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Have sagging urinary bladder. On diabetic medication. History of hysterectomy. Is scanning required, how effective is surgery?

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General & Family Physician
Practicing since : 2007
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Dear Doc,
I am having sagging of urinary bladder for the last 2 weeks and my doc.had advised to apply Zolo ointment for 2 weeks and come for review. She also mentioned that if required a surgical intervention would be done to correct the position. No scan or ultrasound has been done or suggested. Iam diabetic and on medication for the last 22 yrs. Iam 57 yrs.old and had my hysterectomy done through abdomen 22 yrs.ago.
Could you please suggest if any scan is required and if surgery is to be done, is it going to be a minor one and how effective is it?
Posted Wed, 18 Jul 2012 in Urinary and Bladder Problems
Answered by Dr. Neelam Ashish Vanjari 1 hour later

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.
Above answer was peer-reviewed by
Follow-up: Have sagging urinary bladder. On diabetic medication. History of hysterectomy. Is scanning required, how effective is surgery? 17 hours later
Thanks a lot for your clarifications.
Iam scheduled to XXXXXXX the doctor today after 2 weeks of medication. Since the symptom still persists, if my Doctor advises to go in for surgery, I would go in for it as you have also mentioned that this is the effective treatment.
In the meantime could you please let me know how long can I postpone the surgery?My Doc had mentioned that after 2 weeksof Zolo ointment, I might be put on Estogen.Will this help in avoiding surgery?
Because of the present condition, iam avoiding many of my routine work, like brisk walking, lifting weights etc.etc.
Please advise me.
Answered by Dr. Neelam Ashish Vanjari 21 minutes later

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
Above answer was peer-reviewed by
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