The bladder is a hollow organ in the pelvis that stores urine. The pressure created when the bladder fills with urine is what causes the urge to urinate. During urination, the urine travels from the bladder and out the body through the urethra.
In women, 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. If it deteriorates enough, the bladder can prolapse, meaning it is no longer supported and descends into the vagina. This may trigger problems such as urinary difficulties, discomfort, and stress incontinence (urine leakage caused by sneezing, coughing, and exertion, for example).
Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina.
- Grade 1 (mild): Only a small portion of the bladder droops into the vagina.
- Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.
- Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
- Grade 4 (complete): The entire bladder protrudes completely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele).
Prolapsed bladders are commonly associated with menopause. Prior to menopause, women’s bodies create the hormone estrogen, which helps keep the muscles in and around the vagina strong. Women’s bodies stop creating as much estrogen after menopause, and those muscles tend to weaken as a result.
Causes of a Prolapsed Bladder
The following factors are commonly associated with causing a prolapsed bladder:
- Childbirth: This is the most common cause of a prolapsed bladder. The delivery process is stressful on the vaginal tissues and muscles, which support a woman’s bladder.
- Menopause: Estrogen, a hormone that helps maintain the strength and health of muscles in the vagina, is not produced after menopause.
- Straining: Lifting heavy objects, straining during bowel movements, having a long-term condition that involves coughing, or having long-term constipation may damage the muscles of the pelvic floor.
Symptoms of a Prolapsed Bladder
The first symptom that women with a prolapsed bladder usually notice is the presence of tissue in the vagina that many women describe as something that feels like a ball.
Other symptoms of a prolapsed bladder include the following:
- Discomfort or pain in the pelvis
- Tissue protruding from the vagina (The tissue may be tender and may bleed.)
- Difficulty urinating
- A feeling that the bladder is not empty immediately after urinating (incomplete voiding)
- Stress incontinence (urine leakage during sneezing, coughing, or exertion)
- More frequent bladder infections
- Painful intercourse (dyspareunia)
- Low back pain
Some women may not experience or notice symptoms of a mild (grade 1) prolapsed bladder.