Have Sagging Urinary Bladder. On Diabetic Medication. History Of Hysterectomy. Is Scanning Required, How Effective Is Surgery?

Dear XXXXXXX

Thanks for writing in.

I have gone through the details submitted and let me try to provide you with useful information pertaining to this query.

1. 'Sagging urinary bladder' is termed as cystocele in medical language. It is a condition diagnosed based on symptoms and physical examination. On physical examination which might include a colposcopy the gynecologist will be able to see protrusion in the vagina.
If you really want to confirm diagnosis and document it, then you can get "voiding cystourethrogram" done. It is a test that involves taking x-rays of the bladder during urination.

2. There is no need of scan / ultrasound to diagnose cystocele until and unless you want to document it.

3. If your symptoms are very distressing and not getting relieved with kegel's exercise and medicines then only surgery will be advised.

4. Surgical treatment is the effective method of treatment. Various type of procedure can be attempted for cystocele correction, namely:
a) Sling surgery
b) Needle bladder neck suspension surgery
c) Open retropubic suspension surgery
d) Laparoscopic retropubic suspension surgery

Surgeries are not minor and requires stay in hospital for several days. Full recovery needs 4-6 weeks. But some sling procedures may be done under local anesthesia in an outpatient clinic.

Surgeries are effective to fix problem and relieve symptoms. You should be free of your symptoms following this treatment.

I hope I have answered your query. In case of doubt feel free to revert back.

Best regards,
Dr. Neelam.

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Hi XXXXXXX

Thanks for writing in.

Oestrogen is hormone which is responsible for giving strengths to pelvic floor and vaginal wall muscles.
As this hormone levels falls down drastically after menopause, those muscles can become weak resulting in cystocoele. Hysterectomy done years ago might also be responsible for lax supports leading to this cystocoele. I believe this is what has happened in your case.

Accordingly your doctor has rightly prescribed oestrogen creams to strengthen some muscles. However the decision about when to operate is adjudged by the treating physician who can assess the severity of sagging based on the clinical findings.

If I were to be your treating doctor, I would wait for a while to see the effects of oestrogen creams. If severity of symptoms remains same, then I would decide to operate on you.

I hope I have cleared your doubt. Let me know if you need any more information.
If all your queries are answered, please close this discussion. Your feed backs are appreciated.

Best regards,
Dr. Neelam

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