Bladder prolapse, also known as cystocele, is a common condition where the bladder drops from its normal position and bulges into the vagina. It’s a type of pelvic organ prolapse (POP), which occurs when the muscles and tissues that support the pelvic organs weaken or stretch. While it can affect women of any age, it’s particularly prevalent after childbirth and during menopause.
What Causes Bladder Prolapse?
The pelvic floor acts like a hammock, supporting the bladder, uterus, and rectum. When this support system weakens, organs can descend. Several factors contribute to this weakening:
- Childbirth: Vaginal delivery, especially with multiple births, large babies, or prolonged pushing, can stretch and damage pelvic floor muscles and connective tissues.
- Aging and Menopause: Estrogen, a hormone that helps maintain the strength and elasticity of pelvic tissues, decreases significantly during menopause. This can lead to tissue weakening.
- Chronic Strain: Conditions that repeatedly put pressure on the pelvic floor can contribute to prolapse. These include:
- Chronic coughing (e.g., from asthma or smoking)
- Chronic constipation and straining during bowel movements
- Heavy lifting
- Obesity
- Genetics: Some women may have a genetic predisposition to weaker connective tissues.
- Prior Pelvic Surgery: Hysterectomy, while not a direct cause, can sometimes alter pelvic support and contribute to prolapse later on.
Signs and Symptoms of Bladder Prolapse
The symptoms of bladder prolapse can vary depending on the severity. Some women may have mild prolapse and experience no symptoms, while others may have significant discomfort and impact on their daily lives. Common symptoms include:
- Vaginal Bulge or Pressure: Feeling a sensation of something “falling out” of the vagina, or seeing a bulge. This often worsens by the end of the day or after prolonged standing.
- Urinary Problems:
- Difficulty emptying the bladder completely
- Frequent urination
- Urinary urgency (a sudden, strong need to urinate)
- Stress urinary incontinence (leaking urine when coughing, sneezing, laughing, or exercising)
- Recurrent bladder infections
- Pelvic Discomfort: A feeling of heaviness or aching in the pelvis.
- Sexual Dysfunction: Discomfort or pain during intercourse.
- Difficulty with Bowel Movements: In some cases, a severe cystocele can affect bowel function.
Managing Bladder Prolapse: Treatment Options
Treatment for bladder prolapse depends on the severity of your symptoms, your overall health, and your personal preferences.
Conservative Management (for mild to moderate prolapse):
- Pelvic Floor Muscle Exercises (Kegel Exercises): Strengthening these muscles can improve support for pelvic organs. A pelvic floor physical therapist can provide guidance on proper technique.
- Lifestyle Modifications:
- Weight Management: Losing excess weight reduces pressure on the pelvic floor.
- Avoiding Heavy Lifting: Use proper lifting techniques if heavy lifting is unavoidable.
- Managing Chronic Cough: Address underlying causes of chronic cough (e.g., allergies, asthma, smoking cessation).
- Preventing Constipation: Increase fiber and fluid intake, and avoid straining during bowel movements.
- Pessaries: These are removable devices, often made of silicone, that are inserted into the vagina to provide support for the prolapsed organs. They come in various shapes and sizes and are fitted by a healthcare professional. Pessaries are a good option for women who want to avoid surgery or are not candidates for it.
Surgical Management (for more severe prolapse or when conservative measures fail):
- Anterior Colporrhaphy (Bladder Lift): This is a common surgical procedure where the weakened tissue between the bladder and vagina is repaired and strengthened, pushing the bladder back into place.
- Sacrocolpopexy: In cases involving multiple prolapsed organs or significant vaginal vault prolapse (after hysterectomy), synthetic mesh or native tissue may be used to suspend the vagina and other pelvic organs to the sacrum (tailbone). This can be performed open, laparoscopically, or robotically.
- Uterine Preservation Surgery: For women who wish to retain their uterus, various surgical techniques can lift and support the uterus.
Living with Bladder Prolapse: Prevention and Self-Care
While not always preventable, you can reduce your risk and manage symptoms with these strategies:
- Regular Pelvic Floor Exercises: Make Kegel exercises a part of your daily routine.
- Maintain a Healthy Weight:
- Eat a Fiber-Rich Diet: To prevent constipation.
- Practice Good Posture:
- Avoid Smoking: Smoking contributes to chronic cough and can weaken connective tissues.
- Seek Prompt Treatment for Chronic Cough:
Bladder prolapse can be an uncomfortable and sometimes embarrassing condition, but it’s important to remember that it’s common and treatable. If you are experiencing symptoms, don’t hesitate to speak to your Urologist. They can provide an accurate diagnosis and discuss the best management plan for you, helping you regain comfort and improve your quality of life.