Bladder Prolapse (Prolapsed Bladder or Cystocele) - Stages & Treatment

Bladder prolapse is a condition when the bladder that is held in place by the supporting muscles and tissues around it, falls down from its original place and sometimes into the vagina. This happens when the supporting muscles and tissues become weak due to various reasons such as lower production of estrogen, pregnancy, vaginal childbirth, trauma or injury to pelvic floor muscles etc.

In extreme cases, the vagina can protrude through the vaginal opening and the person may have to use her fingers to push it back inside. Bladder prolapse is not uncommon in women.

What are the symptoms of bladder prolapse?

1. A bulged feeling or a ball like feeling in the vagina
2. Discomfort or pain in pelvis region
3. Protrusion of bladder through the vagina
4. Problem passing urine or emptying bladder becomes a problem
5. Stress Urinary Incontinence – leakage of urine when the person coughs, sneezes etc
6. Frequent bladder infections
7. Painful or difficulty in having sex
8. Lower back pain.

What are the stages (grades) of cystocele or prolapsed bladder?

Depending on how far the bladder has fallen/prolapsed, cystocele is classified into 4 grades:

1. Grade I – Where only a small portion of the bladder drops into the vagina
2. Grade II – Cases where the fallen bladder is able to reach the opening of the vagina
3. Grade III – The bladder visibly protrudes out of the vaginal opening
4. Grade IV – Entire bladder is completely out of the vagina. This is usually associated with other pelvic organ prolapse such as uterine prolapse, rectocele or enterocele.

Women may have bladder prolapse after multiple vaginal child births or after they reach menopause. When a woman reaches menopause her body stops producing enough estrogen. Estrogen production is necessary to keep the pelvic muscles strong. In the absence of enough estrogen, the muscles become weak becoming incapable of holding the pelvic organs in their respective places.

What are the causes of bladder prolapse in women?

1. Incorrect ways of lifting weights. When you lift any weight, pressure must be on the legs but not on the abdomen or on lower back.
2. Long term cough or constipation. Putting continuous pressure in the pelvic area can break the tissues in the region making them weak.
3. Obesity or being overweight. Being overweight or obese also lays a lot of pressure in the pelvis region.
4. As mentioned previously, lowered production of estrogen makes the pelvic muscles weak.
5. Pregnancy and Childbirth. Tremendous amount of pressure is laid in the pelvic region as the foetus grows in the womb of the woman tearing many muscles and tissues. In case of multiple vaginal childbirths, the problem is multiplied by several times.
6. Pelvic Surgeries. Any surgery has its own risks. Similarly, when any of the organs in the pelvis is treated through a surgery that can result in weakening of muscles in the pelvis region.
7. Aging

Treatment options for cystocele

Treatment of cystocele depends on the cause.

1. If the bladder prolapse is due to aging or menopause, hormone replacement therapy may be given to the person. Synthetic estrogen helps the muscles stay stronger.
2. Lifestyle Changes may be advised to people who are obese or overweight including a regular regimen for workout.
3. Women with vaginal childbirths will be advised to undergo pelvic floor physical therapy and also workout regularly on strengthening their pelvic floor muscles.
4. A pessary may be provided to some women to support the bladder. Pessary has to be inserted through the vagina.
5. Surgical options include fixing the bladder in its place using artificial mesh like structures or by using the tissues from the same person’s body. How this procedure is performed depends on the expertise of the doctor. Different ways of surgeries include open surgery, minimally invasive surgery or laparoscopic or robot assisted laparoscopic.

What should you do when you see your bladder or anything protruding out of your vagina?

This should be a no-brainer. Talk to your gynecologist, if you have one or look for good gynecologists near you and get in touch as soon as possible. Before the symptoms worsen and the cystocele gets into grade III or grade IV, it is best to get the problem addressed/treated by a specialist. As it becomes difficult to pass urine, this can cause kidney infection or damage.

References:

1. https://www.urologyhealth.org/urology-a-z/b/bladder-prolapse-(cystocele)
2. https://www.webmd.com/women/guide/prolapsed-bladder