The bladder sits in sort of a “hammock” of muscle and tissue inside your abdomen. When the tissue gets weak, the bladder can break through it and go into your vagina. Doctors call this bladder prolapse. It’s a common condition, and it’s treatable.
If you have a mild case, you may not even realize it. But if you do have symptoms, here’s what they might include:
- You feel pressure in your pelvis or vagina
- When you cough or lift something, you feel discomfort in your abdomen
- You have repeated bladder infections
- Your urine may leak out unexpectedly. Or, when you pee, the stream might be weak or take a long time.
- You might feel pain during sex
- You have trouble putting in tampons or applicators
- If you have an extreme case, tissue may bulge through the opening of your vagina. It might make you feel like you’re sitting on an egg.
The symptoms might be strongest if you have to stand for a while. When you lie down, they may ease.
When you discuss bladder prolapse with your doctor, she may call it by another name: cystocele.
Your doctor might also discuss a condition that affects the tube that carries urine from your bladder outside your body. It’s called the urethra, and it also can break through its support and into the vagina. When that happens, it’s called urethrocele. It is not unusual for it and cystocele to occur at the same time.
Should You Have Surgery?
If your symptoms are making your life difficult, surgery may be the answer. You need to think about a few things:
Your age. If you’re young, keep in mind that bladder prolapse can happen again. Even if you have surgery now, you may end up needing another operation down the road. If you’re older, any other health issues you have may affect your decision.
Your plans about having children. If you want more children, it’s best to hold off on surgery until you decide your family is complete.
Your general health. Surgery has some risks, such as infection, blood clots, or problems with the anesthetic. If you have a heart condition, diabetes, or breathing difficulties, any of these things could make an operation riskier. So could smoking or obesity.
Also, talk with your doctor about the chances that surgery could cause new problems. You might develop urinary incontinence -- urine leaking out without your control. Sex might become uncomfortable, and you might feel pain in your pelvis.
Types of Surgery
There are two types of surgery for bladder prolapse. The surgeon might:
Close off or narrow the vagina to create support for the bladder. This makes sexual intercourse impossible. Doctors call this obliterative surgery.
Build back the tissue that holds up the bladder. To do this, the surgeon might use the body’s own tissue or insert artificial mesh. Doctors call this reconstructive surgery.
Let’s look at reconstructive surgery more closely:
The surgeon has a few options. She might rebuild the support for the bladder by using your body’s own tissue. Or, she might insert a mesh and attach it to a bone. A mesh has risks though, including the chance that it may cause an infection or deteriorate over time. So doctors generally restrict it to special situations -- if a woman had previous surgery that failed, or if her own tissue is too weak to rebuild.
Depending on what the surgeon plans to do, she may work through a cut in your abdomen. That might involve a technique called laparoscopic surgery. For that, she makes very small cuts and uses special instruments through the openings. Or, instead of cutting into your abdomen, the surgeon might operate through the vagina.
If you have surgery, the medical team may put you to sleep. Or they may use a drug that makes only the affected part of your body numb.
After the Surgery
The time it takes to recover depends on what the surgeon does. For the first few weeks, you should avoid strenuous exercise and sexual intercourse. You’ll probably have to take a few weeks off from work.
Treatment without Surgery
As you think about surgery, you also should consider available therapies and treatments that don’t involve an operation.
Exercises might strengthen the muscles that help hold the bladder in place. They’re called Kegel exercises. To do them, you squeeze and release the muscles that cut off the flow of urine.
A device called a pessary might help support your bladder. This is a plastic or rubber ring that your doctor fits especially to you. It’s a common alternative to surgery, especially if surgery would be risky for you. Your doctor would show you how to clean it and put it back in place.
Estrogen therapy might help if you’ve already gone through menopause. Estrogen helps the muscles in the pelvis stay strong, but the body produces less of it after menopause. Replacing it with an estrogen cream, pill, or ring would make up for that loss.
A mild case of bladder prolapse may not need treatment at all. Your doctor might suggest that you just wait and see if the symptoms get worse.