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Bladder Prolapse (Cystocele/Fallen Bladder)

Are you a woman experiencing discomfort or a bulging in the vaginal area, problems with urination and/or painful intercourse? Then perhaps your bladder has shifted out of its normal position. Read on to learn more about bladder prolapse and what treatments are available.

What is bladder prolapse?

Under normal conditions in women, the bladder is held in position by a "hammock" of supportive pelvic floor muscles and ligaments. When these muscles and tissues are stretched and/or weakened, the back of the bladder can sag through this layer of muscles and ligaments and into the vagina, resulting in bladder prolapse, also referred to as a cystocele. In severe cases, the sagging bladder will appear at the vagina's opening and can even protrude (drop) through it. Bladder prolapse can be very bothersome, can be associated with problems emptying the bladder, urinary tract infections or incontinence (unwanted loss of urine), and can usually be corrected.

What causes bladder prolapse?

Prolapse can develop for a variety of reasons, but the most significant factor is stress on this supportive "hammock" during childbirth. Women who have multiple pregnancies or deliver vaginally are at higher risk. Other factors that can lead to prolapse include: heavy lifting, chronic coughing (or other lung problems), constipation, frequently straining to pass stool, obesity, menopause (when estrogen levels start to drop) and previous pelvic surgery.

What are the symptoms for bladder prolapse?

Symptoms associated with prolapse include: frequent urination or urge to urinate; stress incontinence; not feeling bladder relief immediately after urinating; frequent urinary tract infections; discomfort or pain in the vagina, pelvis, lower abdomen, groin or lower back; heaviness or pressure in the vaginal area; painful intercourse; or tissue protruding from the vagina that may be tender and/or bleeding. Mild cases of prolapse may not cause any symptoms.

How is bladder prolapse detected?

Prolapse can usually be detected with a pelvic examination. However, a voiding cystourethrogram may be required. This test involves a series of X-ray pictures that are taken during urination which will show the shape of the bladder and will help identify obstructions blocking the normal flow of urine. Other X-rays and tests may also be required to find or rule out problems in other parts of the urinary system, including urodynamics, cystoscopy and fluoroscopy.

What are the treatment options for bladder prolapse?

For mild prolapse cases, behavior therapies such as Kegel exercises (which help strengthen pelvic floor muscles) may be enough. Other treatments for more advanced cases can include estrogen replacement therapy, and a pessary (vaginal support device) to provide better support for the organs. Surgery is usually required for bothersome cases that cannot be managed with a pessary.

If prolapse is left untreated, over time the condition may get worse. In rare cases, severe prolapse can cause urinary retention (inability to urinate) which may lead to kidney damage or infection.

 

For more information, see Loss of Bladder Control (Bladder Proplapse).

Reviewed January 2011

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Bladder Prolapse Glossary
  • abdomen: Also referred to as the belly. It is the part of the body that contains all of the internal structures between the chest and the pelvis.

  • bladder: The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.

  • bladder prolapse: When the bladder slips out of its correct position.

  • chronic: Lasting a long time. Chronic diseases develop slowly. Chronic renal (kidney) failure may develop over many years and lead to end-stage renal (kidney) disease.

  • constipation: A condition in which a person has difficulty eliminating solid waste from the body and the feces are hard and dry.

  • continence: The ability to control the timing of urination or a bowel movement.

  • cyst: An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.

  • cystocele: Fallen bladder. When the bladder falls or sags from its normal position down to the pelvic floor. It can cause either urinary leakage or urinary retention.

  • cystoscopy: Also known as cystourethroscopy. An examination with a narrow, flexible tube-like instrument passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.

  • cystourethrogram: Also called a voiding cystogram. A specific X-ray that examines the urinary tract. A catheter (hollows tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body)and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The X-rays will show if there is any reverse flow of urine into the ureters and kidneys.

  • estrogen: Female hormone produced by the ovaries.

  • estrogen replacement therapy: Also known as ERT. Use of the female hormone estrogen to replace that which the body no longer produces naturally after medical or surgical menopause.

  • fluoroscopy: Imaging technique that takes a real time "movie" of the body.

  • groin: The area where the upper thigh meets the lower abdomen.

  • incontinence: Loss of bladder or bowel control; the accidental loss of urine or feces.

  • infection: A condition resulting from the presence of bacteria or other microorganisms.

  • ions: Electrically charged atoms.

  • kidney: One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.

  • liver: A large, vital organ that secretes bile, stores and filters blood, and takes part in many metabolic functions, for example, the conversion of sugars into glycogen. The liver is reddish-brown, multilobed, and in humans is located in the upper right part of the abdominal cavity.

  • menopause: The time in a woman's life when menstrual periods permanently stop.

  • obstruction: something that obstructs, blocks, or closes up with an obstacle

  • pelvic: Relating to, involving or located in or near the pelvis.

  • pelvic examination: Assessment of the inner organs of the pelvis by vaginal examination.

  • pelvic floor muscles: The hammock or sling of muscles in the pelvic floor that normally assists in maintaining continence by supporting the pelvic organs (bladder, uterus and rectum).

  • pelvis: The bowl-shaped bone that supports the spine and holds up the digestive, urinary and reproductive organs. The legs connect to the body at the pelvis.

  • pessary: A specially designed object worn in the vagina to hold the bladder in its correct position and prevent leakage of urine. Pessaries come in many shapes and sizes.

  • prolapse: The protrusion or dropping of the uretus (uterine prolapse), rectum (rectocele) or bladder (cystocele) into the vagina.

  • retention: In ability to empty urine from the bladder, which can be caused by atonic bladder or obstruction of the urethra.

  • stool: Waste material (feces) discharged from the body.

  • stress incontinence: Also referred to as stress urinary incontinence. The most common type of incontinence that involves the leakage of urine caused by actions--such as coughing, laughing, sneezing, running or lifting--that put pressure on the bladder from inside the body. Can result from either a fallen bladder or weak sphincter muscles.

  • tissue: Group of cells in an organism that are similar in form and function.

  • urge: Strong desire to urinate.

  • urinary: Relating to urine.

  • urinary retention: Failure to empty the bladder totally.

  • urinary tract: The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.

  • urinary tract infection: Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.

  • urinate: To release urine from the bladder to the outside. Also referred to as void.

  • urination: The passing of urine.

  • urine: Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.

  • urodynamics: The study of the storage of urine within and the flow of urine through and from the urinary tract.

  • urodynamics: A series of tests that measures the bladder's ability to hold and release urine.

  • vagina: The tube in a woman's body that runs beside the urethra and connects the uterus (womb)to the outside of the body. Sometimes called the birth canal. Sexual intercourse, the outflow of blood during menstruation and the birth of a baby all take place through the vagina.

  • vas: Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

  • void: To urinate, empty the bladder.

  • voiding: Urinating.

  • voiding cystourethrogram: Also referred to as VCUG or voiding cystogram. A specific X-ray that examines the urinary tract. A catheter (hollows tube) is placed in the urethra (tube that drains urine from the bladder to the outside of the body)and the bladder is filled with a liquid dye. X-ray images are taken as the bladder fills and empties. The X-rays will show if there is any reverse flow of urine into the ureters and kidneys.

Bladder Prolapse Anatomical Drawings

click images for a larger view
 

 

 

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