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.
When to Seek Medical Care for a Prolapsed Bladder
Any woman who notices symptoms of a prolapsed bladder should see their doctor. A prolapsed bladder is commonly associated with prolapses of other organs within a woman’s pelvis. Thus, timely medical care is recommended to evaluate for and to prevent problematic symptoms and complications caused by weakening tissue and muscle in the vagina. Prolapsed organs cannot heal themselves, and most worsen over time. Several treatments are available to correct a prolapsed bladder.
Exams and Tests for a Prolapsed Bladder
An exam of the female genitalia and pelvis, known as a pelvic exam, is required in order to diagnose a prolapsed bladder. A bladder that has entered the vagina confirms the diagnosis.
For less obvious cases, the doctor may use a voiding cystourethrogram to help with the diagnosis. A voiding cystourethrogram is a series of X-rays that are taken during urination. These help the doctor determine the shape of the bladder and the cause of urinary difficulty. The doctor may also test or take X-rays of different parts of the abdomen to rule out other possible causes of discomfort or urinary difficulty.
After diagnosis, the doctor may test the nerves, muscles, and the intensity of the urine stream to help decide what type of treatment is appropriate.
A test called urodynamics or video urodynamics may be performed at the doctor's discretion. These tests are sometimes referred to as "EKGs of the bladder". Urodynamics measures pressure and volume relationships in the bladder and may be crucial in the decision making of the urologist.
Cystoscopy (looking into the bladder with a scope) may also be performed to identify treatment options. This test is an outpatient office procedure that is sometimes performed on a television screen so the person can see what the urologist sees. Cystoscopy has little risk and is tolerable for the vast majority of people.
Prolapsed Bladder Treatment
A mild (grade 1) prolapsed bladder that produces no pain or discomfort usually requires no medical or surgical treatment. The doctor may recommend that a woman with a grade 1 prolapsed bladder should avoid heavy lifting or straining, although there is little evidence to support this recommendation.
For cases that are more serious, the doctor takes into account various factors, such as the woman’s age, general health, treatment preference, and the severity of the prolapsed bladder to determine which treatment is appropriate.
Nonsurgical treatments for a prolapsed bladder include the following:
- Pessary: A pessary is a device that is placed within the vagina to hold the bladder in place. Pessaries must be removed and cleaned at regular intervals to prevent infection. Some pessaries are designed to allow the woman to do this themselves. A doctor must remove and clean other types. Estrogen cream is commonly used along with a pessary to help prevent infection and vaginal wall erosion. Some women find that pessaries are uncomfortable or that they easily fall out.
- Estrogen replacement therapy: Many women with prolapsed bladders may benefit from this therapy. Estrogen helps strengthen and maintain muscles in the vagina.
Prolapsed Bladder Care at Home
For mild-to-moderate cases of prolapsed bladder, the doctor may recommend activity modification such as avoiding heavy lifting or straining. The doctor may also recommend Kegel exercises. These are exercises used to tighten the muscles of the pelvic floor. Kegel exercises might be used to treat mild-to-moderate prolapses or to supplement other treatments for prolapses that are more serious.
Medications for Prolapsed Bladder
Estrogen replacement therapy may be used for a prolapsed bladder to help the body strengthen the tissues in and around the vagina. Estrogen replacement therapy can't be used by everyone (such as in people with certain types of cancer). Women’s bodies stop creating as much estrogen naturally after menopause, and the muscles of the vagina may weaken as a result. In mild cases of prolapsed bladder, estrogen may be prescribed in an attempt to reverse bladder prolapse symptoms, such as vaginal weakening and incontinence. For more severe degrees of prolapse, estrogen replacement therapy may be used along with other types of treatment.
Estrogen can be administered orally as a pill or topically as a patch or cream. The cream has very little systemic absorption and has a potent effect locally where it is applied. Topical administration has less risk than the oral preparations. The application of estrogens to the anterior vagina and urethral area may be very helpful in alleviating urinary symptoms, such as urgency and frequency, even in the face of prolapsed bladder.
Prolapsed Bladder Surgery
Severe prolapsed bladders that cannot be managed with a pessary usually require surgery to correct them. Prolapsed bladder surgery is usually performed through the vagina, and the goal is to secure the bladder in its correct position. The bladder is repaired with an incision in the vaginal wall. The prolapsed area is closed and the wall is strengthened.
Depending on the procedure, surgery can be performed while the woman is under general, regional, or local anesthesia. For smaller surgeries, many women go home the same day of surgery.
Various materials have been used to strengthen pelvic weakness associated with prolapsed bladder.
The risks of placing mesh through the vagina to repair pelvic organ prolapse may outweigh its benefits, according to the FDA. However, the use of mesh may be appropriate in some situations. A surgeon should explain in detail the risks, benefits, and potential complications of these materials and they should explain about the procedure itself before proceeding with the surgery.
After surgery, most women can expect to return to a normal level of activity after six weeks. However, surgeons may recommend reducing or eliminating activities that cause straining for up to six months.
Other Therapy for Prolapsed Bladder
Physical therapy such as electrical stimulation and biofeedback may be used for a prolapsed bladder to help strengthen the muscles in the pelvis.
Electrical stimulation: A doctor can apply a probe to targeted muscles within the vagina or on the pelvic floor. The probe is attached to a device that measures and delivers small electrical currents that contract the muscles. These contractions help strengthen the muscles. A less intrusive type of electrical stimulation is available that magnetically stimulates the pudendal nerve from outside the body. This activates the muscles of the pelvic floor and may help treat incontinence.
- Biofeedback: A sensor is used to monitor muscle activity in the vagina and on the pelvic floor. The doctor can recommend exercises that can strengthen these muscles. These exercises may help strengthen the muscles to reverse or relieve some symptoms related to a prolapsed bladder. The sensor can monitor the muscular contractions during the exercises, and the doctor may be able to determine if the targeted muscles would benefit from the exercises.
Follow-up for Prolapsed Bladder
A woman undergoing treatment should schedule follow-up visits with their doctor to evaluate progress. Pessaries need to be removed and cleaned at regular intervals to prevent complications.
Prolapsed Bladder Prevention
To prevent a prolapsed bladder, a high-fiber diet and a daily intake of plenty of fluids can reduce a person’s risk of developing constipation. Straining during bowel movements should be avoided, if possible. Women with long-term constipation should seek medical attention in order to lessen the chance of developing a prolapsed bladder.
Heavy lifting is associated with prolapsed bladder and should be avoided, if possible.
Obesity is a risk factor for developing a prolapsed bladder. Weight control may help prevent this condition from developing.
Outlook for a Prolapsed Bladder
A prolapsed bladder is rarely a life-threatening condition. Most cases that are mild can be treated without surgery, and most severe prolapsed bladders can be completely corrected with surgery.
Media file 1: Line drawing indicating the relationship between the kidney, ureters, and bladder.