Definition

What is a prolapsed bladder?

The bladder is a hollow organ in the pelvis that stores urine. The pressure created when the bladder fills with urine is what causes the urge to urinate. During urination, the urine travels from the bladder through the urethra out of the body.

In women, the front wall of the vagina supports the bladder. This wall can weaken or loosen with age. Pregnancy and childbirth, as well as pelvic surgery such as a hysterectomy, can weaken this part of the vaginal wall, as well. If it deteriorates enough, the bladder can prolapse, meaning it is no longer supported adequately and descends into the vagina. This may trigger problems such as urinary difficulties, discomfort, and stress incontinence (urine leakage caused by sneezing, coughing, exertion, etc.). Other organs can also prolapse into the vagina, including the uterus, the small intestine, and the rectum (rectocele).

Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina.

  • Grade 1 (mild): Only a small portion of the bladder droops into the vagina.
  • Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.
  • Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
  • Grade 4 (complete): The entire bladder protrudes completely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele).

How common is a prolapsed bladder?

Prolapsed bladder is common — approximately 40% of women over 50 years of age will have pelvic organ prolapse, and approximately 10% will require surgery for pelvic organ prolapse and urinary incontinence (leakage of urine).

Please discuss with your doctor for further information.

Symptoms

What are the symptoms of a prolapsed bladder?

The first symptom that women with a prolapsed bladder usually notice is a feeling of pressure in the vagina or bladder.

Other symptoms of a prolapsed bladder include the following:

  • Discomfort or pain in the pelvis, lower abdomen, and when sitting
  • Tissue protruding from the vagina (The tissue may be tender and may bleed.)
  • Palpable bulge in the vagina
  • Difficulty urinating
  • A feeling that the bladder is not empty immediately after urinating (incomplete voiding)
  • Stress incontinence (urine leakage during sneezing, coughing, exertion, etc.)
  • More frequent bladder infections
  • Painful intercourse (dyspareunia)
  • Incontinence during intercourse
  • Low back pain
  • Some women may not experience or notice symptoms from a mild (grade 1) prolapsed bladder.

There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.

When should I see my doctor?

If you have any signs or symptoms listed above or have any questions, please consult with your doctor. Everyone’s body acts differently. It is always best to discuss with your doctor what is best for your situation.

Causes

What causes a prolapsed bladder?

Factors commonly associated with causing a prolapsed bladder are those that weaken the pelvic floor muscles and ligaments that support the bladder, urethra, uterus, and rectum, which can lead to detachment from the ligaments or pelvic bone where the muscles attach:

  • Pregnancy and childbirth: This is the most common cause of a prolapsed bladder. The delivery process is stressful on the vaginal tissues and muscles, which support a woman’s bladder.
  • Aging can lead to weakening of the muscles.
  • Menopause: Estrogen, a hormone that helps maintain the strength and health of supporting tissues in the vagina, is not produced after menopause.
  • Previous pelvic surgery: such as hysterectomy (removal of the uterus)

Risk factors

What increases my risk for a prolapsed bladder?

There are many risk factors for a prolapsed bladder, such as:

Diagnosis & treatment

The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.

How is a prolapsed bladder diagnosed?

An exam of the female genitalia and pelvis, known as a pelvic exam, is required in order to diagnose a prolapsed bladder. A bladder that has entered the vagina confirms the diagnosis.

For less obvious cases, the doctor may use a voiding cystourethrogram to help with the diagnosis. A voiding cystourethrogram is a series of X-rays that are taken during urination. These help the doctor determine the shape of the bladder and the cause of urinary difficulty. The doctor may also test or take X-rays of different parts of the abdomen to rule out other possible causes of discomfort or urinary difficulty.

After diagnosis, the doctor may test the nerves, muscles, and the intensity of the urine stream to help decide what type of treatment is appropriate.

A test called urodynamics or video urodynamics may be performed at the doctor’s discretion. These tests are sometimes referred to as “EKGs of the bladder”. Urodynamics measures pressure and volume relationships in the bladder and may be crucial in the decision making of the urologist.

Cystoscopy (looking into the bladder with a scope) may also be performed to identify treatment options. This test is an outpatient office procedure that is sometimes performed on a television screen so the person can see what the urologist sees. Cystoscopy has little risk and is tolerable for the vast majority of people.

How is a prolapsed bladder treated?

A mild (grade 1) prolapsed bladder that produces no pain or discomfort usually requires no medical or surgical treatment. The doctor may recommend that a woman with a grade 1 prolapsed bladder should avoid heavy lifting or straining, although there is little evidence to support this recommendation.

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. Treatment may include surgery and nonsurgical methods.

Nonsurgical treatments

  • Pessary: A pessary is a device that is placed within the vagina to hold the bladder in place. Pessaries must be removed and cleaned at regular intervals to prevent infection. Some pessaries are designed to allow the woman to do this herself. A doctor must remove and clean other types. Estrogen cream is commonly used along with a pessary to help prevent infection and vaginal wall erosion. Some women find that pessaries are uncomfortable or that they easily fall out.
  • Estrogen replacement therapy: Many women with prolapsed bladders may benefit from this therapy. Estrogen helps strengthen and maintain muscles in the vagina.

Prolapsed Bladder Surgery

Severe prolapsed bladders that cannot be managed with a pessary usually require surgery to correct them. Prolapsed bladder surgery is usually performed through the vagina, and the goal is to secure the bladder in its correct position. The bladder is repaired with an incision in the vaginal wall. The prolapsed area is closed and the wall is strengthened.

Depending on the procedure, surgery can be performed while the woman is under general, regional, or local anesthesia. For smaller surgeries, many women go home the same day of surgery.

Various materials have been used to strengthen pelvic weakness associated with prolapsed bladder.

The risks of placing mesh through the vagina to repair pelvic organ prolapse may outweigh its benefits, according to the FDA. However, the use of mesh may be appropriate in some situations. A surgeon should explain in detail the risks, benefits, and potential complications of these materials and he or she should explain about the procedure itself before proceeding with the surgery.

After surgery, most women can expect to return to a normal level of activity after six weeks. However, surgeons may recommend reducing or eliminating activities that cause straining for up to six months.

Other Therapy for Prolapsed Bladder

Physical therapy such as electrical stimulation and biofeedback may be used for a prolapsed bladder to help strengthen the muscles in the pelvis.

Electrical stimulation: A doctor can apply a probe to targeted muscles within the vagina or on the pelvic floor. The probe is attached to a device that measures and delivers small electrical currents that contract the muscles. These contractions help strengthen the muscles. A less intrusive type of electrical stimulation is available that magnetically stimulates the pudendal nerve from outside the body. This activates the muscles of the pelvic floor and may help treat incontinence.

Biofeedback: A sensor is used to monitor muscle activity in the vagina and on the pelvic floor. The doctor can recommend exercises that can strengthen these muscles. These exercises may help strengthen the muscles to reverse or relieve some symptoms related to a prolapsed bladder. The sensor can monitor the muscular contractions during the exercises, and the doctor may be able to determine if the targeted muscles would benefit from the exercises.

Lifestyle changes & home remedies

What are some lifestyle changes or home remedies that can help me manage a prolapsed bladder?

The following lifestyles and home remedies might help you cope with a prolapsed bladder:

  • Activity modification, such as avoiding heavy lifting or straining
  • Kegel exercises. These are exercises used to tighten the muscles of the pelvic floor. Kegel exercises might be used to treat mild-to-moderate prolapses or to supplement other treatments for prolapses that are more serious

To prevent a prolapsed bladder, a high-fiber diet and a daily intake of plenty of fluids can reduce a person’s risk of developing constipation. Straining during bowel movements should be avoided, if possible. Women with long-term constipation should seek medical attention in order to lessen the chance of developing a prolapsed bladder.

Obesity is a risk factor for developing a prolapsed bladder. Weight control may help prevent this condition from developing.

If you have any questions, please consult with your doctor to better understand the best solution for you.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: October 31, 2017 | Last Modified: October 31, 2017

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