated with the Aug 1, 2017 · Grade Description Stage Description; 0: cystocele, rectocele, and vaginal vault prolapse. Enterocele: This refers to the bulging of the small bowel against the vaginal wall. 8% had cystocele, 18. Surgical options are generally only advised when the rectocele is severe (grade 3 or 4). Search dates: March 8 Aug 24, 2018 · A rectocele is one type of pelvic organ prolapse. 7. This can be done by plication (stitching the tissue together). If the posterior vaginal prolapse causes few or no symptoms, simple self-care measures — such as performing Kegel exercises to strengthen pelvic muscles — might give relief. Aug 30, 2021 · It is also common to repair the front wall of the vagina to provide support to the bladder, which is known as cystocele repair, and the back wall of the vagina to provide support to the rectum, which is known as rectocele repair. Anterior Colporrhaphy (Cystocele Repair) with or without Mesh. Vaginal Vault Prolapse—The top of the vagina loses its support and drops. Pelvic organ prolapse (POP) refers to the protrusion of one or more female pelvic organs outside the pelvis through the vagina including uterus, bladder and intestines, and causes the pelvic organs to drop downward to the vaginal wall. Study with Quizlet and memorize flashcards containing terms like A woman is admitted for repair of cystocele and rectocele. 6). Vaginal Repair of Cystocele, Rectocele, and Enterocele. In the majority of patients with massive eversion of a post-hysterectomy vagina, an enterocele is present. The most advanced (grade 3) cystocele occurs when the bladder bulges out through the opening of the vagina. Your surgeon may also use a specialized mesh to further support the muscles. Grade 1 (mild): Only a small portion of the bladder droops into the vagina. Dec 12, 2022 · Treatment for Cystocele. by turning the urine red. Unlike many other reconstructive surgeries used to treat pelvic organ prolapse (POP), your provider can perform the procedure without having to make a large incision (cut) into your abdomen. Apr 6, 2023 · Diagnosis. A rectocele occurs when the musculature in the lower floor of the vagina weakens allowing the rectum to prolapse or protrude into the vagina. Uterine Prolapse—The uterus drops into the vagina. Jun 27, 2024 · In certain cases, some of the weakened muscle tissue that is forming the rectocele may be removed and the wall between the rectum and the vagina may need to be reinforced. Why do you need to repair a rectocele? Healthcare providers usually only recommend surgical repair for rectocele if you have bothersome symptoms — like vaginal bulge, difficulty pooping, pain or sexual dysfunction — and nonsurgical treatments don’t help. A rectocele is a herniation (bulge) of the front wall of the rectum into the back wall of the vagina (see Figure 6). Arrow indicates level of introitus. Grade 2. In a rectocele, there is a defect in the fascia between the rectum and the vagina. An enterocele is caused by the small bowel pushing into the vagina. Dec 14, 2019 · A grade 2 cystocele occurs when the cystocele is present at the introitus. Not doing certain activities, such as heavy lifting or straining during bowel movements, that could cause the cystocele to get worse. These conditions occur mostly in women and it is thought that it may be a weak area in the female anatomy as the back wall of the vagina rests against the front wall of Treatment for Cystocele. The uterus: Prolapse of the uterus (uterine prolapse) Often, a woman has more than one type. 1-0 absorbable suture is used to suture the margins of the levator ani muscles in an interrupted fashion. Staging of Prolapse [edit | edit source]. scrotal cystocele The exact cause of a rectocele is unknown, but symptomatic rectoceles usually occur in conjunction with weakening of the pelvic floor. Cystocele (or bladder prolapse) is a condition in women where the bladder is no longer in its normal position. The degree of cystocele, urethro-cele, rectocele, enterocele, and uterine descent were graded as 0 (none), 1 (minimal), 2 (moderate), and 3 (severe). Anterior Vaginal Wall Prolapse. Gh: Genital hiatus length. urinary bladder hernia. Rectocele. 48 Failure to recognize the associated complex pelvic floor dysfunction in patients with a rectocele will lead to Sep 26, 2020 · Grade 3 Cystocele: involves partial bladder passage through the opening of the vagina upon exertion and is considered severe. With a rectocele, weaknesses in the pelvic floor cause the rectum to bulge onto your back vaginal wall. Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina. 1 In the UK, POP accounts for 20% of women waiting for major gynecological surgery and is a leading indication for hysterectomy in postmenopausal Cystocele: Fallen or Dropped Bladder. Depending on the severity, cystocele may be. A posterior vaginal prolapse, also known as a rectocele, occurs when the wall of tissue that separates the rectum from the vagina weakens or tears. Study with Quizlet and memorize flashcards containing terms like 1. A rectocele is a bulge (hernia) that occurs in the front wall of the rectum and pushes it into the vagina. 0005). The medical term for this is a cystocele. Occasionally, mesh (a prosthetic material or patch) can be used to reinforce the repair. A cystocele repair is a surgery to put your bladder back in its normal place. Apr 21, 2023 · A rectocele is a type of pelvic organ prolapse. This is also called a cystocele or cystourethrocele. An anterior prolapse most often involves the bladder. The Baden–Walker Halfway Scoring System is used as the second most used system and assigns the classifications as mild (grade 1) when the bladder droops only a short way into the vagina; (grade 2) cystocele, the bladder sinks far enough to reach the opening of the vagina; and (grade 3) when the bladder bulges out through the opening of the Mar 9, 2015 · CHAPTER 54. Your surgeon will fix the wall between your bladder and vagina to keep your bladder from moving again. As you consider surgery, be sure to ask questions. Conclusions: Surgeons have responded to the increased contribution of apical support defects to cystocele/rectocele by modifying their diagnostic coding practices. Mar 27, 2020 · Space-filling pessaries are ideal for treating higher grades of prolapse and incontinence. Cystocele repair surgery A cystocele repair is a surgery to put your bladder back in its normal place. Cystocele (or “dropped bladder”) is the most common type of female prolapse and one of the few types of bladder prolapse that may impact the body. See also. The various surgical approaches have different risks and benefits. What causes a cystocele? Apr 6, 2023 · Vaginal hysterectomy, Hysterectomy, Laparoscopic surgery, Sacral nerve stimulation, Botox injection, Robotic surgery, P elvic floor reconstruction, Minimally Complete procidentia with cystocele and rectocele. Prolapse Severity. A. During the exam, your provider looks for a tissue bulge into your vagina that indicates pelvic organ prolapse. Based on the grading scale I thought that classified it as moderate, grade 2. Cystocele repair surgery. The search included review articles and was limited to English language studies. Procedures Rectocele Treatment for Rectocele. Apr 6, 2023 · Anterior vaginal prolapse, also known as a cystocele (SIS-toe-seel) or a prolapsed bladder, is when the bladder drops from its usual position in the pelvis and pushes on the wall of the vagina. Prolapse affecting the rear part of the pelvis (posterior A cystocele is mild-grade 1-when the bladder droops only a short way into the vagina. With a more advanced cystocele, your bladder and vaginal wall may drop down far enough that they reach or bulge into the vaginal canal and potentially out through the opening of the vagina. Your bladder bulges a lot past the opening of your vagina. rtifty puh krfg mexlbvz ljm whsmm odqlq sqtu vak rhcf