Bladder prolapse, also known as cystocele, describes the condition that the bladder
drops out of its proper position and descends into the vagina. It occurs when pelvic
floor muscles weaken and cannot support the bladder. A prolapsed bladder can
cause problems such as urinary difficulties, discomfort and stress
Usually, the weakness or looseness of pelvic muscles is the result of aging and lack of estrogen. So, women in their menopause are more likely to develop this condition. Injury or childbirth can also cause the pelvic muscles to weaken. Bladder prolapse is more common among women with Hispanic and Asian descents, while African-American women have a reduced risk of having the disorder.
Based on how far the bladder drops into the
vagina, bladder prolapse is separated into 4 grades:
- Grade 1 (mild): Only a small part of the bladder drops into the
- Grade 2 (moderate): The bladder falls enough to be able to reach the
opening of the vagina.
- Grade 3 (severe): The bladder extends up to the vagina’s opening.
- Grade 4 (complete): The entire bladder protrudes completely outside
Risk factors that can weaken the pelvic
floor muscles and ligaments which support the bladder include:
- Pregnancy and childbirth
This is the most common cause of bladder prolapse. The delivery process puts stress on the vaginal tissues and muscles, which support a woman’s bladder.
Aging can lead to the weakening of the muscles.
Estrogen, a female sex hormone that helps
maintain the strength and health of supporting tissues in the vagina, is not
produced after menopause.
Previous pelvic surgery, such as removal of
the uterus, can weaken the pelvic muscles.
- Strenuous activity
Lifting heavy objects, straining during bowel movements, and forceful cough may cause strain in the pelvic muscle.
- Overweight and obesity
Being heavy weight is also one of the top
risks of developing bladder prolapse.
This may also put extra stress on the
pelvic floor muscles.
The most common symptom of bladder prolapse
is that you may notice extra tissue in your vagina, which feels a little bit
like a ball. Other signs and symptoms of a prolapsed
- Discomfort or pain in the pelvis
- Pressure or heaviness in the vaginal area
- Trouble urinating, like frequent urination or the urge to urinate
- A feeling that the bladder is not empty immediately after urinating
- Stress incontinence (urine leakage during sneezing or coughing)
- More frequent bladder infections
- Painful intercourse
- Low back or lower abdomen pain
For women in the mild grade (grade 1) of
bladder prolapse, they may not experience any symptoms.
Generally, methods that can help doctors
confirm the diagnosis of bladder prolapse include:
- Pelvic and perineal examination
Your doctor will inspect if the bladder
bulge into the vagina. Also, he or she will assess the muscle strength by
asking you to contract the pelvic muscle.
- Voiding cystourethrogram
During the test, the doctor will place a
catheter into the bladder through the urethra. The bladder is emptied and then
a sterile contrast (dye) is passed through the catheter into the bladder until
the bladder is full enough to void. Then, a series of X-ray films are taken
during bladder filling and during urination. This test can determine any
deformities and irregularities in the appearance and function of the bladder.
This is a non-invasive procedure done to
see the inside view of the urinary tract. Using a scope, the doctor can
determine if there are any abnormalities in the bladder, ureter and urethra.
- Urodynamics or video urodynamics
This test may be performed at the doctor’s
discretion. Urodynamics can help measure pressure and volume relationships in
the bladder and assess the function of the urethra.
Treatment for bladder prolapse can vary depending on what grade prolapse you have. Luckily enough, bladder prolapse is rarely a life-threatening condition. Most cases can be corrected non-surgically.
Nonsurgical treatment for bladder prolapse consists of:
- Conservative management, including behavioral therapy and pelvic floor muscle exercise
The goals of conservative treatment are to
reduce symptoms, prevent worsening pelvic organ prolapse, increase support for
the pelvic floor muscle and avoid or delay surgery.
- Mechanical device
For individuals who are too sick to have
surgery or who refuse surgery, they can choose a pessary. This is a device
(rubber ring) that is inserted into the vagina to hold the bladder in the
- Estrogen replacement therapy
This therapy helps the body strengthen the
muscles around the vagina. It can be administered orally as a pill or topically
as a patch or cream.
- Lifestyle changes
Your doctor may suggest that you avoid
lifting heavy objects. If you have chronic constipation, remedies to correct
this are also recommended.
In some cases, symptoms may continue and become more serious. At this time, surgery can be an option to relieve symptoms associated with bladder prolapse. Procedures that can be helpful include:
- Vaginal repair
In this surgery, the surgeon will lift the
bladder to its original normal position. It also includes taking off
unnecessary tissues and tightening layers of pelvic muscle and ligaments.
- Implanting mesh
Mesh is an implanted material used to
strengthen or reinforce pelvic muscles. However, patients should discuss the
risks and side effects, such as pain, infection or mesh erosion, with their
surgeon to decide the best course of treatment.
If the condition recurs, another surgery is needed. If prolapsed uterus occurs, the doctor may recommend removal of uterus or Hysterectomy. This procedure may help in relieving symptoms, but it prevents you to bear a child.
Keywords: bladder prolapse; cystocele; prolapsed bladder.