Bladder prolapse, also known as cystocele, occurs when the tissue between a woman's vaginal wall and bladder weakens and stretches. This causes the bladder to bulge into the vagina. Prolapsed bladder is often associated with menopause. Estrogen helps keep the muscles in and around the vagina strong, and after menopause, you don’t create as much of this. The four grades associated with this condition are:
- Grade 1 (mild): Only a small portion of the bladder droops into the vagina.
- Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.
- Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.
- Grade 4 (complete): The entire bladder protrudes entirely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele).
- A feeling of fullness or pressure in your pelvis and vagina
- Increased discomfort when you strain, cough, or lift
- A sense that you haven't completely emptied your bladder after urinating
- Repeated bladder infections
- Pain or urinary leakage during sexual intercourse
- In severe cases, a bulge of tissue that protrudes through your vaginal opening and may feel like sitting on an egg
Symptoms are especially noticeable after standing for extended periods of time and often go away when you lie down.
- Pregnancy and vaginal childbirth: This is the most common cause because the delivery process is very stressful on vaginal tissues and muscles.
- Being overweight or obese
- Repeated heavy lifting
- Straining with bowel movements
- A chronic cough or bronchitis
- Childbirth: Women have a higher risk of anterior prolapse if they have vaginally delivered one or more children.
- Aging: Your risk of anterior prolapse increases as you age. This is especially true after menopause because there is a decrease in the production of estrogen.
- Hysterectomy: Your pelvic floor support may become weakened if you have had your uterus removed.
- Genetics: Women who are born with weaker connective tissues are more susceptible to bladder prolapse.
In mild cases, you don’t usually need surgery. You can take self-care measures such as exercises that strengthen your pelvic floor muscles. Also, it is a good idea to schedule check-ups with your doctor to make sure it isn’t progressing. If your self-care methods aren’t working, you can consider:
A supportive device (pessary): A plastic or rubber ring that is inserted into your vagina to support the bladder. Many women use this when surgery is too risky, or they want to fix the problem temporarily.
Estrogen therapy: Using estrogen is another option especially if you’ve already experienced menopause. Estrogen is essential to keeping your pelvic muscles strong.
If surgery is necessary, the doctor with put the prolapsed bladder back into place and then tighten the muscles of the pelvic floor. If your vaginal tissue is fragile, then a tissue graft may be used.
- Perform Kegel exercises on a regular basis: These exercises can strengthen your pelvic floor muscles, and this is especially important after you have a baby.
- Treat and prevent constipation: High-fiber foods can help
- Avoid heavy lifting, and lift correctly: Use your legs instead of your waist or back when lifting.
- Control coughing: Don’t smoke and get treatment for a chronic cough or bronchitis.
- Avoid weight gain: Talk to your doctor to determine your ideal weight and get advice on weight-loss strategies, if you need them.