Under normal circumstances for women, the bladder is held in place by supportive pelvic floor muscles and tissue. The front wall of the vagina supports the bladder. This wall can weaken or loosen with age. Significant bodily stress such as childbirth can also damage this part of the vaginal wall. The bladder can drop and bulge through this layer and into the vagina when these tissues are stretched and weak. This results in bladder prolapse also called cystocele. In severe cases, the prolapsed bladder can appear at the opening of the vagina. Sometimes it can even protrude, and drop through the vaginal opening.
A prolapsed bladder may trigger problems such as urinary difficulties, discomfort, and involuntary urination, like, urine leakage caused by sneezing, coughing, or certain exercises. Fallen bladders are separated into four grades based on how far the bladder droops into the vagina:
Grade 1 is mild symptoms, only a small portion of the bladder droops into the vagina.
Grade 2 is moderate, where the bladder droops just enough to be able to reach the opening of the vagina.
Grade 3 is severe, this is where the bladder protrudes from the body through the vaginal opening.
Grade 4 is where the entire bladder protrudes outside the vagina, usually associated with other forms of pelvic organ prolapse like uterine prolapse, rectocele, and enterocele.
The prolapsed bladder can be caused by intense physical activity, like lifting heavy objects. Constipation or repeated muscle straining during bowel movements, as well as aging and a drop in the hormone estrogen. Estrogen helps to keep the muscles around the vagina strong, but women produce less estrogen as they enter menopause. Vaginal births may involve straining the muscles of the floor of the pelvis. During vaginal birth, the pelvic floor muscles undergo considerable stretching and strain.
Symptoms of a prolapsed bladder may include a feeling of fullness, heaviness, or pain in the pelvic area or lower back. This feeling may get worse when the person is standing, lifting, or coughing. Difficulty emptying your bladder, having to run to the bathroom frequently to pass urine, or just a feeling as if you have to go a lot. When you notice all these symptoms, you might wonder if you need surgery. The answer is no, you might not need surgery after all, as prolapsed bladder treatment depends on the severity of the condition and whether you experience all these symptoms.
If it’s not bothering you, a healthcare provider may recommend only avoiding heavy lifting or straining, which could worsen your prolapsed bladder. If a woman’s symptoms bother her and she wants treatment, the health care provider may recommend pelvic muscle exercises, a vaginal pessary, or surgery.
Pelvic floor or Kegel exercises involve strengthening the pelvic floor muscles, and you can do it yourself. Strong pelvic floor muscles more effectively hold pelvic organs in place. You do not need special equipment for Kegel exercises. These exercises involve tightening and relaxing the muscles that support pelvic organs. To do Kegels, sit in a comfortable position, close your eyes, and visualize the muscles that can stop urine flow. Tighten these muscles as much as possible. Hold this position for 3–5 seconds. It should feel as though the muscles are lifting up as a result of the squeezing. Release the muscles and rest for a few seconds and repeat this up to 10 times.
Avoid holding your breath. Rather, breathe freely during these exercises. Repeat the exercises three times a day. Maintain your focus, for best results, you need to focus on tightening only your pelvic floor muscles. Try and make Kegel exercises part of your daily routine. You can do Kegel exercises discreetly at just about any time, whether you’re sitting at your desk or relaxing on the couch. Some exercises may be too difficult for a person with a very weak pelvic floor. Performing the exercises may even weaken the muscles more. Until you’ve done several months of pelvic floor work, you should avoid the following exercises, situps with the legs held straight in the air, lifting heavy weights for minimal repetitions, double leg lifts, running, jumping, and other high-impact activities.
In more severe circumstances your doctor may recommend surgery to repair the vaginal wall that supports and reposition your bladder to its normal position. The most common prolapsed bladder repair is an anterior vaginal repair or anterior colporrhaphy. The surgeon makes an incision in the wall of the woman’s vagina and repairs the defect by folding over and sewing together extra supportive tissue between the vagina and bladder. The repair tightens the layers of tissue that separate the organs, creating more support for the bladder.
Although not life-threatening, a cystocele can have a negative impact on a woman’s quality of life. If it is not treated at all, the condition can continue to get worse. In the worst cases, you may be unable to urinate, which can cause kidney damage or infection. Bladder prolapse is common in women. The symptoms of bladder prolapse can be troublesome but can be treated. If you have symptoms, contact your doctor today to get the best advice.