Bladder Prolapse

What Is a Bladder Prolapse?

The bladder is a balloon shaped, muscular bag that sits comfortably within the pelvis as it constantly fills with urine. The muscular front walls of the vagina (anterior walls) and the pelvic area help to support the bladder and hold it in place. If the muscles in the front wall of the vagina loosen and deteriorate too much, then a bladder prolapse can occur, where the bladder falls into the vagina.

A bladder prolapse causes the pressure inside the bladder to increase, causing discomfort and urinary incontinence. We’ve all experienced what it feels like to have a full bladder, with nowhere to empty it, and how it no longer sits comfortably within the pelvis. Urinary incontinence can range from occasional stress urinary incontinence, where women may leak a small amount of urine if they cough or sneeze, to a more severe inability to hold in urine.

A bladder prolapse is a common condition in women. It can be disruptive, embarrassing and inconvenient, but it is treatable.

As with most medical problems, it’s important not to put off treatment. Allowing your prolapse to go untreated for a long period of time leads to weakened pelvic muscles and damage to associated nerves - increasing the risk of recurrence. So avoid unnecessary delays and speak to your doctor if you have any concerns.


Types of Bladder Prolapse

There are three different types of bladder prolapse, cystocele, urethrocele, and cystourethrocele. These can occur in isolation or together:

  • Cystocele - The most common type of pelvic organ prolapse, when the whole bladder bulges or drops into the vagina. Cystocele is commonly associated with the prolapse of other organs within the pelvis.
  • Urethrocele - When the tissues surrounding the urethra (the tube that carries urine from the bladder and out of the body) prolapse, or drop down into the vagina.
  • Cystourethrocele - Both the bladder and the urethral tissues prolapse into the vagina together.

What Are the Stages of a Bladder Prolapse?

A bladder prolapse is diagnosed by a doctor or surgeon, and can occur in three stages, or grades:

  • Stage 1 – The bladder has dropped only a short distance into the vagina, and bladder prolapse symptoms are mild.
  • Stage 2 – The bladder has dropped a further distance into the vagina, and has reached the outer opening of the vagina. Bladder prolapse symptoms are moderate.
  • Stage 3 – The bladder has dropped so sufficiently into the vagina, that it begins to protrude out through the outer opening of the vagina. Bladder prolapse symptoms become the most advanced they can get.

What Are the Symptoms of a Bladder Prolapse?

There are many symptoms that accompany a bladder prolapse. In the early stages of a prolapsed bladder, they may even be unnoticeable. The following warning signs are common and can be experienced as very mild to severe, you may also only experience a few of these symptoms:

  • a heaviness or a feeling of pressure in the vagina
  • a feeling that there is something inside and/or falling out of the vagina
  • visible tissue poking out from the vagina that is tender and/or bleeds
  • a frequent urge and/or an urgent need to pass urine
  • difficulty urinating, not feeling like your bladder has fully emptied after passing urine
  • urinary incontinence – the inability to hold urine in when not on the toilet
  • stress incontinence – passing small amounts of urine when coughing, sneezing, laughing, exercising or lifting heavy weight
  • Nocturia – the medical term for getting up more than once during the night to pass urine
  • discomfort and pain when urinating
  • frequent bladder or urinary infections such as cystitis
  • pain during sex
  • pain in the lower back, pelvis or groin

With the number of different prolapse conditions and their close proximity to each other in the body, it can be difficult to know which symptoms point to which condition. Visiting your doctor to get a diagnosis is important, and can help you decide which course of treatment is best for you.


What Causes a Bladder Prolapse?

The bladder and / or the urethral tissue can prolapse into the vagina if the pelvic floor muscles are weakened. These can be weakened by several factors:

  • Pregnancy – Extra weight on the pelvic floor can cause the muscles to weaken.
  • Childbirth – Again, around 50% of women who give birth vaginally will experience some level of prolapse. A large baby or a difficult birth where you’ve had to push a lot or forceps were used may increase your risk. More than one birth also increases your risk of experiencing a vaginal prolapse. Mothers who deliver four babies vaginally are at 12 times greater risk than women who have not given birth vaginally.
  • Menopause – The change in hormones you experience during this time of your life, particularly the drop in oestrogen, can cause your pelvic floor muscles to weaken. Effects can be worsened by the general loss of muscle tone associated with ageing.
  • Body weight – Being overweight or obese can increase your chances of suffering a pelvic organ prolapse due to the weight on your pelvic area.
  • Persistent coughing – Constant heavy coughing can add pressure to the pelvic floor. If you smoke and have a persistent smokers cough or if you have a lung condition that results in a cough, such as asthma or bronchitis, then you could be at a higher risk.
  • Heavy lifting – Repeated and incorrect heavy lifting puts extra pressure on your pelvic floor.
  • Constipation – Continued straining to pass a stool will put extra pressure on the pelvic floor, and could cause it to weaken.
  • Hysterectomy – Many women who have had a hysterectomy (the complete removal of the womb and cervix) suffer a secondary prolapse. The uterus provides support for the other pelvic organs, if it is no longer there, then the bladder can gradually fall towards the vaginal opening.
  • Previous pelvic surgeries – A hysterectomy or previous vaginal prolapse surgery can weaken the pelvic floor muscles, and is likely to be part of the cause of any future pelvic organ prolapses.
  • Medical conditions – Medical conditions that weaken the pelvic floor muscles, such as joint hypermobility syndrome (the ability to manoeuvre joints into unusual positions).

How Can I Prevent a Bladder Prolapse?

There are a few steps you can take to prevent a prolapsed bladder. These are all good practices to carry out, whether you’re worried about developing a bladder prolapse or not. Even if you’re young and haven’t had children, these steps can be added to your daily routine that your future self will thank you for:

  • Kegel exercises – Also known as pelvic floor exercises, Kegel exercises are simple and quick to do and can easily be slotted into your day. No one will even know you’re doing them! Kegel exercises are essential in preventing existing prolapses deteriorating further.
  • Maintain your weight – Excess weight is not only unhealthy for your heart, being overweight can put extra pressure on your pelvic floor muscles and cause, or worsen, a bladder prolapse. The National Institute for Heath and Care Excellence (NICE) recommend keeping your BMI under 30.
  • Avoid constipation – Constant straining can weaken your pelvic floor muscles, cause haemorrhoids and anal bleeding. Eat well and stay hydrated so that your bowel movements are regular. A high fibre breakfast will help. You can also use a toilet stool to bring your knees up and force you into the ideal posture for fully eliminating your bowels when you’re on the toilet.
  • Lift heavy weights safely – Lifting correctly will make all the difference to not only your back, but your pelvic area too. The National Health Service (NHS) suggest holding the load close to your waist and avoid bending your back.
  • Have good posture, even when sitting down - Walk tall and sit tall; no slouching at your desk or in the car. Remember BBC – Bum to the Back of the Chair.

If you do have a prolapsed bladder, or you have had one, you can help prevent it from getting worse, or returning, by doing the following:

  • Wearing a vaginal pessary – A vaginal pessary will help to better support even severely prolapsed bladders. It’s a small device, usually made from silicone, that is placed inside the vagina to help support the vaginal wall and keep the bladder in place. Different shapes and sizes of vaginal pessaries suit different shapes and sizes of women; your doctor can help you find the right one.
  • Avoiding high impact exercise – High impact exercise puts increased pressure on the pelvic floor, especially troublesome if you suffer with stress incontinence. Stick to low impact, prolapse friendly workouts, such as swimming and road cycling.
  • Using a pelvic toner – The Kegel8 Ultra 20 Pelvic Toner features a programme specifically developed with prolapse in mind. Depending on the severity of your bladder prolapse, it can help reduce your symptoms and improve your bladder prolapse within 12 weeks by strengthening your pelvic floor muscles.

What Treatments are Available for a Bladder Prolapse?

Your prolapsed bladder treatment very much depends on the severity of your condition. Many minor cases will not require treatment, and following the tips above can help prevent it from becoming a bladder prolapse that does.

  • Non-surgical prolapsed bladder treatment - Kegel exercises using weighted vaginal cones to strengthen your pelvic muscles, and electronic pelvic toners with specific prolapsed bladder exercise programmes, may be all the treatment you need. Losing weight can also help significantly, as can wearing a vaginal pessary. In some menopausal women, oestrogen replacement therapy can also help. These non-surgical treatments are often preferred, particularly when future children are desired, which may reduce the success of previous surgical procedures.
  • Surgical prolapsed bladder treatment – There are circumstances when you might need surgical intervention for your prolapsed bladder; such as when non-surgical treatments do not fully relieve the symptoms and they remain severe. Procedures involve surgically repairing the vaginal wall and placing the bladder back into its natural position within the pelvic cavity. The most common surgical prolapsed bladder treatment is called an ‘anterior vaginal repair’. Your surgeon repairs the walls of the vagina by stitching the folded tissues onto themselves, to make them stronger. Some surgeries use synthetic or biological mesh as added support to weakened muscle. The use of synthetic mesh in these surgeries is currently only recommended within the context of research, as current evidence into the safety of the procedure is insufficient. Surgery is considered as an option only when symptoms are severe and cannot be treated through other means, as there is a risk of further damage in the case of complications. It is important to note that surgery is unable to repair the pelvic floor muscles, so you will need to perform pelvic floor exercises after your recovery to prevent the prolapse from returning and to support any synthetic or biological mesh from stretching which could lead to a prolapse reoccurring.

To learn more about what treatments are available, visit the Prolapse Treatment page.


How Long Does It Take to Recover from Bladder Prolapse Surgery?

Surgical bladder prolapse treatment can either be carried out under a local anaesthetic or a general anaesthetic. You may need an overnight stay in hospital, but should be fully recovered in four to six weeks. It is important to remember that every women is different and will recover at different speeds. You can improve your recovery by eating well to avoid constipation, not smoking, and following your doctors advice on completing pelvic floor exercises.

If you do opt for surgery, it is important to note that surgery cannot repair your pelvic floor muscles. You will need to perform pelvic floor exercises after you recover from your surgery, to prevent the prolapse from recurring and to support any synthetic or biological mesh from stretching. Other non-surgical treatments should also be followed to prevent future prolapses; such as eating well to avoid constipation, and maintaining a healthy weight.


Sources

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