Under normal conditions in women, the bladder is held in position by a “hammock” of supportive pelvic floor muscles and ligaments. When these muscles and tissues are stretched and/or weakened the back of the bladder can sag down and into the vagina resulting in bladder prolapse. In severe cases, the sagging bladder will appear at the vagina’s opening and can even protrude (drop) through it. Bladder prolapse can be very bothersome and be associated with other problems involving the lower urinary tract.
Prolapse can develop for a variety of reasons, but the most significant factor is stress on the muscles and ligaments during childbirth. Women who have multiple pregnancies or deliver vaginally are at higher risk of prolapse in the future. Other factors that can lead to prolapse can include; consistent heavy lifting, chronic coughing (or other lung problems), frequent constipation or straining to pass stool, obesity, menopause (when estrogen levels start to drop) and previous pelvic surgery.
Bladder Prolapse or Cystocele Signs & Symptoms
Mild cases of prolapse may not cause any symptoms or have minor symptoms that often go unnoticed. Symptoms associated with advanced prolapse can include frequent urination or the urge to urinate without urinating, stress incontinence (leaking when coughing, laughing or sneezing), frequent urinary tract infections, discomfort or pain in the vagina, heaviness or pressure in the vaginal area, painful intercourse or tissue protruding from the vagina.
Bladder Prolapse or Cystocele Diagnosis
Prolapse can usually be detected with a pelvic examination performed by your urologist and sometimes a cystourethrogram may be required for a more conclusive diagnosis. This test involves a series of X-Rays that are taken during urination that show the shape of the bladder and identify if there are any obstructions blocking the normal flow of urine.
Other testing that may be required for diagnosis involving other parts of the urinary tract include a urodynamic study, cystoscopy or fluoroscopy.
Bladder Prolapse or Cystocele Treatment
Behavior therapies such as Kegel exercises are normally the best option for mild cases of prolapse by re-teaching the muscles in the pelvic floor. More advanced cases can be treated with estrogen replacement therapy medications in conjunction with Kegel exercises. Surgery is the last option offered to patients with extreme prolapse cases that cannot be managed with other treatment options.