Innovation for Pelvic Health

Pelvic prolapse is a common condition affecting adult women of all ages, with an estimated 11% of all women undergoing surgical intervention by age 80 for this condition. ¹ Anterior wall defects, or cystoceles, are very common in women and result from a weakness in the anterior vaginal wall support, a continuous connective tissue support from each pelvic sidewall laterally and from the anterior pubic symphysis to the sacrum posteriorly. There are two main defects responsible for cystoceles: central  and lateral. Central defects are caused by a weakness in the perivesical or pubocervical fascia in the midline. Lateral defects stem from a detachment of the vesicopelvic fascia from the arcus tendineus fascia pelvis. The weakened vesicopelvic fascia allows the bladder and urethra to slide down as a unit. The etiology of cystoceles is multifactorial and includes genetic factors that determine tissue strength, parity, hormonal status, age, and previous pelvic surgery. Many cystoceles are asymptomatic; however, they can become symptomatic if the bladder descends to the level of or outside the introitus. Patients may present with a vaginal bulge or pressure while standing that may resolve when they are supine. Many women with symptomatic cystoceles also have concomitant lower urinary tract symptoms including stress incontinence, urgency with or without urge incontinence, and a sensation of incomplete bladder emptying; they may even need to manually reduce the prolapse in order to void to completion.