Do I need surgery for a prolapsed bladder?
Not necessarily. Prolapsed bladder treatment depends on the severity of the condition and whether a woman has symptoms. If a woman’s prolapsed bladder does not bother her, a healthcare provider may recommend only that she avoid heavy lifting or straining, which could worsen her prolapsed bladder. If a woman has symptoms that bother her and wants treatment, the health care provider may recommend pelvic muscle exercises, a vaginal pessary, or surgery.
Visit the Columbus Regional Health Surgical Services web page to learn more about robotic surgery and the types of procedures offered.
Below is an informational overview about the condition.
What is a prolapsed bladder?
A prolapsed bladder, also called a cystocele or dropped bladder, is the bulging or dropping of the bladder into the vagina. The bladder, located in the pelvis between the pelvic bones, is a hollow, muscular, balloon-shaped organ that expands as it fills with urine. During urination the bladder empties through the urethra, located at the bottom of the bladder. The urethra is the tube that carries urine outside of the body.
What causes a prolapsed bladder?
A prolapsed bladder occurs when the muscles and supportive tissues between a woman’s bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening. In a prolapsed bladder, the bladder tissue remains covered by the vaginal skin. A prolapsed bladder may result from damage to the muscles and tissues that hold the pelvic organs up inside the pelvis. A woman’s pelvic organs include the vagina, cervix, uterus, bladder, urethra, and small intestine. Damage to or weakening of the pelvic muscles and supportive tissues may occur after vaginal childbirth and with conditions that repeatedly strain or increase pressure in the pelvic area, such as
- repetitive straining for bowel movements
- constipation
- chronic or violent coughing
- heavy lifting
- being overweight or obese
Normal bladder position
Prolapsed bladder
A woman’s chances of developing a prolapsed bladder increase with age, possibly because of weakening muscles and supportive tissues from aging. Whether menopause increases a woman’s chances of developing a prolapsed bladder is unclear.
Need to schedule an appointment with a gynecologist?
What are the symptoms of a prolapsed bladder?
The symptoms of a prolapsed bladder may include
- a vaginal bulge
- the feeling that something is falling out of the vagina
- the sensation of pelvic heaviness or fullness
- difficulty starting a urine stream
- a feeling of incomplete urination
- frequent or urgent urination
Women who have a prolapsed bladder may also leak some urine as a result of movements that put pressure on the bladder, called stress urinary incontinence. These movements can include coughing, sneezing, laughing, or physical activity, such as walking. Urinary retention––the inability to empty the bladder completely––may occur with more severe prolapsed bladder if the cystocele creates a kink in the woman’s urethra and blocks urine flow.
Women with mild prolapsed bladders often do not have any symptoms.
How is a prolapsed bladder diagnosed?
Diagnosing a prolapsed bladder requires medical tests and a physical exam of the vagina. Medical tests take place in a health care provider’s office, an outpatient center, or a hospital. The healthcare provider will ask about symptoms and medical history. A healthcare provider uses a grading system to determine the severity of a woman’s prolapsed bladder. A cystocele receives one of three grades depending on how far a woman’s bladder has dropped into her vagina:
- grade 1—mild, when the bladder drops only a short way into the vagina
- grade 2—moderate, when the bladder drops far enough to reach the opening of the vagina
- grade 3—most advanced, when the bladder bulges out through the opening of the vagina
If a woman has difficulty emptying her bladder, a healthcare provider may measure the amount of urine left in the woman’s bladder after she urinates. The remaining urine is called the postvoid residual. A healthcare provider can measure postvoid residual with a bladder ultrasound. A bladder ultrasound uses a device, called a transducer, that bounces safe, painless sound waves off the bladder to create an image and show the amount of remaining urine. A specially trained technician performs the procedure, and a radiologist—a doctor who specializes in medical imaging—interprets the images. A woman does not need anesthesia.
A healthcare provider can also use a catheter—a thin, flexible tube—to measure a woman’s postvoid residual. The healthcare provider inserts the catheter through the woman’s urethra into her bladder to remove and measure the amount of remaining urine after the woman has urinated. A postvoid residual of 100 mL or more is a sign that the woman is not completely emptying her bladder. A woman receives local anesthesia.
A healthcare provider may use a voiding cystourethrogram—an x-ray exam of the bladder—to diagnose a prolapsed bladder as well. A woman gets a voiding cystourethrogram while urinating. The x-ray images show the shape of the woman’s bladder and let the health care provider see any problems that might block normal urine flow. An x-ray technician performs a voiding cystourethrogram, and a radiologist interprets the images. A woman does not need anesthesia; however, some women may receive sedation. A healthcare provider may order additional tests to rule out problems in other parts of a woman’s urinary tract.
Search for an OB/GYN specialist
How is a prolapsed bladder treated?
As mentioned earlier, prolapsed bladder treatment depends on the severity of the cystocele and whether symptoms are present. If symptoms are not bothersome, a healthcare provider may recommend only avoiding heavy lifting or straining, which could worsen the cystocele. If a woman has symptoms that bother her and requires treatment, the healthcare provider may recommend pelvic muscle exercises, a vaginal pessary, or surgery.
Pelvic floor, or Kegel, exercises involve strengthening pelvic floor muscles. Strong pelvic floor muscles more effectively hold pelvic organs in place. A woman does not need special equipment for Kegel exercises.
The exercises involve tightening and relaxing the muscles that support pelvic organs. A healthcare provider can help a woman learn proper technique.
A vaginal pessary is a small, silicone medical device placed in the vagina that supports the vaginal wall and holds the bladder in place. Pessaries come in a number of shapes and sizes. A healthcare provider has many options to choose from to find the most comfortable pessary for a woman.
Pessary device
Pessary inserted in the vagina
A healthcare provider may recommend surgery to repair the vaginal wall support and reposition the woman’s bladder to its normal position. The most common prolapsed bladder repair is an anterior vaginal repair—or anterior colporrhaphy. The surgeon makes an incision in the wall of the woman’s vagina and repairs the defect by folding over and sewing together extra supportive tissue between the vagina and bladder. The repair tightens the layers of tissue that separate the organs, creating more support for the bladder. A surgeon who specializes in the urinary tract or female reproductive system performs an anterior vaginal repair in a hospital. The woman receives either regional or general anesthesia. The woman may stay overnight in the hospital, and full recovery may take up to 4 to 6 weeks.
Eating, Diet, and Nutrition
Researchers have not found that eating, diet, and nutrition play a role in causing or preventing a prolapsed bladder.
Points to Remember
- A prolapsed bladder, also called a cystocele or dropped bladder, is the bulging or dropping of the bladder into the vagina.
- A prolapsed bladder occurs when the muscles and supportive tissues between a woman’s bladder and vagina weaken and stretch, letting the bladder sag from its normal position and bulge into the vagina or through the vaginal opening.
- Diagnosing a prolapsed bladder requires medical tests and a physical exam of the vagina.
- Prolapsed bladder treatment depends on the severity of the cystocele and whether a woman has symptoms.
This information originally appeared at the National Institute of Diabetes and Digestive and Kidney Diseases web site.