Connective tissue separates the pelvic organs. The tissue, called fascia, is attached to nearby muscles. When healthy, the fascia and muscles support the bladder, vagina and rectum. Defects in the fascia can cause cystoceles and rectoceles.

In a cystocele there is a defect in the fascia between the bladder and vagina. This allows a part of the bladder wall to bulge into the vagina. There are three grades of cystocele:

• Grade 1: mildest form, where the bladder drops only partway into the vagina
• Grade 2: moderate form, where the bladder has sunken far enough to reach the opening of the vagina
• Grade 3: most severe form, where the bladder sags through the opening of the vagina

In a rectocele there is a defect in the fascia between the rectum and the vagina. This allows part of the wall of the rectum to bulge into the vagina.

The sooner that a cystocele or rectocele is treated, the better the outcome. If you suspect you have this condition, contact your doctor.

The walls between the vagina and bladder or rectum can be damaged by one or more of the following factors:

• Difficult vaginal births
  • Multiple births
  • The use of forceps to assist delivery
  • Perineal tears during delivery
  • Episiotomy during birth
• Strain from lifting heavy objects
• Chronic cough
• Chronic constipation
• Weakening of vaginal muscles caused by a lack of estrogen after menopause

If you have any of these risk factors, tell your doctor:

• Age: postmenopausal
• History of difficult vaginal births
• History of straining during bowel movements
• Obesity
• Smoking

Many cases are mild and do not have symptoms.

In more serious cases, the symptoms of cystocele include:

• Urine leakage while laughing, sneezing, or coughing
• Incomplete bladder emptying after urination
• Pain or pressure in the pelvis
• Frequent bladder infections
• Pain during sexual intercourse
• Feeling of tissue bulging out of vagina

Symptoms of rectocele include:

• Pain or pressure in the vagina
• Pain during sexual intercourse
• Pain or pressure in the rectum
• Difficult passage of stool
• Needing to apply pressure on vagina to pass stool
• Feelings of incomplete stool passage
• Feeling of tissue bulging out of vagina

If you have any of these symptoms, do not assume it is due to cystocele or rectocele. These symptoms may be caused by other, less or more serious health conditions. If you have any one of them, see your doctor.

Your doctor will ask about your symptoms and medical history. A physical exam will be done. Tests for cystocele may include the following:

• Pelvic examination
• Voiding cystourethrogram—an x-ray test done during urination
• Urine tests to look for signs of infection

Tests for rectocele may include:

• Examination of the vagina and rectum
• Defecagram—an x-ray test done during defecation

Talk with your doctor about the best plan for you. For the mildest cases of cystocele and rectocele, no treatment is needed. For more serious cases, treatment options include the following:

• Your doctor may suggest that you avoid heavy lifting
• Kegel exercises (squeezing the pelvic floor muscles) may help to strengthen the muscles around the vagina and bladder
• For rectocele—a diet that allows for easy passage of stools by adding fiber, liquids, and a stool softener if necessary

A pessary is a device that is inserted into the vagina. It can provide support to keep the bladder and/or rectum in place.

Adding estrogen may help strengthen the walls of the vagina after menopause. It may be delivered in the form of pills, creams, or patches.

For severe cases, surgery may be needed to move the bladder or rectum back into place.

If you are diagnosed with cystocele or rectocele, follow your doctor's instructions.