10 Cystocele Repair Rules for Avoiding Bladder Prolapse Surgery

Cystocele repair rules

Cystocele repair (bladder prolapse repair) is one of the most commonly performed types of prolapse surgery.

Some women with cystocele problems remain active and largely symptom free while others require prolapse surgery for debilitating symptoms.

This 10 step Physiotherapist cystocele repair guide helps you reduce your risk of worsening bladder prolapse and prolapse surgery.

1. Regular Kegels

Kegels (pelvic floor exercises) can reduce the risk of worsening bladder prolapse. Research shows that rehabilitation including pelvic floor muscle training lifts the bladder and reduces bladder prolapse symptoms in women with mild to moderate prolapse 1.

Pelvic floor exercises combined with a pessary device may assist some women with their pelvic floor training. Some women say that using a pessary device makes their pelvic floor exercises feel easier.

2. Use a Pessary DeviceRing Pessary

A pessary for prolapse is a device that sits within the vagina to support the prolapsed tissues.

Using a pessary lifts prolapsed tissues  often helping to reduce prolapse symptoms. Pessaries can help some women perform a greater range of general activities and exercises.

There are different pessaries devised specifically for cystocele treatment e.g. ring , gehrung, donut and cube pessaries.

3. Use ‘The Knack’

‘The Knack’ is an exercise technique that supports and protects bladder prolapse.

Doing ‘The Knack‘ involves a strong inwards lift and squeeze of the pelvic floor muscles immediately before and during pressure on the pelvic floor e.g. sneezing or coughing.

Research shows that learning the correct way to do ‘The Knack’ and practicing this exercise along with pelvic floor muscle training and lifestyle management lifts prolapsed tissues and reduces prolapse symptoms 1.

4. Empty Your Bladder Correctly Without Straining

Some women with bladder prolapse have difficulty emptying their bladder causing them to strain. Pushing down through the pelvic floor and straining to empty the bladder can cause worsening bladder prolapse.

Bladder Emptying Video
Watch Bladder Emptying Video

Using the correct bladder emptying position involves sitting on the toilet seat and leaning forward with chest raised. Relaxing the pelvic floor muscles, bulging the abdomen forward gently and double void technique can help bladder emptying without straining.

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Prolapse Exercises teaches you how to:

  • Exercise safely after prolapse surgery
  • Reduce your risk or repeat prolapse
  • Avoid unsafe exercises
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5. Avoid Straining and Constipation

Straining to empty your bowels and constipation can worsen your bladder prolapse. The pelvic floor tissues become stretched and weaken with straining. When the pelvic floor stretches and weakens, prolapse problems can become worse.

Use the correct position and technique for bowel movements. Appropriate diet for constipation can reduce the need to strain and improve stool consistency making bowel emptying easier.

6. Manage Lifestyle and General Health Factors That Worsen Cystocele

Some lifestyle factors are known to worsen cystocele.

These include:

  • Smoking – causes chronic coughing and associated pressure on the pelvic floor
  • Obesity – increases the load the pelvic floor during upright daily activities
  • Hay fever – sneezing and coughing load the pelvic floor
  • Chronic lower back and/or pelvic pain – reduce core strength and pelvic floor support
  • Inappropriate gym and fitness exercises – including intense core abdominal exercises, inappropriate high impact exercises and strength exercises, returning to the wrong exercises too quickly after childbirth or with menopause and beyond
  • Poor diet – causing chronic constipation and straining
  • Chronic chest problems – causing coughing e.g. asthma, bronchitis, bronchiectasis

Manage these factors well to reduce your overall risk of worsening cystocoele. Good management may involve working with your doctor or allied health practitioner e.g. dietician or physiotherapist.

7. Avoid Heavy Lifting

Heavy lifting can worsen bladder prolapse particularly when repeated using the wrong lifting technique.

If moving an object causes you to strain it’s too heavy for you to lift. Heavy lifting from ground level is more likely to worsen your prolapse than lifting from waist height or above.

Use the correct lifting technique for all lifting. Delegate heavy lifting tasks to others where possible.

8. Avoid High Impact Exercises

RunningIf you’re living with cystocele you’ll know that running and jumping usually increase prolapse symptoms. These exercises place a downward load on your pelvic floor every time you land.

Unfortunately some women with bone density problems such as osteopenia perform high impact exercises to load their bones, only to find they develop prolapse problems.

Maintain your general fitness with low impact exercises such as cycling and walking. Choose appropriate strength exercises in the gym if you’re seeking to  improve your bone density with exercise.

9. Keep Your Whole Body Strong

Safe strength exercisesWhole body strengthening can help you better manage your bladder prolapse. When the body weakens, greater pressure is placed on the pelvic floor with everyday activities such as cleaning and laundry.

Unfortunately some women become so fearful of strength exercises making their prolapse worse that they stop exercising.

Understanding pelvic floor friendly general strengthening exercises and exercising regularly will help your whole body stay strong reducing pressure on your prolapse.

10. Monitor Your Cystocele Symptoms

Cystocele symptomsMonitoring bladder prolapse symptoms helps you know how well you’re managing your prolapse and whether or not your condition is improving.

Bladder prolapse symptoms may include:

  • Sensation of bulging in the vagina (plus visible bulge)
  • Feeling of heaviness or pressure within the pelvis
  • Pressure in the lower abdomen
  • Difficulty emptying the bladder
  • Changing position to empty the bladder
  • Gas emptying from the vagina (often noticeable with sexual intercourse)

Bladder prolapse symptoms can change on a daily basis so try not to be obsessive about noticing symptoms. Becoming fixated on symptoms usually makes them more apparent (and often worse).

A reduction in your prolapse symptoms may indicate a general improvement in your pelvic floor condition. Use the guidelines above to direct your prolapse management if you notice your symptoms worsening.

Further Reading

» How to Reverse Pelvic Prolapse and Avoid Prolapse Surgery

» How to Cope With Your Prolapse & Feel Good About Yourself Again

» Safe Bending After Prolapse Surgery and With Prolapse Problems


1HoffBrækken I, Memona M, Majida M, EllströmEngh M, Bo K (2010). Can pelvic floor muscle training reverse pelvic organ prolapse and reduce prolapse symptoms? An assessor-blinded, randomized, controlled trial. American Journal of Obstetrics and Gynecology. Volume 203, Issue 2, Pages 170.e1-170.e7.


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