Also known as cystocele, a prolapsed bladder occurs when the bladder falls out of its anatomical position and protrudes into or through the vagina. There are varying degrees of this condition, with mild cases occurring when the bladder slightly drops into the vagina to severe ones when it visibly protrudes through the vulva. According to clinical data, vaginal child birth is the most common cause of bladder cystocele although the condition can also be caused by heavy lifting, obesity and even constipation.
The treatment methods adopted for each patient depend on how severe the prolapse is. They range from self care practices to surgical procedures. Bladder prolapse can be divided into 4 categories depending on how far the bladder drops into the vagina:
- Mild prolapse – only a small portion reaches the vagina.
- Moderate – the bladder is visible at the opening of the vagina.
- Severe – a portion of the bladder actually protrudes outside the vagina.
- Complete prolapse – the entire bladder completely protrudes out. This usually occurs when bladder prolapse is accompanied by other forms of pelvic organ prolapse (vaginal prolapse, bowel prolapse and uterine prolapse).
Bladder prolapse treatment options
Self care advice
Patients may not require any treatment for mild-moderate prolapse especially if it is not causing any discomfort and pain. Instead, they are usually advised to carry out the following self care procedures designed to help prevent the condition from worsening and improve it.
- Avoid standing for long and heavy lifting.
- Increasing dietary fiber intake by consuming more whole grain bread, vegetables, and fresh fruits.
- Losing weight (for patients with unhealthy body mass index).
- Performing pelvic floor exercises on a regular basis.
1. Pelvic Floor Exercises (Physical Therapy)
Pelvic floor muscles are the muscles used to control urine flow from the bladder. The bladder and the urethra are both surrounded by pelvic floor muscles. A prolapse is more likely to happen when these muscles are damaged or weak. According to recent clinical observations, performing pelvic floor exercises can reduce a mild prolapse and drastically reduce the odds of getting one among healthy individuals. To perform pelvic floor exercises, the patent has to sit in a comfortable position and flex the muscles 15 to 20 times in a row while breathing normally. The patient should avoid tightening the buttock, stomach and thigh muscles while flexing the pelvic muscles..
2. HRT (Hormone Replacement Therapy)
Some cases of bladder prolapse are associated with the onset of menopause. In this case, the muscles get weaker as the body’s hormone production starts falling. The doctor can suggest estrogen to improve the vaginal muscle. Hormone replacement therapy can help reduce some of the effects of prolapse such as vaginal dryness and increased discomfort during intercourse.
HRT can be administered as:
- a tablet inserted into the vagina
- a cream applied to the vagina
- a patch to stick onto the skin
- an implant under the skin.
A vaginal pessary is a ring-like device inserted into the vagina to hold back the prolapse. The rings are typically made of rubber (latex) or silicon and are available in a range of sizes and shapes. Vaginal pessaries are preferred when the prolapse is severe but the patient would not want to undergo surgery. The pessary is usually fitted by a specialist nurse or a gynecologist. It should be removed and a new one inserted every few months by a specialist.
Ring pessaries are known to cause irritation, vaginal discharge, sores and even bleeding. Other side effects are:
- Passing tiny amount of urine when sneezing, coughing or during exercise.
- An imbalance in the natural bacteria found in the vagina.
- The ring can interfere with sex. However, most women can have sex without experiencing any problems.
- Difficulties with bowel movements.
If, in the opinion of the health care professional, the benefits of surgery outweigh the risks , then it can be considered as a treatment option. The use of bladder prolapse surgery to treat various forms of pelvic organ prolapse is quite common and at least one out of every ten women undergo this surgery before they hit 80. The surgical procedure is aimed at repairing the tissue surrounding the vaginal opening. The procedure is actually quite simple; the bladder is pushed back up and the connective tissue between the vagina and the bladder is secured to ensure that the bladder remains in the right position. Sometimes, the surgeon has to remove any excess tissue surrounding the urethra and vaginal walls. In case the patients also suffers from urinal incontinence, the doctor has to provide sling support for the urethra or use bladder neck suspension.