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What is Bladder Prolapse?

Most of the time, the bladder is held in place by a "hammock" of supportive pelvic floor muscles and tissue in women. Bladder prolapse happens when these tissues are stretched and become weak, the bladder can drop and bulge through this layer and into the vagina.

Bladder prolapse may also be called cystocele. Bladder prolapse is common in women. The symptoms of bladder prolapse can be bothersome, and in rare cases the prolapsed bladder can appear at the opening of the vagina.

Prolapse can be treated, but some women have bladder prolapse and are not bothered by it.

Symptoms

The most common symptom is the feeling of a bulge in the vagina that you can see or feel.

Other signs and symptoms related to prolapse:

  • frequent voiding or the urge to pass urine
  • urinary incontinence (unwanted loss of urine)
  • not feeling at ease right after voiding
  • frequent urinary tract infections
  • pain in the vagina, pelvis, lower belly, groin or lower back
  • feeling extra weight or pressure in the vaginal area
  • painful sex
  • tissue sticking out of the vagina

Some cases of prolapse may not cause any symptoms or pain.

Causes

Prolapse can happen for many reasons. We know a major cause is stress on this supportive "hammock" when giving birth. Women who have many pregnancies, deliver vaginally, or have long or difficult childbirth are at higher risk.

Other factors that can lead to prolapse are:

  • heavy lifting
  • too much coughing (or other lung problems)
  • constipation
  • frequent straining to pass stool
  • obesity
  • menopause (when estrogen levels start to drop)
  • prior pelvic surgery
  • aging

Diagnosis

Prolapse can be found with a clinical history and a pelvic exam. The exam may be done while you are lying down, straining or pushing, or standing. Your doctor will exam your prolapse at this time.

Other tests and imaging studies may also be done to check the pelvic floor, such as:

  • cystoscopy
  • urodynamics
  • x-rays
  • ultrasound
  • MRI

Treatment

Ways to Manage Bladder Prolapse may involve:

1. No treatment. Some women have bladder prolapse and do not have bothersome symptoms. You do not need to treat your prolapse if it is:

  • not causing you problems
  • not blocking your urine flow

2. Behavior therapy. This can include:

  • kegel exercises (which help strengthen pelvic floor muscles)
  • pelvic floor physical therapy
  • a pessary (a vaginal support device)

3. Drug therapy. This includes:

  • estrogen replacement therapy

Surgery

The goal of surgery is to repair your body and improve the way you feel. Surgery can be performed through the vagina or the abdomen. There are several ways the surgery can be done, they include:

  • Open surgery- when an incision (cut) is made through the abdomen
  • Minimally invasive surgery- uses small incisions (cuts) in the abdomen
  • Laparoscopic- the doctor places surgical instruments through the abdominal wall
  • Robot-assisted laparoscopic- robotic instruments are placed through the abdominal wall. They are attached to robotic arms, and are controlled by the surgeon.

Before having surgery you should talk with your surgeon. You should learn about the risks, benefits, and other choices/options available. It is of great value to give informed consent to your doctor. This can best be done after your doctor has answered all of your questions.

Make sure to seek treatment if you are experiencing any of the signs of symptoms of prolapse.

Article Updated - April 2020