What is Prolapsed Bladder?

Prolapsed bladder, also known as fallen bladder or cystocele, is a condition where the bladder drops down from lack of support. A concave dome-shaped group of pelvic floor muscles and tissues hold the bladder and other organs in place. Due to a variety of reasons, these muscles and tissues can weaken over time. This causes the bladder to descend from its fixed position and slip downwards into the vagina, much like a big toe begins to rub, then protrude through an old, worn sock. In more severe cases, the bladder may dangle completely outside of the vagina.

What Causes Prolapsed Bladder?

• Childbirth: A difficult delivery, long labor, a large baby or multiple births are the most common causes. A baby’s eagerness or shyness to enter the world can be difficult on a woman’s vaginal tissues and muscles.
• Strain: Heavy lifting, straining during bowel movements, excessive or chronic coughing can weaken the pelvic floor muscles.
• Menopause: Once Mother Nature decides we’re done with babies and periods, the body no longer produces estrogen, which is vital in maintaining the health of vaginal tissue.
• Obesity: Excess weight also puts undue strain on pelvic muscles and tissues the same way carrying a sack of potatoes can strain the arms and back.

What are the Symptoms?

• A sensation of pressure in the bladder or vagina
• Leakage of urine when coughing, exerting oneself, sneezing, laughing, etc.
• Protrusion of tissue from the vagina that may bleed or be sore
• Frequent bladder infections
• A sensation that the bladder is not completely empty right after urinating
• Difficulty urinating
• Pelvic pain or discomfort
• Lower back pain
• Painful intercourse
• Incontinence during intercourse.

In cases where the bladder prolapse is mild, women may not experience any symptoms at all, and the condition may only be discovered during a routine examination.

When Should You See Your Doctor?

If you notice that you may have any of these symptoms and suspect a prolapsed bladder, you should see your doctor immediately. This condition often means that other pelvic organs may also be prolapsed, as the same muscles and tissues hold the uterus, cervix, vagina, rectum, and intestines in place as well. This is not a condition that repairs itself. It usually worsens over time, but it can be fixed thanks to many modern methods available today.

Diagnosis and Tests

In obvious cases, an examination of the pelvis and genitalia can visually confirm prolapsed bladder. If less evident, the doctor may use something called a Voiding Cystourethrogram to confirm diagnosis. This is a sequence of x-rays taken while the patient is urinating so that the physician can see the bladder shape and what may be causing flow problems. He may also request additional x-rays of different abdominal sections to eliminate other theories, after which he may test muscles, nerves and the force of the urine stream to conclude his diagnosis and recommend treatment. Additional tests, if necessary are:

• Cystoscopy: examines the bladder using a scope
• Urodynamics or Video Urodynamics: measures bladder pressure and volume
• Ultrasound: Uses sound waves that form an image
  Magnetic Resonance Imaging (MRI): Magnets and radio waves that produce images of soft internal tissues and organs.

Treatment

If tests confirm prolapsed bladder, your doctor will categorize its degree as mild, moderate, severe or complete. If it is mild, it usually requires no immediate treatment other than to refrain from heavy lifting or exertion.
For more serious cases, depending on health, age and other factors, some non-surgical treatments include:

• Pessary: A device placed into the vagina to hold the bladder in the correct position. He may also prescribe an estrogen cream to prevent vaginal wall degradation and infection. Just like dentures, pessaries need regular, thorough cleaning.
• Estrogen replacement therapy: Estrogen strengthens, maintains and preserves vaginal muscles.
• Electrical stimulation: Probes send small electrical currents to contract the muscles and strengthen them. Electrical stimulation can also be magnetically delivered from outside the body targeting the pudendal nerve to help with incontinence.
• Biofeedback: A sensor is used to check muscular contractions during exercise to make sure they are being done correctly and are being beneficial.

Surgery

Should you need surgery, one of the following may be recommended:

• Tension Free Vaginal Tape Surgery (TVT): A mesh tape placed under the urethra like a sling to keep it stable and in place.
• Retropubic Suspension Surgery: Abdominal surgery to lift sagging urethra and bladder neck.
• Electrical Stimulation: A series of sessions using a vaginal or anal electrode to aid stress and urge incontinence.
• Urethral Bulking: Injection of bulking agents (collagen, autologous substances) around the urethra to treat incontinence.
• Burch Colposuspension: Attachment of the vaginal wall to a ligament near the pubic bone.
• Urethral sling surgery: A sling that lifts the urethra to its correct position and to aid urine retention.
• Posterior Tibial Nerve Stimulation (PTNS): A small electrode introduced into the lower leg. The procedure decreases the need for frequent urination and requires several sessions.
• Sacral Nerve Stimulation (SNS): An electrical stimulator placed under the skin of the buttocks that sends pulses to the lower back nerve (sacrum) to aid with bladder control.
• Transobturator Tape Surgery (TOT): Similar to TVT with some small variations.

Types of Reconstructive Surgery

• Anterior and Posterior Colporrhaphy: Resuspension of rectum and bladder.
• Sacrohysteropexy: Repairs uterine prolapse by attaching the cervix to the sacrum with mesh.
• Sacrocolpopexy: Repairs vaginal vault prolapse by attaching the vaginal vault to the sacrum with mesh.

What Can You Do?

• Maintain a healthy weight.
• Eat fiber to prevent constipation.
• Don’t smoke. Chronic coughing contributes to bladder prolapse.
• Train your bladder by trying to maintain a regular schedule of set times for urination.
• Wear clothing you can remove easily if you suffer from frequent urination or overactive bladder.
• Do Kegels and strengthen your pelvic floor muscles.
• Cut back on tea, coffee and sodas that contain caffeine. Caffeine can have a diuretic effect.

Make an Appointment Today

Prolapsed bladder and its effects can be uncomfortable, restrictive and inhibit a normal lifestyle. Our board-certified OB/GYNs can address these issues so you can get back to living the life you deserve.

Call and make an appointment today at 770.720.7733 or request an appointment online.