Bladder prolapse

What is bladder prolapse?

A bladder prolapse (also called a cystocoele) develops when your bladder bulges into your vaginal wall.

A group of muscles called the pelvic floor supports your bladder, uterus (womb) and bowel and holds them in place. If your pelvic floor muscles become weak, these organs can bulge into the wall of your vagina.

The term ‘prolapse’ means ‘to fall out of place’.

What causes bladder prolapse?

The most common causes of bladder prolapse are pregnancy and childbirth. Bladder prolapse affects about half of all females who have had a baby, particularly those who have had a vaginal birth. Hormonal changes and the extra weight of pregnancy can weaken your pelvic floor muscles. These muscles can also be stretched or torn during a vaginal birth.

Your risk of bladder prolapse increases with each vaginal birth you have. This is particularly so if your labour was very long, if your baby was big or if you had a forceps or vacuum birth.

Other causes of bladder prolapse include:

• menopause and ageing — after menopause, you have lower levels of oestrogen, which maintains the strength of your pelvic floor muscles
• constipation and straining
• a chronic cough, such as from smoking or a lung problem
• being overweight
• repeated heavy lifting
• an inherited condition that causes a higher risk of prolapse
• previous pelvic surgery

What are the symptoms of bladder prolapse?

If your bladder prolapse is mild, you might not experience any symptoms. Your doctor or nurse might notice it when you have a cervical screening test.

If your bladder bulges further down your vagina, you may notice:

• pressure or a ‘dragging’ feeling in your vagina
• a lump that bulges out of your vagina — it may go away when you lie down and come back when you stand up
• difficulty passing urine, such as needing to strain or a flow that stops and starts
• a feeling that you have not fully emptied your bladder
• urinary incontinence (leaking urine)
• problems or pain during sexual intercourse
• frequent urinary tract infections

If you have bladder prolapse, you might also have bowel or uterine prolapse, where your bowel or uterus bulges into your vaginal wall.

How is bladder prolapse diagnosed?

Your doctor can diagnose bladder prolapse by asking about your symptoms and doing an internal examination with a speculum. This will help the doctor find out how severe the prolapse is, the condition of your pelvic floor muscles and whether your bowel or uterus have also prolapsed.

What tests will I need?

Your doctor may refer you for some tests, including:

• an ultrasound to look at your pelvis and to measure how much urine remains in your bladder after you urinate
• a bladder function (urodynamic) test for incontinence
• a urine test to check for infection

How is bladder prolapse treated?

There are different treatment options available. The treatment your doctor recommends will usually depend on how severe the prolapse is and how much it is affecting you.

If your symptoms are mild, they may improve with lifestyle changes and pelvic floor exercises. If your prolapse is severe you will probably need surgery. If your symptoms aren’t affecting your quality of life, you may choose not to have treatment. You might reconsider if your condition gets worse over time.

Lifestyle changes

Changes that can help include:

• losing weight if you are overweight
• quitting smoking
• treating constipation or chronic cough
• avoiding heavy lifting
• choosing low-impact exercise

Pelvic floor exercises

These are exercises that tighten your pelvic floor muscles and make them stronger. It’s best to see a pelvic floor physiotherapist to make sure you are doing them correctly.

Other non-surgical options

A pessary (a small plastic or silicone device) can be inserted high up into your vagina to provide support to the vaginal wall.

Oestrogen cream can make your vagina less dry and help prevent urinary tract infections.

Surgery

You might choose to have surgery if your symptoms are severe or other options have not worked. There are several different surgical procedures that can put your bladder back into place and provide support for it. If you need surgery, your doctor will discuss the best type for you.

Recovery usually takes around 6 weeks. You should avoid straining, heavy lifting, swimming, high-impact exercise and sexual intercourse while you recover.

Can bladder prolapse be prevented?

There are some things you can do that may help prevent prolapse:

• Do pelvic floor exercises every day.
• Avoid lifting children and heavy objects.
• Maintain a healthy weight to prevent extra stress on your pelvic floor.
• Eat foods rich in dietary fibre and drink 6 – 8 glasses of water every day to help prevent constipation and straining.
• Get some exercise every day. Include exercise that strengthens your core muscles and avoid high-impact exercise such as jumping and running.
• Avoid straining to pass urine or bowel motions. When you sit on the toilet, lean forward with your feet apart and take the time you need.

When should I see my doctor?

See your doctor if:

• you are experiencing troublesome symptoms
• you are concerned you may have bladder prolapse
• lifestyle changes and pelvic floor exercises are not helping your symptoms
• you have a chronic cough
• you have constipation