Mild cystocele may have no symptoms, the feeling of incomplete urination is a manifestation of severe prolapse. The main symptom of women with cystocele is the prolapse of the vagina or related symptoms. They feel something protruding from the vagina. During labor, coughing, straining, or when abdominal pressure increases or the bladder is full of urine, the object increases in size and urine leaks out. After lying down or urinating, it shrinks or even disappears. Patients have a feeling of fullness in the vagina, a feeling of descent in the pelvic cavity, stress urinary incontinence or incomplete urination, pain in the lumbar sacral region that worsens after standing for a long time, and difficulty in sexual intercourse. Often, patients need to push the prolapsed vagina themselves to empty the urine.
Clinical Staging:
1. Degree I (mild): The anterior vaginal wall prolapse has reached the hymen edge but has not protruded outside the vaginal orifice.
2. Degree II (moderate): Part of the anterior vaginal wall has prolapsed outside the vaginal orifice.
3. Degree III (severe): The entire anterior vaginal wall has prolapsed outside the vaginal orifice.
Signs include prolapse of a mass in the vagina, stress urinary incontinence, and 39% of women with cystocele experience stress urinary incontinence.
In a condition of a full bladder, the patient is first placed in a lithotomy position to examine the external genitalia. If no corresponding signs are found or the extent of the maximum prolapse cannot be confirmed, a standing position examination is performed. If no obvious prolapsed tissue is found, gently separate the labia minora to expose the vestibule and hymen, assess the integrity of the perineum, and estimate the size of the prolapsed tissue. Compression of the posterior vaginal wall with the posterior blade of the speculum helps to expose the anterior vaginal wall. Then, ask the patient to strain or cough forcefully, observe the prolapse of pelvic organs, and it helps to differentiate between lateral defects and central defects. The former is manifested by the disappearance or separation of the vaginal sulcus; while the median prolapse is manifested by the presence of the vaginal sulcus, the descent of the anterior vaginal wall is accompanied by the descent of the bladder, and is accompanied or not accompanied by excessive movement of the urethra. If concurrent urethral prolapse occurs, when abdominal pressure increases, the urethra rotates downward and forward.
Studies have shown that the feeling of incomplete urination in women with severe prolapse is attributed to urethral obstruction. When prolapse is reduced, urethral dysfunction is exposed, accompanied by stress urinary incontinence. For women with severe prolapse, it is very important to check urethral function after the prolapsed object is returned to its original position. If the patient urinates normally after the prolapsed object is returned, but still leaks urine during forced coughing or Valsalva maneuvers, it suggests dysfunctions of the urethral sphincter muscles.