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Q: I'm scheduled for a repair of a cystocele in two weeks. Could you please tell me a little about the procedure, possible complications, and success rate? Thank you.

-- M.R., Buffalo

A: Because of the lead-time requirements of the column and Web site, I suspect by the time you read this, you will have already had your surgery. But let me give a brief overview of cystoceles and their repair anyway.

A cystocele ("-cele" is from the Greek word for hernia) is one of three types of vaginal hernias that are commonly seen in women who have had several children. It is the prolapse of the urinary bladder into the vagina.

Rectoceles are hernias of the rectum into the vagina. Enteroceles are hernias of part of the small intestine into the vagina.

Cystoceles are caused by the stretching and weakening of the pelvic muscles and supportive tissues (ligaments) as a result of multiple vaginal childbirths, or by changes that occur when estrogen levels decrease, such as after menopause.

When this weakening takes place, the bladder descends into the pelvic area and can actually protrude from the opening of the vagina.

Some women with this condition have no symptoms. When symptoms do occur, there is a sense of fullness or heaviness in the pelvis and some discomfort.

Some women complain of an aching back. Many have urination problems, such as stress incontinence and urinary urgency.

Although a cystocele is not life-threatening and does not lead to more serious conditions, it can be very uncomfortable and damage your quality of life, especially with regard to your sexuality. Women with cystoceles are also more likely to develop urinary problems, including urinary tract infections (UTIs).

Most women whose cystoceles were accidentally found in routine exams, and who have no symptoms, often choose not to have any treatment, but rather wait and see what happens.

If symptoms or quality of life issues are great enough, then a woman can opt for surgery. The standard surgical procedure recommended is the insertion of a pessary. This is a ring that is placed in the vagina, which mechanically holds the bladder from descending into the vagina. There are a number of types of pessaries and methods of insertion.

The surgeon should be sufficiently experienced to be able to select the appropriate procedure or modification. One of the most common procedures is known as the four-corner bladder and bladder neck suspension procedure, which has been shown to be effective in moderate cases of cystocele with little chance of recurring symptoms.

Supportive measures that can be tried, with or without surgery, include a high-fiber diet to keep bowel contents soft, which limits bearing down during bowel movements; weight reduction if you're overweight; and the limiting of any straining and lifting. Specific exercises, called Kegel exercises, may be recommended.

I hope by now the procedure went well and you're on the road to full recovery. Be sure to ask your doctor what, if anything, you need to do to reduce the risk of recurrence. And let him know if you experience any symptoms or discomfort.

Update on caffeine: Many people have experienced headaches either when they consume a lot of caffeine during a day or when they regularly consume large amounts of caffeine and then stop abruptly.

But the National Headache Foundation has recently reported that past research shows that caffeine increases the effectiveness of aspirin or acetaminophen by 40 percent in treating headaches.

The research applies to the use of medications that contain caffeine and does not specifically indicate how effective an aspirin with a cup of coffee might be -- a combination that may upset some stomachs.

We're all different and respond differently to medications. So when you take any medication, it's important to monitor the benefits and side effects you experience and to report major problems to your pharmacist or doctor.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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