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Bladder Prolapse

Bladder prolapse at a glance

  • Bladder prolapse (BP) occurs when the “hammock” of pelvic floor muscles that support the bladder weakens and the bladder drops (prolapses) out of its proper position.
  • Bladder prolapse, also called cystocele, commonly occurs in women due to age, injury or childbirth.
  • The main symptom of BP is tissue protruding in the vagina, which women describe as a feeling like a ball.
  • BP is categorized (graded) on a scale of 1 to 4, based on how far the bladder drops into the vagina.
  • Treatment ranges from lifestyle changes to medications and surgery.

What is bladder prolapse?

When pelvic floor muscles weaken the bladder can prolapse (drop) out of its proper position. As women age, the front vaginal wall that supports the bladder can weaken or loosen. If weakened, the bladder can prolapse, meaning it is no longer supported and descends into the vagina. A prolapsed bladder can cause problems such as urinary difficulties, discomfort and stress incontinence.

The bladder is one of five pelvic organs susceptible to prolapse, called pelvic organ prolapse (POP). About 40 percent of women experience POP. A complex structure of muscles, ligaments and skin holds the pelvic organs in place. Age, injury and childbirth are the most common reasons the pelvic organs prolapse.

Bladder prolapse cases are categorized into four grades according to the extent of the prolapse.

  • Grade 1 (mild): A small portion of the bladder drops into the vagina.
  • Grade 2 (moderate): Part of the bladder falls as low as the opening of the vagina.
  • Grade 3 (severe): The bladder sticks out through the vaginal opening.
  • Grade 4 (complete): The whole bladder protrudes outside the vagina; this often occurs along with prolapse of other pelvic organs.

Causes of bladder prolapse in women

Significant bodily stress from childbirth is the most common cause of bladder prolapse. When a baby is delivered, the process damages vaginal tissues and muscles, which support a woman’s bladder.

Bladder prolapse frequently occurs with menopause, when women’s bodies begin to produce less estrogen. The hormone estrogen strengthens muscles of and around the vagina, so when estrogen decreases with menopause, those muscles often weaken.

Any type of heavy straining such as lifting heavy objects, straining during bowel movements or long-term constipation can also damage important pelvic floor muscles, causing bladder prolapse.

Symptoms of bladder prolapse in women

Some women may not experience symptoms from a grade 1 (mild) prolapse. A bulge of tissue that can be seen or felt in the vagina is usually the first symptom women notice from a prolapsed bladder. Women also experience discomfort in the pelvis and trouble urinating, including frequent urination or the urge to urinate, and stress incontinence (urine leakage during coughing or sneezing). Other symptoms include:

  • Pressure and heaviness in the vaginal area
  • Pain in the lower back, vagina, groin and lower abdomen
  • Painful intercourse
  • Frequent bladder infections.

Treatment of bladder prolapse in women

Treatment depends on the grade of prolapse. Grade 1 prolapse usually requires no treatment because there is no pain or discomfort. Realistic lifestyle changes, such as frequent Kegel exercises and avoiding heavy lifting or straining, can also help.

There are nonsurgical and surgical treatments for more serious cases.

Nonsurgical options

A pessary is a device (rubber ring) that is inserted into the vagina to hold the bladder in the correct position. Because the pessary sits high in the vagina, day-to-day activities are possible and more comfortable.

Electrical stimulation targets the muscles inside the vagina or on the pelvic floor. A probe is attached to a device that delivers small electrical currents to the muscles. These contractions help the muscles by strengthening and activating them, which helps prevent the bladder from prolapsing.

Biofeedback is a sensor used to monitor vaginal muscle activity. This sensor helps doctors determine the best exercises for each patient that will strengthen the muscles supporting the bladder.

Hormonal therapy may be used to help the body strengthen the tissues in and around the vagina. Estrogen replacement therapy can be administered orally as a pill or topically as a patch or cream.

Surgical options

If needed, surgery can treat bladder prolapse by securing the bladder in its correct position. The procedure can be performed under a spinal or general anesthetic, as the surgeon makes an incision in the vagina, then places stiches in the tissue supporting the vagina. Stitches can be at the front or back walls of the vagina (or both) depending on the severity of prolapse.

Mesh, an implanted material used to strengthen or reinforce pelvic muscles, is another surgical option available to treat BP. However, patients should discuss the risks and side effects (pain, infection or mesh erosion) with their urologic surgeon when deciding the best course of treatment. The risks of placing mesh through the vagina to repair pelvic organ prolapse may outweigh its benefits, according to the Food and Drug Administration. However, the use of mesh may be appropriate in some situations. A surgeon can explain the risks, benefits, and potential complications of these materials in detail.