Cystocele, also known as prolapsed bladder, occurs when the supportive tissue between the bladder and vaginal wall weakens, allowing the bladder to bulge into the vagina. Common causes include childbirth, heavy lifting, chronic coughing, constipation, obesity, and menopause. Symptoms include frequent urination, incontinence, discomfort in the pelvis or vagina, and tissue protruding from the vagina. Treatment options include Kegel exercises, estrogen therapy, pessaries, and surgery. The document then provides a case study of a 57-year-old female patient diagnosed with mild cystocele who is undergoing conservative treatment and pelvic floor physiotherapy including Kegel exercises, biofeedback

1. CYSTOCELE
Presented by :
Rahila Najihah Ali
DPH/0102/11

2. Anatomy of Pelvic

3. Definition
• Also known as prolapsed bladder
• Occurs when the supportive tissue between a
woman's bladder and vaginal wall weakens
and stretches, allowing the bladder to bulge
into the vagina
• May associated with problems emptying the
bladder, urinary tract infections or
incontinence

4. Causes
• Stress on the supportive "hammock" during
childbirth
• Frequent heavy lifting
• Chronic coughing (or other lung problems)
• Constipation (frequently straining to pass stool)
• Obesity,
• menopause (estrogen levels start to drop)
• previous pelvic surgery.

5. Symptoms
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•
•
•
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Frequent urination or urge to urinate
Stress incontinence
Not feeling bladder relief immediately after urinating;
Frequent UTI
Discomfort or pain in the vagina, pelvis, lower
abdomen, groin or lower back
• Heaviness or pressure in the vaginal area;
• Painful intercourse
• Tissue protruding from the vagina that may be tender
and/or bleeding.

6. Grade of cystocele
• Divided into 4 grade

7. Investigation
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•
•
•
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Pelvic examination
Voiding cystourethrogram
Urodynamics
Cystoscopy
Fluoroscopy.

8. Treatment
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•
•
•
Kegel exercises
Estrogen replacement therapy
Pessary (vaginal support device)
Surgery

9. Complication
• If case is left untreated, over time the
condition may get worse.
• Can cause to urinary retention (inability to
urinate) which may lead to kidney damage or
infection

10. Subjective Assessment
Name :
Age :
Sex :
D.O.Ax :
Dr. dx:
Dr. mx :
Madam B
57 y/o
Female
3rd October 2013
Mild cystocele with grade I uv
prolapse
conservative mx and refer to physio

11. C/c : Pt. c/o having incomplete urine and feel
there’s mass protrusion at vaginal opening when
BO. Problem occur many times in a week but no
pain
Current Hx : Pt. start having this problem since
many years ago (not remember since when) but
just recently came to see doctor at Klinik
Kesihatan batu 14 and referred to physiotherapy
General Health : Good
PMHx : Pt. has DM and under medication ( since 5
years ago)

12. Medication / Steroid :
• Pt. cannot remember the name
Obstetric Hx :
• Gravida 3
• 1st child, do abortion in 1975. 8/52 . D&c
done

13. Gynecological Hx :
Pt have 2 children
- 2nd female child, born in 1976 wt. 3.9kg
through svd. Episiotomy done.
- 3rd female child, born in 1979 wt. 4.2 kg
through SVD. Episiotomy done.
Menopausal Status : already menopause since 5
years ago

14. Bowel fx :
Normal
Stress Incontinence : Present during coughing
wt. minimal leakage
Incontinence frequency : Everyday wt.
moderate severity.
Micturation Frequency :
Day : 9 times
Night : 1 time

15. No. of drinks : 1
Type of drink : Warm water (6 cups/day)
Urgency : No
Social Hx : Every evening, pt. go to jogging
nearly 2 hrs.

16. Objective Assessment
Observation :
• Pt. is moderate size of Chinese lady. She
presented with mild flabbiness of abdominal
muscle.
Palpation :
• Unable to palpate d/t patient resist
Special test :
• Provocation test (-ve)

17. Analysis
• Incontinence and bladder prolapse d/t pelvic
floor muscle weakness
• Pelvic floor muscle d/t weakness of slow
twitch fiber (STF) and fast twitch fiber (FTF)

18. Goals
Short term Goal :
• To strengthen the pelvic floor muscle
• To minimal the amount of protrusion
Long term goal :
To regain pelvic floor muscle control during
stress activity

19. Plan of Treatment
• Do kegel’s exercise
• Biofeedback’s training
• Kegel’s exercise on the gym ball
• HEP

20. Intervention
Kegel’s exercise
Position : Supine lying wt both knees flex
Instruction : Tighten your pelvic floor
muscles, hold the contraction for five
seconds, and then relax for five seconds.
Repetition : Do for 10 times

21. Biofeedback’s training
Position : Supine lying with both knees flex
Instruction : Put Ten’s pad to the pt. 2 at
between ASIS. 2 at the pt.s’ gluteal fold.
Cross the tens’ wire. Do the kegel’s ex.
along with ten’s contraction.
Duration : 15 minutes
Precaution : Keep breathing and do not use
help from abdominal muscle

22. Kegel’s exercise on the gym ball
Position : Pt. sit on the gym ball with the leg
slightly apart
Instruction : During sitting, bring the gym ball
to forward, backward and side. While bring
the ball, do the kegel’s exercise.
Duration : do for 10 minutes

23. Home exercise programme
Ask pt. to do the kegel’s exercise at home for
80 times per day. Kegel’s can do in every static
position like sitting and standing.
Do kegel’s every times pt. fell like to do stress
activity to pelvic floor muscles.

24. Evaluation
• Pt able to do the kegel’s exercise correctly
• KIV biofeedback training

25. Review
• Reassess the grade of the pelvic floor muscle
• Continue with biofeedback training and
kegel’s ex. On the gym ball on next visit

26. Reference
Book
• Mantle J , Haslam J , Barton S ; Physiotherapy
in Obstretrics and Gynaecology . 2nd edition .
ELSEVIER ( 2005)
• Madhuri G.B (2007) Textbook of
Physiotherapy for Obstretrics and
Gynaecological conditions , Jaypee Publishers.