The urinary bladder is a hollow organ in the pelvis that stores urine. During urination, urine leaves the bladder and exits the body through the urethra. The vagina supports the front of the bladder in women. This wall can weaken with age or get damaged during vaginal childbirth. If weakness is significant, the bladder can prolapse (fallen bladder or bladder drop), and this is called bladder prolapse or cystocele.
Many patients may be asymptomatic in the early stages. Signs and symptoms of a prolapsed bladder depend on the extent and grade of prolapse. Patients can usually tell if their bladder has dropped when they face difficulty urinating, pain or discomfort, and stress incontinence (leakage of urine due to exertion or coughing, sneezing, and laughing), which are the most common symptoms of a prolapsed bladder. One of the early symptoms of a prolapsed bladder is the presence of tissue that feels like a ball in the vagina. Some common signs and symptoms of a prolapsed bladder include:
- Discomfort or pain in the pelvis, lower abdomen, and groin
- Lower back pain
- Protrusion of tissues from the vagina, which may cause pain and bleed
- Painful sexual intercourse
- Difficulty urinating
- Incomplete voiding (feeling of incomplete emptying of the bladder after urinating)
- Stress incontinence (leakage of urine due to exertion or coughing, sneezing, and laughing)
- Recurrent bladder infections presenting with fever, chills, painful urination, and cloudy urine
- Feeling increased pressure in the vaginal/genital area
What are the grades of bladder prolapse?
Prolapsed bladders are categorized into four grades based on the severity:
- Grade 1 (mild): Only a small portion of the bladder protrudes into the vagina. There are usually no symptoms at this stage and may be diagnosed only during routine examination by a doctor.
- Grade 2 (moderate): The prolapsed bladder reaches the opening of the vagina.
- Grade 3 (severe): The bladder protrudes out of the vaginal opening.
- Grade 4 (complete): The bladder completely protrudes outside the vagina. This may be associated with prolapse of other pelvic organs such as the uterus or rectum. It is usually seen in menopausal women.
What causes bladder prolapse?
Common causes of the prolapsed bladder are as follows:
- Childbirth is the most common cause of a prolapsed bladder. During a normal vaginal delivery, there may be damage to the muscles supporting the bladder causing bladder prolapse.
- Menopause: Decline in estrogen levels after menopause reduces the tone and strength of the pelvic muscles, which support the pelvic organs including the bladder.
- Excessive straining: Frequently lifting heavy objects due to work or weightlifting, chronic constipation, and chronic cough can damage and weaken the pelvic floor muscles.
- Obesity: Increased weight increases pressure over the abdomen and pelvis, weakening the pelvic floor muscles.
- Pelvic surgery: Surgery in the pelvis such as a hysterectomy (surgical removal of the uterus) can cause damage to the muscles of the pelvic floor).
How to treat bladder prolapse?
Women who have mild bladder prolapse without symptoms usually don’t require treatment. The doctor may advise regular follow-up and conservative measures such as exercises to strengthen the pelvic muscles and prevent worsening. You do not need to treat your prolapse if it is not causing distress.
Treatment options for bladder prolapse depend on the grade of the condition. A combination of medical treatment and exercises to strengthen the pelvic floor muscles, and lifestyle modifications may be needed.
Treatment options include:
- Behavioral techniques:
- Fluid and diet management: This includes reducing or avoiding alcohol, caffeine or acidic foods, and fluid consumption.
- Bladder training: This includes training the bladder to delay urination after having the urge to urinate. The patient could start by trying to hold off going to the bathroom for 10 minutes every time there’s an urge to urinate and gradually lengthening the time between going to the bathroom.
- Double voiding: This means to urinate and then waiting to urinate again after a few minutes.
- Pelvic floor muscle exercises: The pelvic floor muscles support the bladder. Strengthening the pelvic floor muscles by exercises recommended by the doctor can help manage urinary incontinence. These are also called Kegel exercises. The first step is to imagine that you're trying to stop the urinary flow and then contract or tighten the muscles to imaginarily stop urinating and hold the position for 2-10 seconds and then relax for 2-10 seconds. This should be performed at least thrice a day for a few minutes each time.
- Electrical stimulation: Electrodes can be temporarily inserted into the rectum or vagina to stimulate and strengthen pelvic floor muscles.
- Medications: Estrogen replacement therapy can help menopausal women.
- Surgery: Surgery may be performed through the vagina or abdomen. Surgical treatments include open surgery, minimally invasive surgery, laparoscopic surgery, and robot-assisted laparoscopic surgery.
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