Prolapsed Bladder

Bladder prolapse (cystocele), or a dropped bladder, is one type of pelvic organ prolapse. The supportive tissues that normally hold up the bladder become weak, and the bladder can drop or fall inside the pelvis. The bladder can then hang down and press into the vagina.

This condition is believed to affect at least half of people who have given birth, but it often occurs without any symptoms. Therefore, many more people may be living with a prolapsed bladder and not know it.

This article discusses the symptoms, causes, diagnosis, and treatment options for a prolapsed bladder.

What Are the Symptoms of a Prolapsed Bladder?

Many people live with cystocele without any symptoms at all. Generally, the worse the prolapse is (the farther down it falls), the more severe the symptoms. Symptoms of a prolapsed bladder include:

• A feeling of something falling out of the vagina
• Pressure inside or near the vagina
• Urinary control issues and incontinence (leakage)
• Trouble when starting to urinate (urinary hesitancy)
• Weak urine stream or incomplete bladder emptying (urinary retention)
• Sense of incomplete urination (feeling a need to void again right after using the toilet)

If the prolapsed bladder falls far enough, it can also affect sexual intercourse.

What Causes a Prolapsed Bladder?

The bladder can fall into the vagina for many reasons. It is supported by muscle and other tissue (pelvic floor muscles) inside the pelvis. Over time, pressure and strain can weaken these stabilizing tissues, and the bladder moves downward toward the vagina.

The pelvic floor can be overstretched or become weak for many different reasons, including:

• Pregnancy
• Having given birth, especially vaginally
• Ongoing (chronic) coughing
• Lifting heavy objects
• Having obesity
• Constipation
• Pelvic surgery
• Genetic factors
• Connective tissue disorders
• Older age

Increased pressure in the belly (abdominal cavity) increases the risk of developing a prolapsed bladder.

How Is a Prolapsed Bladder Diagnosed?

A healthcare provider can diagnose bladder prolapse. You may be referred to a urologist, a provider specializing in the urinary system or a urogynecologist, a gynecologist specializing in the pelvic floor and urinary tract. They will determine which tests and examinations are most helpful for understanding how your body is functioning.

Your visit may include:

• Giving a medical history (symptoms and bathroom patterns)
• A physical examination
• A pelvic examination
• Cystoscopy (a small camera inserted through the urethra to the bladder
• Imaging, such as X-rays, magnetic resonance imaging (MRI), and ultrasound
• A urodynamic study (assessing how the bladder and urethra function)
  

How Is a Prolapsed Bladder Treated?

Consult with a healthcare provider to discuss the risks and benefits of different treatment options for a prolapsed bladder.

Wait and Watch

Many people have a dropped bladder and no symptoms, so they do not seek treatment. Once your prolapsed bladder has been identified and diagnosed, you may elect to have a healthcare provider monitor your situation with regular exams.

Pelvic Floor Therapy

Some physical therapists specialize in pelvic floor therapy to help you gain better control over the muscles that support your bladder.

Kegel exercises are one type of pelvic floor therapy, but physical therapists trained in pelvic floor exercises have many more tools to help you improve.

For many people, pelvic floor therapy can help with the symptoms of a prolapsed bladder, but it does not restore the bladder to its original position or fix the prolapse.

Pessary

A nonsurgical treatment some people choose to have is called a pessary, small silicone tools inserted into your vagina and help support the bladder's position. A healthcare provider (usually a gynecologist) will help you to select the correct device during a pelvic exam.

Many types of pessary can be inserted and removed at home. A healthcare provider inserts other types that remain in place for several months. They will teach you how to insert, remove, and properly care for your device.

Surgery

There are two main kinds of surgery to treat a prolapsed bladder. A provider will discuss the different options.

• Colporrhaphy: The surgeon enters through the vagina, lifts the bladder back into place, and stitches the surrounding tissue to tighten the supporting structures. Some surgeons insert mesh near the vaginal wall to help support the bladder.
• Colpocleisis: The surgeon closes off the vagina (obliterates the opening) to help support the bladder in place. This surgery prevents future vaginal sexual intercourse.
  

What Is the Prognosis?

Most people live with bladder prolapse without symptoms and are never diagnosed. See a healthcare provider if you have pelvic pain, urinary incontinence, or other symptoms.

Once your bladder has fallen inside your belly, the only permanent fix is surgery. However, you may be able to manage the symptoms without surgery. If your prolapse is mild, ask your provider about steps you can take to slow or halt the progression of the prolapse. For some people, safe lifting techniques and other lifestyle changes may help.

If you have been diagnosed with cystocele, your provider will often categorize how far the bladder has fallen. Many different levels of treatment are available, and you should discuss your options.

How to Cope

A prolapsed bladder can be uncomfortable, causing pressure or a feeling that something is falling out of your vagina. Issues with voiding (urinating) can also be frustrating or may lead to infections or kidney disease complications.

Consult with a healthcare provider, such as a urologist or gynecologist, about your concerns. You provider will do their best to be straightforward and compassionate. You may be able to find some treatments that help manage your symptoms.