The downward displacement of one or more of the pelvic organs by deviating from their normal positions is called Cystocele, Rectocele. This condition can also be defined as herniation of the pelvic organs.
Causes of Vaginal Sagging
More than one factor can cause vaginal sagging. Among these reasons;
- Vaginal birth
- Menopause and age factor
- Chronic constipation
- Chronic cough
- Genetic factors
- Standing heavy lifting
- History of hysterectomy
Studies on patients with sagging pelvic organs have revealed that approximately 30% of them have a family history of sagging. Situations such as invasive births, giving birth to a large baby, difficult birth may cause sagging in the genitals. Vaginal sagging problem is seen in one out of 9 women.
Vaginal Prolapse Cystocele-Rectocele Symptoms
The diagnosis of Vaginal Prolapse Cystocele-Rectocele is made by vaginal examination findings. There is no consensus regarding the usability of imaging methods for the diagnosis of Vaginal Prolapse Cystocele-Rectocele. Rectal examination may be preferred to differentiate rectocele from enterocele. The difference can also be distinguished by outpatient examination.
The vast majority of patients present with the sensation of a mass in the vagina. It can create sagging structures that cause pressure in the vagina. The sagging can become severe when the person is standing and walking. There may be noise during sexual intercourse. Incontinence may occur in 40% of patients with prolapse. It may be necessary to support the bladder and push the bladder by hand while urinating due to drooping. Urine may remain in the overhanging area in the bladder due to the inability to fully empty the urine. The mucosa of the overhanging organ will swell outward. Therefore, irritation and pressure ulcers may be observed.
Vaginal Prolapse Cystocele-Rectocele Treatment
Mild cases that do not show symptoms may not need to be treated. Pessers are preferred in non-surgical approaches. The main treatment method is surgery to repair pelvic floor weakness. Vaginal hysterectomy can be applied for the treatment of uterine prolapse in patients over 40 years of age who do not want children. Manchester/Fothergill operations are preferred in the treatment of young patients. Le Fort operation is preferred in elderly patients who cannot undergo hysterectomy due to their age and the applications in which the vagina is completely closed. In the procedure, the vaginal mucosa is removed.
Cystocele
Cystocele is prolapse of the bladder floor. In addition to other complaints, urinary incontinence can also be seen. Bulging can be observed on the upper wall of the vaginal region. The bulging is seen in the form of outpouching outwards. If the process progresses, urine may remain in the bladder even after urination. The treatment is surgical, and sometimes there are patients who try to urinate by the support of their hand.
Complaints of Cystocele Patients
Some of the patients experience palpable swelling due to the sagging bladder. Apart from this, there are also patients who say that there is a feeling of fullness in the vagina because something is hanging out of the vagina. Patients may experience pain during sexual intercourse, involuntary urination at night, difficulty urinating, frequent urination and urinary incontinence.
How is Cystocele Diagnosed?
The diagnosis of cystocele is made by vaginal examination. The patient is asked to strain during the examination. The degree of sagging is determined using ultrasound. If the patient has urinary incontinence, a urodynamic test may be requested.
Cystocele Treatment
Cytocele, also known as bladder prolapse, may not manifest itself with any specific symptoms initially. No treatment is required for cystocele that does not cause any complaints in the patient. Surgery is performed for cystoceles that cause discomfort. Surgery is usually performed through the vagina. There are some points to be considered after cystocele treatment. These include avoiding chronic lung diseases and not lifting heavy. One of the points that the patient may benefit from after cystocele treatment is weight loss.
What is a ureterocele?
The ureters are tubular structures that drain urine from the kidney to the bladder. Ureterocele is the bulging of the parts of these tubes entering the bladder. Ureterocele sizes vary. While some of them are seen in very small structures, it is known that some of them can be large enough to even obstruct the bladder.
Ureterocele Diagnosis
In general, the enlargement of a baby’s kidneys can be visualized in mother's womb thanks to ultrasound techniques. In such cases, ureterocele can be diagnosed in the first week after birth. Urinary tract infection may develop if there are signs of urinary reflux or obstruction in the urinary tract due to ureterocele. The diagnosis of the disease can also be made during the examinations performed after a urinary tract infection.
If children and babies have severe enlargement of their kidneys and ureters, presence of stones, urinary infection and bladder emptying problems surgery might be required.
Ureterocele Treatment
While some of the ureteroceles can be treated with simple methods, some may require more extensive surgery. The treatment method is determined by the specialist according to the clinical picture of the patient. Among the factors affecting the treatment method to be chosen by the surgeon;
- Presence of additional urinary tract anomaly
- Whether the bladder is affected by the condition
- Whether there is urine leakage towards the kidney or not
- Whether the kidney is working or not
- The state and degree of obstruction in the urinary tract
- The size of the ureterocele
If patients have urinary infections, they should be treated before surgery. Before the procedure, the patient will be asked to fast for 4-6 hours by the specialist. The application is carried out under general anesthesia for children.
Depending on the surgeon's preference, a urinary catheter may be inserted for a short period of time after the surgical procedure. This catheter is usually removed on the day of the procedure or within the next 1-2 days if there is no bleeding. Pain and spasms may occur in the patient's bladder as soon as the catheter is inserted. Depending on the incision made, it is common for the urine to be slightly bloody. According to the age of the child, with the advice of a specialist, oral liquid and food intake can be started after 2 - 4 hours.
