Bladder Prolapse - Causes, Symptoms, and Treatment

Introduction:

A urinary bladder is a sac-like organ that stores urine produced by the kidneys. The bladder is held in place by pelvic floor muscles and tissues in women. In pelvic prolapse, these tissues get stretched and become weak, leading to the bladder drop and bulge through this layer into the vagina. Bladder prolapse is also called a cystocele in women. It is more common in women as compared to men. The prolapsed bladder can be seen at the vaginal opening in rare incidences. It is a curable condition.

What Are the Causes of Bladder Prolapse?

Bladder prolapse can occur due to a couple of reasons.

• Vaginal delivery (the pelvic and ligaments' connection weakens due to chronic straining during childbirth).

• Lifting heavy objects.

• Lung conditions that involve too much coughing.

• Constipation.

• Obesity.

• Postmenopausal women are prone to bladder prolapse because they have less estrogen (female sex hormone). Estrogen keeps the vaginal muscles and tissues toned. After menopause, the vaginal tissues can become thinner and less elastic, allowing the bladder to bulge into the vagina.

• Previous pelvic surgery.

• Aging.

• Frequent straining while passing motion.

What Are the Stages of Bladder Prolapse?

There are various stages of bladder prolapse according to its severity. Commonly used grading for bladder prolapse includes:

Stage 1 - The bladder is a little into the vagina.

Stage 2 - The bladder protrudes far into the vagina and is close to the vaginal opening.

Stage 3 - The bladder protrudes out of the vagina.

Stage 4 - is the most severe form, where all the pelvic organs, including the bladder, protrude out of the vagina.

Nowadays, the pelvic organ prolapse quantification (POP-Q) system is used.

What Are the Symptoms of Bladder Prolapse?

The symptoms of bladder prolapse are:

• Heaviness in the pelvic area.

• A bulge in the vaginal area.

• Pain or pressure in the lower part of the belly or pelvic area.

• Lower back pain.

• Frequent occurrence of urinary tract infections.

• Frequent urge to urinate.

• Urine leakage.

• Incomplete bladder emptying.

• Pushing the bladder up into the vagina while passing urine or motion.

• Painful intercourse.

• Constipation.

• Difficulty while inserting tampons or vaginal applicators.

• Pelvic pressure gets worse with standing up, coughing, and lifting.

How Is Bladder Prolapse Diagnosed?

Bladder prolapse can be diagnosed with a clinical history and pelvic examination.

1. Pelvic Examination - The individual is examined while lying down or standing up. During an examination, the doctor looks for a tissue protrusion in the vaginal wall, indicating a pelvic organ prolapse. The person is then asked to put pressure as if passing the motion to check how much this influences the degree of prolapse. The individual is then asked to contract the pelvic floor muscles as if trying to stop the urine flow to test the strength of the muscles.

2. Urine and Bladder Testing - The individual is checked to assess how well the bladder empties in case of a substantial prolapse. Suppose one is retaining more urine in the bladder than average after passing urine. In that case, the doctor will run a couple of tests on the urine sample to find out the presence of a urinary tract infection.

3. A detailed medical history is taken to assess the severity of the prolapse.

4. Imaging tests such as:

• Cystoscopy.

• Urodynamics (a test of bladder function to evaluate the various types of incontinence).

• X-rays.

• A pelvic ultrasound is done to rule out the presence of any mass or cysts that might be putting pressure on the bladder.

• Magnetic resonance imaging (MRI) scan.

• A midstream urine test to exclude the presence of urinary tract infection.

How Is Bladder Prolapse Treated?

The bladder prolapse treatment depends on how much the prolapse bothers the individual and its stage. Based on the stages of the prolapse, a treatment plan can be chalked out. There are various ways to treat bladder prolapse; they are:

Treatment for Asymptomatic Bladder Prolapse:

Some women with bladder prolapse are symptomatic with no difficulty passing urine or motion, thus not requiring any treatment. Certain lifestyle modifications and physiotherapy can manage such cases.

1. Lifestyle Modifications -

• Weight loss.

• Management of constipation.

• Stop smoking.

• Correct position of sitting on the toilet.

• Avoiding heavy lifting objects.

• Getting treated for chronic cough and lung diseases.

2. Behaviour Therapy -

• Kegel exercises (exercises that help to strengthen pelvic floor muscles).

• Pelvic floor physical therapy.

Treatment for Symptomatic Bladder Prolapse:

There are other treatment procedures to be followed for symptomatic bladder prolapse, along with making some lifestyle changes, pelvic floor exercises, and chronic cough.

1.Non-surgical Approach -

• Vaginal Pessary: A pessary is a removable device mostly made of silicone. It is inserted within the vagina to give support to the bladder preventing its prolapse. Surgery is not needed to insert a pessary. A nurse or a gynecologist can do it. One requires a regular check-up if using a vaginal pessary for the long term.

• Drug Therapy: Estrogen replacement therapy is given to replace the female sex hormone or estrogen when the body stops making estrogen during menopause.

2.Surgical Approach -

Surgery is advised in a few cases when the other techniques fail. The type of surgery depends upon the kind of prolapse and the urinary tract symptoms. There are a few ways to perform the surgery.

• Open Surgery: When the incision is made through the abdomen.

• Minimally Invasive Surgery: This surgery uses more minor cuts in the abdomen.

• Laparoscopic Surgery: A small cut is made, and the surgery is carried out using a flexible wand with a video camera attached at one end.

• Robot-assisted Laparoscopic Surgery: Robotic instruments are placed through the abdominal wall and are controlled by the surgeon.

The recovery from the surgery takes around six weeks. The doctor would advise about how to take care of the patient during recovery and recommend a physiotherapist for various appropriate exercises.

How To Prevent Bladder Prolapse?

• Prevent Constipation - A high-fiber diet and enough hydration can help prevent constipation, thus lowering the risk of bladder prolapse.

• Avoid lifting heavy objects.

• Maintaining a healthy weight.

• Doing pelvic floor exercises.

• Getting treated for chronic cough.

Conclusion:

Bladder prolapse is a condition in which the supportive tissues around the bladder and vaginal wall become weak, allowing the bladder to drop or bulge into the vaginal canal. It is usually asymptomatic. It is a curable condition. However, if the prolapse is left untreated, it might remain the same or worsen with time. Severe prolapse might cause renal blockage or urinary retention in rare conditions, leading to kidney damage or infection. The prognosis of the condition is good, and it can be prevented by following certain lifestyle modifications.