Bladder Prolapse

Bladder prolapse, or anterior vaginal prolapse, is one of the leading causes of urinary incontinence in women. The condition forces the bladder to drop from its normal position due to weakened pelvic floor muscles.

As pelvic floor support becomes compromised, weakened muscles can cause the bladder to slouch against the front wall of the vagina. A prolapsed bladder can obstruct the vaginal cavity, leading to issues such as loss of bladder control and an increased urge to pee. Many women with bladder prolapse face difficulties performing daily activities and intense exercise.

Don't let a prolapsed bladder cause emotional distress and limit your social life. This article can help you manage bladder prolapse symptoms by understanding its causes and treatment.

What Is Bladder Prolapse?

The word prolapse means "falling out of place." So if you have a bladder prolapse, you have a bladder falling out of place. Often referred to in the medical world as a cystocele, bladder prolapse tends to affect older women, especially those who have undergone pregnancy and vaginal childbirth.

The condition occurs when factors like childbirth or menopause cause the supportive tissue, ligaments, and pelvic floor muscles to become stretched or damaged. As a result, the hammock-like structure in the pelvic floor sags, pushing the bladder into the vagina.

You'll likely feel an increased pressure in your pelvic organs and vaginal area if you have a prolapsed bladder. In severe cases, you may feel or see a bulge in the vagina.

Not only can a prolapsed bladder be uncomfortable, but it can also exacerbate stress incontinence and impact your ability to empty your bladder fully. Without timely treatment, bladder prolapse symptoms can worsen and result in serious problems such as severe abdominal pain and urinary tract infections.

Where Does the Bladder Fall?

When the bladder falls out of place, it bulges or drops into the front wall of the vagina. Think of your pelvic floor as a support system. It's tasked with supporting the organs that lie on it, but sometimes it gets weakened or stretched.

Over time, these changes can lead to a drooping bladder and spontaneous urine leaks when you cough, run, or lift weights. The bulging sensation in your vagina often disappears when you lie down and comes back once you get up.

With bladder prolapse, the bulging organ often causes heaviness in your pelvic floor and can obstruct urine flow.

Causes of Bladder Prolapse

The pelvic floor muscles and ligaments generally offer ample support to hold the bladder in position. Any factors that weaken, stretch, or damage these vital supportive structures can force the bladder to drop into the vagina, resulting in urinary problems.

In short, anything that puts pressure on the pelvic floor can cause bladder prolapse. That means events, such as pregnancy, childbirth, and even repeatedly lifting a child, put you at risk. Other risk factors include:

• Carrying a little extra weight
• Smoking
• Coughing/Sneezing
• Certain exercises
• Constipation or straining on the toilet to empty the bowel or bladder
• Family history
• Having another type of pelvic prolapse

Menopause Can Also Cause Bladder Prolapse

Menopause brings about a lot of changes, and some of those changes impact your pelvic floor. Hormones, such as estrogen, help keep the vaginal muscles strong and flexible, but those levels typically drop during and after menopause. As a result, the support system that we call the pelvic floor lets the bladder ease into the vagina.

While there isn't much you can do to restore estrogen levels after menopause, you can take measures to boost the tone and strength of your pelvic structures. Performing regular Kegel exercises with your doctor's consent and adopting a healthy lifestyle may help you activate and enhance your pelvic floor muscles. Be sure to avoid severe exertion that can damage pelvic floor organs and supporting tissues. 

Bladder Prolapse Symptoms 

Bladder prolapse typically comes with some symptoms that are hard to ignore, so you may not know you have it, but you'll at least know something is wrong. Many women with bladder prolapse experience stress incontinence, which is when laughter, coughs, or other activities that put pressure on the bladder cause bladder leaks.

Another symptom is feeling like you need to pee even though you've just gone. The most common symptom with bladder prolapse, though, is feeling like there's a ball in your vagina. Other signs to look for include:

• Pelvic heaviness/fullness
• Frequent or urgent urination
• Feeling like something is falling out of your vagina
• Having a hard time starting a urine stream
• Pelvic and/or lower back discomfort
• Painful sex
• Inability to completely empty the bladder in more severe cases, including urinary retention

It's a good idea to schedule an appointment with your doctor for an internal pelvic examination if you're concerned. Doctors can identify the presence of lumps or damage in your pelvic area. Early diagnosis and treatment are imperative to restoring proper bladder support and function.

Diagnosis of Bladder Prolapse

If you think you're dealing with a prolapsed bladder, the best thing to do is talk to your primary care physician or a doctor who specializes in bladder health. They'll ask what your bladder prolapse feels like and perform various tests to rule out other conditions. Some of the most common tests are:

• Bladder scan: The medical professional will likely have you pee and then measure how much urine is left in the bladder afterward, such as post-void residual.
• Pelvic ultrasound: Your doctor can perform an ultrasound to check the area for masses or cysts and examine the bladder for residual fluid after urination.
• Mid-stream urine test: A urine test can help rule out any possible bladder or urinary tract infections.
• Voiding cystourethrogram: This x-ray exam allows your health care provider to see your bladder while peeing.
• Bladder function test: This test helps your doctor check for involuntary urine leakage often associated with bladder prolapse.

Bladder Prolapse Grading System

A grade will be assigned once tests are out of the way and bladder prolapse is confirmed. The grade is based on how far the bladder has dropped into the vagina, which also determines your condition's severity. The good news is although bladder prolapse can be unpleasant, it's not considered life-threatening. The grading system looks something like this:

• Grade 1: Mild. The bladder droops a little bit into the vagina. 
• Grade 2: Moderate. The bladder drops down low and is close to the vaginal opening.
• Grade 3: Severe. The bladder bulges out through the opening of the vagina.
• Grade 4: Complete. The entire bladder sits outside of the vagina's opening.

Grade 1 bladder prolapse typically presents mild discomfort in the pelvic floor or vagina. With Grade 2, 3, and 4 prolapses, you'll likely experience more severe symptoms, such as pressure in the vaginal walls and obstructed urine flow.

Treatments for Bladder Prolapse

The treatment for bladder prolapse depends on the severity of your case. For instance, someone with Grade 1 may have little to no symptoms. In this case, completing pelvic floor training exercises, managing weight loss, addressing constipation, and using a bladder leak product to catch drips might do the trick.

Moderate cases of bladder prolapse require more than self-help. Your doctor might refer you to a physiotherapist who will review how your pelvic floor currently functions and give you tips on exercises to strengthen those muscles. In some cases, a pessary ring is needed to support the bladder.

Surgery is a last resort and is usually recommended for those with a more severe prolapsed bladder. The technique used in surgery is based on the combination of prolapse and urinary symptoms. The most common procedures include either tape, tissue graft, or supportive mesh to hold the bladder in place.

Bladder sling surgery can also effectively treat bladder prolapse and stress incontinence for many patients. A bladder sling comprises thin, narrow straps anchored to the pubic bone to lift the bladder and urethra. These devices may effectively reduce pressure on the prolapsed organ, preventing it from falling into the vaginal wall.

The Bottom Line

If you're experiencing a bulge or you feel something falling into your vagina, then bladder prolapse might be the culprit. Most ladies, especially those over 50, will experience some type of pelvic prolapse as they get older. Fortunately, there's a lot you can do to manage bladder prolapse and combat issues associated with it, including urinary retention and incontinence.

With lifestyle changes, such as eating a fiber-rich diet and choosing low-impact exercise, you can help reduce the risk of bladder prolapse. You can help this condition by doing regular pelvic floor exercises and treating chronic coughs. Non-surgical solutions, such as vaginal pessaries, can support the prolapsed organ and help alleviate your symptoms.