What is Bladder Prolapse?
A bladder prolapse (also known as cystocele) happens when the front wall of the vagina weakens, causing the bladder to descend or bulge into the vaginal canal. It happens when the pelvic floor muscles and ligaments that support the bladder become stretched or weakened, leading to the bladder's downward displacement. Common names for bladder prolapse that you might hear are:
- Fallen bladder
- Anterior wall prolapse
- Cystocele
- Herniated bladder
- Dropped bladder
What are the types of bladder prolapse (cystoceles)?
There are three grades of bladder prolapse:
- Grade 1 (mild). The bladder drops a short way into the vagina.
- Grade 2 (moderate). The bladder drops to the opening or slightly outside of the vagina.
- Grade 3 (severe). The bladder bulges a fair amount past the opening of the vagina.
What causes Bladder Prolapse and who is at the greatest risk?
Bladder prolapse can be caused by several factors, including:
Pregnancy and Childbirth
Pregnancy and childbirth (especially a vaginal delivery) can significantly strain the pelvic floor muscles, potentially leading to bladder prolapse.
Aging and Menopause
With age, the pelvic floor muscles naturally weaken, and hormone levels that help maintain muscle strength and tissue elasticity, decrease naturally during menopause. The main hormone that is depleted is estrogen. This particular hormone helps keep your pelvic muscles strong. Without it, it can contribute to the development of bladder prolapse.
Chronic Straining
Conditions that involve chronic straining during bowel movements, such as chronic constipation, can place excessive pressure on the pelvic floor muscles, leading to bladder prolapse.
Pushing out urine can also lead to a weakened pelvic floor. When pushing out urine, several things can occur to the pelvic floor muscles. Creating muscle confusion. A healthy pelvic floor coordinates contractions and relaxation correctly during specific activities to remain functional. When urination occurs, the pelvic floor muscles relax to release the waste. If consistent pushing is occurring, it is contracting and counterintuitive to what should happen naturally. The strained muscles could get confused and be more lax as a result. Often this begins as urinary incontinence but could lead to a serious pelvic floor issue such as bladder prolapse.
Connective Tissue Disorders
Certain connective tissue disorders can lead to weakness of the collagen fibers, so much that the pelvic supports are already unnaturally thin. These congenital disorders include joint hypermobility syndrome, Marfan syndrome, and Ehlers-Danlos syndrome.
Smoking
Smoking tobacco was found to correlate with a severe degree of bladder prolapse significantly.
Obesity
A high BMI can increase intra-abdominal pressure that weakens the pelvic floor muscles and fascia.
Symptoms of Bladder Prolapse
The symptoms of bladder prolapse can vary depending on the degree of prolapse and individual factors. A mild case may not present many obvious symptoms but one of the first and most notable signs of prolapse is a feeling like there’s a ball of tissue in the vagina. Knowing the symptoms is the best way to advocate for yourself in diagnosing bladder prolapse early.
Below are some common symptoms associated with bladder prolapse, but are also common to other pelvic floor dysfunctions. It is essential to consult with a health professional to diagnose properly.
There are several symptoms related to pain and discomfort including:
- Low back pain
- A sense of a ball of tissue inside the vagina or the sensation that something is falling out of the vagina
- Pain or discomfort in the pelvic area
- Pain during sexual intercourse
Symptoms relating to urinary function include:
- Difficulty urinating or with bowel movements
- Urinary incontinence
- Incomplete voiding (the feeling that your bladder isn’t empty after urinating)
When to see a Physician for Bladder Prolapse
Any woman who notices the symptoms of a prolapsed bladder should consult their physician. A prolapsed bladder is commonly seen with prolapses of other organs within the pelvic region. Prolapsed organs cannot improve without proper medical care, and can worsen over time. It is pertinent to get medical attention to prevent worsening symptoms and complications caused by weakening tissue and muscle in the vagina. A healthcare provider experienced in pelvic floor disorders can conduct a thorough evaluation, discuss treatment options, and develop a personalized plan tailored to your needs and preferences. They will guide you through the process, provide support, and address any concerns you may have.
Treatments for Bladder Prolapse
The treatment options for bladder prolapse depend on the severity of the condition, the presence of symptoms, and individual preferences. A mild (grade 1) prolapsed bladder that produces no pain or discomfort usually requires no surgical treatment and can improve by avoiding straining and heavy lifting as well as strengthening the pelvic floor muscles with proper guidance.
For cases that are more serious, the doctor takes into account various factors, such as the woman’s age, general health, treatment preference, and the severity of the prolapsed bladder to determine which treatment is appropriate.
Pelvic Floor Exercises
Pelvic floor exercises can help strengthen the pelvic floor muscles and support the uterus. You can work with a pelvic floor physical therapist to create a custom exercise plan. Another great supplement to in-person physical therapy is an at-home program that can help keep you on track with your daily exercises. Every Mother's app-based proven program offers pelvic floor muscle training guided by pelvic PTs to help reduce symptoms while improving strength, and function in the core and pelvic floor.
Pessary Device
A pessary, a removable device inserted into the vagina, can support the bladder and alleviate symptoms of bladder prolapse. Different types and sizes of pessaries are available, and they need to be correctly fitted and regularly cleaned.
Hormone Replacement Therapy
Estrogen replacement therapy may be used for a prolapsed bladder to help the body strengthen the tissues in and around the vagina. Estrogen replacement therapy is not appropriate for everyone, it is important to consult with your physician when weighing the risks and benefits of any medication.
Prolapsed Bladder Surgery
Prolapsed bladder surgery is usually performed through the vagina, which aims to secure the bladder in its correct position. Severely prolapsed bladders (grade 3) that cannot be managed with a pessary usually require surgery to correct them.
It is important to discuss the potential risks, benefits, and expected outcomes of each treatment option with a healthcare provider specializing in pelvic floor disorders. They will guide you in making an informed decision based on your specific circumstances and preferences.
Common Questions About Bladder Prolapse
Can bladder prolapse be prevented?
While it may not always be possible to prevent bladder prolapse, certain measures can help reduce the risk. A few precautionary measures you can take to reduce your risk may include:
- Maintaining a healthy body weight
- Strengthening pelvic floor muscles via exercises, as found in the Every Mother program and or prescribed by a pelvic floor physical therapist
- Treating a chronic cough
- Treating constipation (having enough fiber in your diet and staying hydrated can help)
- Lifting properly and avoiding strain
Will bladder prolapse affect my ability to have sexual intercourse?
Bladder prolapse can cause discomfort or pain during sexual intercourse. However, with appropriate treatment and management, many individuals can resume a satisfying sexual relationship.
Can bladder prolapse recur after treatment?
Bladder prolapse can recur, especially if the underlying risk factors, such as chronic constipation or obesity, are not addressed. Following a healthy lifestyle, practicing pelvic floor exercises, and maintaining regular follow-up with your healthcare provider can help minimize the risk of recurrence.
Can I still have children if I have bladder prolapse?
It is generally recommended to address bladder prolapse before planning for pregnancy. Treatment options can be discussed with a healthcare provider, as they can provide guidance based on individual circumstances and desired family planning goals.
