Bladder prolapse: do you suffer from it? Here's what you need to do

By Cristiano Antonino On Jun 14, 2023

Women suffering from bladder prolapse may complain of various symptoms ranging from a feeling of discomfort in the pelvic area after standing for a long time, to bladder dysfunction such as urinary incontinence or difficulty emptying the bladder completely during urination

For a correct diagnosis it is necessary to consult your gynecologist.

Obviously not all cases of cystocele are of the same severity, so even the resolution of the problem can require simple muscle strengthening exercises up to surgery.

What is meant by bladder prolapse

Bladder prolapse consists in the dislocation (sliding) of the bladder into the vagina due to a weakening of the structures of the pelvic wall and in particular of the band between the bladder and the vagina (vesico-vaginal band).

This weakening occurs following significant traumas, such as that of childbirth; or for hormonal variations, such as those that occur in menopause; or following surgery (e.g. hysterectomy). Women are therefore the most affected subjects.

Cystocele, depending on its severity, can be classified into three different grades (other classifications also exist):

Mild or first degree cystocele. In this case only a small part of the bladder prolapses into the vagina, therefore the patients are mostly asymptomatic or complain of mild symptoms.
Moderate or second degree cystocele. In this case the bladder slides towards the bottom of the vagina. Symptoms in this case are more common and could affect the patient’s quality of life.
Severe or third-degree cystocele. It is the most serious form of prolapse and is symptomatic; in this case the damage to the vesicovaginal band is such as to allow the bladder to protrude completely into the vagina and protrude externally through the genital lips.

What are the causes

Bladder prolapse, as already mentioned, has the weakening of the pelvic floor as its main cause; by pelvic floor we mean the set of muscles, ligaments and connective tissue found in the pelvic cavity, below in the abdominal cavity.

These structures play a fundamental role, as they support the organs present in this anatomical site: not only the bladder but also the uterus, urethra, and rectum.

There may be a certain genetic predisposition to cystocele, therefore it is easier to suffer from it if there is a certain family history.

However, traumas are mainly responsible for the deterioration of the pelvic floor structures, up to their rupture.

Among the causes of trauma we find mainly:

Natural childbirth: the muscles of the pelvic area, in fact, after childbirth must regain tone and elasticity. Therefore, women who have given birth multiple times are most at risk.
Pregnancy: the weight of the baby and the increase in the size of the uterus put pressure on the structures of the pelvic floor causing them to weaken.
Heavy lifting: especially when done incorrectly, it can put some pressure on the pelvic floor and predispose to cystocele.
Aging and menopause: the reduced estrogen production that occurs during this phase of life is associated with a reduced resistance of the connective tissue of the pelvic floor.
Chronic constipation: Excessive straining during bowel movements weakens the muscles and connective tissue of the pelvic floor.
Hysterectomy: Surgery can make the pelvic floor more fragile contributing to the increased risk of bladder prolapse.
Obesity or overweight.
Cough in chronic bronchitis.

Bladder prolapse symptoms and associated diseases

The symptoms are different depending on the severity of the prolapse.

Especially the mild forms, sometimes the moderate ones, are not associated with any symptoms, so much so that many women do not even know they suffer from them.

Other moderate forms, and always the severe ones, are instead associated with disabling disorders and affecting the quality of life including:

Pain or a feeling of pressure in the pelvic area, especially when standing for many hours.
Difficult or incomplete bladder emptying, with an increase in the number of urinations per day.
Urinary incontinence.
Continuous urinary urgency.
Difficulty having sex and pain during intercourse.
Reduction of vaginal sensitivity, which can often lead to the impossibility of reaching orgasm.

Recurring urinary tract infections

In any case, even in the presence of mild symptoms, it is recommended to consult your gynecologist.

Furthermore, the presence of a weaker pelvic floor could be associated with an increased risk of uterine prolapse.

Diagnosis

It is always recommended to consult a gynecologist (or a urologist) in case of suspected bladder prolapse; no symptom should be underestimated.

After a careful anamnesis, the gynecologist will go on to the objective examination with vaginal exploration, verifying the condition of the woman’s bladder both in supine position and in standing position.

During the visit, the doctor may ask the patient to contract the pelvic muscles in order to control the strength of the muscles themselves.

In addition, laboratory and radiological tests can sometimes be recommended, which are useful for staging the disease and excluding any complications.

Between these:

Urinary cystourethrography: this is a radiographic examination that uses a contrast medium; allows you to observe the shape of the bladder and possibly the incomplete emptying of the bladder during urination. The procedure could be a little annoying due to the need to introduce the contrast medium directly into the bladder
Other imaging techniques: for example ultrasound and resonance, which allow you to make a more complete anatomical study of the area of interest.
Urinalysis: required in cases where the patient reports symptoms suspicious for urinary tract infection; the doctor may also request a urine culture in association with the urine test to evaluate the prescription of suitable antibiotic drugs.
Specific questionnaires: the questions will focus on the sensation of pain and how much the symptoms affect the patient’s daily life.

The risks

Patients with cystocele are not life threatening at all, however their quality of life is reduced.

Furthermore, in the absence of correct treatment, bladder prolapse is destined to worsen significantly, and therefore the related symptoms will also be more severe, frequent and disabling.

Prevention of bladder prolapse

Although in some cases, such as natural childbirth, it is not possible to eliminate the risk factors of bladder prolapse, correct pelvic floor training and some healthy daily habits can help prevent it.

Kegel exercises can be performed to strengthen the muscles in the area.

As far as everyday life is concerned, it is good to follow a diet rich in fiber to avoid constipation, lift weights correctly, avoid smoking to prevent chronic cough and bronchitis and lose weight in cases of overweight or obesity.

How to treat bladder prolapse

Treatment of cystocele depends on how severe it is and whether there are associated conditions – for example, uterine prolapse.

In the event of a mild cystocele, it will be sufficient to use the preventive measures described: in this way, the prolapse will be prevented from increasing and affecting the quality of life.

If the situation worsens, it is advisable to resort to the specific treatments indicated by your gynecologist or urologist.

Nonsurgical treatments, such as estrogen therapy or a pessary, tend to be used initially.

The latter is a ring made of flexible material such as rubber or silicone that must be inserted deeply into the vagina, at the level of the posterior fornix, in such a way as to mechanically support the bladder and prevent its prolapse.

Obviously, the doctor will instruct the patient on the right way to insert it and how best to clean it.

However, these treatments may fail. In this case, or where the cystocele was already severe or associated with uterine prolapse, the specialist doctor could indicate surgery.

The operation consists in bringing the bladder back to its normal anatomical location, then “repairing” the portion of lacerated tissue using various strategies.

The operation is not free from complications and unfortunately the cystocele could recur after years.

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