A cystocele occurs when the bladder descends into the vagina due to pelvic floor muscle weakness and may result in incomplete emptying of the bladder and potentially urinary leakage. It is typically graded from mild (grade 1) to severe (grade 3, the bladder protrudes out of the vagina). Precipitating factors include repeated muscle straining (during childbirth) and/or estrogen deficiency leading to weakening of the vaginal walls (seen with menopause). Hysterectomies also weaken the pelvic floor muscles and may lead to a cystocele.

A cystocele can be managed with pelvic floor physical therapy which includes strengthening of the pelvic floor muscles. Physical therapy can be extremely effective for a grade 1 to 2 prolapse. A pessary may also be prescribed by the referring physician in conjunction with physical therapy. Surgery may be prescribed when physical therapy and/or a pessary are not effective.

A cystocele may be prevented through correct body mechanics with lifting, avoidance of straining with activities, controlling constipation (increases pressure on the bladder during straining to have a bowel movement), weight control, core stabilization exercises, and kegels (performed under the supervision of the physical therapist).

Herniation of the small intestine between the rectum and vagina.

A rectocele is the protrusion of rectal tissue in the posterior vaginal wall. It may occur with childbirth, chronic constipation, chronic coughing, heavy lifting, estrogen deficiency, abdominal weakness, and/or obesity. Symptoms may include constipation and/or pelvic pain, fecal and/or urinary incontinence. A rectocele may be prevented through correct body mechanics with lifting, avoidance of straining, controlling and treating constipation, weight control, core stabilization exercises, and kegels. A rectocele can be successfully managed through pelvic floor physical therapy.

Uterine Prolapse
Herniation of the uterus into the vagina.

Pelvic Floor Therapy May Include:
• EMG Biofeedback for muscle reeducation.
• Manual therapy including myofascial or trigger point release, visceral or connective tissue manipulation.
• Core stabilization and strengthening.
• Pelvic floor strengthening through Kegel exercise training.
• Instruction in correct body mechanics and instruction in avoiding activities that can increase pelvic prolapse.

Aquacare/Fitness Forum Physical Therapy has pelvic floor specialists at most locations. Visit our location page to schedule a free screening or evaluation with one of our pelvic floor therapists.