Bladder Prolapse - Symptoms, Risk factors and Treatment

Bladder prolapse or anterior vaginal prolapse is a condition in which the urinary bladder falls from its normal position in the pelvis.

The urinary bladder is a hollow organ located in the pelvis which stores the urine. When it becomes full, the urge to urinate arises. 

What causes bladder prolapse?

In the pelvis, the urinary bladder is located in front of the vagina and the anterior wall of the vagina is responsible for supporting the bladder. The pelvic organs such as the urinary bladder, intestines, and uterus are strongly held in place by the pelvic floor- a group of muscles located at the base of the pelvis. 

When the pelvic floor becomes weak, it is unable to properly hold the organs in place, and it can result in organs dropping from the original location. When the urinary bladder drops from its normal place, bladder prolapse occurs.

Various causes can weaken the pelvic wall, such as:

Childbirth: Childbirth through a normal vaginal delivery is stressful for the pelvic floor muscles and is the most common cause of bladder prolapse.

Causes other than childbirth that weaken the pelvic floor can include:

• Lifting heavyweights
• Chronic constipation
• Chronic cough
• Aging
• Obesity
• Pelvic surgery
• Menopause

Menopause contributes to pelvic floor weakening due to a drop in estrogen levels. Estrogen is a hormone produced by the female body during the reproductive years, and it helps in maintaining the strength of the pelvic floor muscles. After menopause, estrogen levels start to decrease, which can weaken the pelvic floor and thereby contributing to bladder prolapse.

Symptoms of bladder prolapse:

The symptoms of bladder prolapse include:

• Feeling something like a ball in the vagina
• Pelvic pain
• Painful sexual intercourse (dyspareunia)
• Low back pain
• Trouble urinating
• Frequent urge to urinate
• A feeling of pressure on the vagina
• Tissue coming out of a vagina
• Feeling of incomplete emptying of bladder just after urinating (incomplete voiding)
• Leaking of urine during sneezing or coughing(stress incontinence)
• Increased infections of the bladder

Diagnosis of bladder prolapse:

Bladder prolapse can be diagnosed by a history and physical exam. For further evaluation, your doctor may suggest the following tests such as:

• Ultrasound
• X-ray
• MRI
• Cystoscopy
• Urodynamics

Treatment of bladder prolapse:

Bladder prolapse may not need any treatment at all in some cases. If treatment is needed, the options may include:

Pelvic floor muscle exercises: Exercises to strengthen the pelvic floor can help support the pelvic organs in place. Kegel exercises are usually recommended for strengthening the pelvic floor.

Pessary: A pessary is a ring-like device inserted in the vagina to help support the bladder. Pessary does not cure the actual prolapse but helps in relieving the symptoms. The pessary must be cleaned regularly as needed as it can increase the chances of infections.

If the above-mentioned strategies fail to provide relief, your doctor may suggest surgery to treat bladder prolapse.

Conclusion:

Bladder prolapse or cystocele is a condition in which the bladder drops down from its normal location. Sometimes, it may not need any treatment at all. If the condition becomes very bothersome, it can be treated with surgery. To prevent bladder prolapse, it is important to do exercises that strengthen the pelvic floor, especially if you have a history of one or more childbirths through vaginal delivery.