What to Know About Bladder Prolapse (Cystocele)

A bladder prolapse (cystocele) is a common condition in which your bladder pushes into your vagina due to weakened pelvic muscles. It’s highly treatable with exercise or surgery.

Bladder prolapse occurs when your bladder drops into your vagina. This condition may affect more than 3 in 10 women , according to a 2002 study. Though the condition is relatively harmless in its earliest stages, it can eventually cause issues such as increasing discomfort, difficulty urinating, and kidney problems.

If you feel pressure in your vaginal area, you may be experiencing prolapse. But the condition is highly treatable in its earliest stages. Here’s what to know.

What are the symptoms of bladder prolapse?

The earliest stages of bladder prolapse often do not cause symptoms. But as the condition progresses, you may experience :

Grade 1 (mild symptoms)

• mild pressure in your pelvic/vaginal area
• a sensation that something is falling or sliding out of your vagina
• mild discomfort or irritation
• frequent urination

Grade 2 (moderate symptoms)

• a noticeable obstruction protruding into your vaginal wall
• a feeling that your bladder doesn’t fully empty after peeing
• episodes of urinary leakage or incontinence
• moderate pelvic/vaginal discomfort or pain

Grade 3 (severe symptoms)

• an obvious bulge or mass sticking out of your vagina that may bleed or be tender
• a lack of relief or a feeling that your bladder has not truly emptied after urinating
• constant urine leakage or incontinence
• pain during intercourse
• more severe pelvic, lower back, groin, or vaginal pain
• constipation (in rare cases)

What causes bladder prolapse?

Your pelvic floor, which consists of tissues, muscles, and ligaments, supports your bladder and helps keep it in place.

These tissues and muscles may stretch out, weaken, or become damaged due to factors such as aging and pregnancy.

Over time, these weakened muscles may allow your bladder to drop and herniate or protrude into your vaginal area — this is called a bladder prolapse.

What are the risk factors for bladder prolapse?

The following factors can contribute to this condition and raise your risk of experiencing it:

• Higher body weight: Extra weight can put pressure on your pelvic and abdominal area, straining your pelvic floor. According to a 2017 research review , compared with women with a body mass index (BMI) of 25 or below, those with a BMI above 25 have a 36% higher risk of bladder prolapse and those with a BMI over 30 have a 47% higher risk.
• Older age: Many studies have demonstrated a strong connection between older age and vaginal or bladder prolapse. Over time or with a lack of exercise, the muscles in your vaginal wall may weaken and cause a cystocele.
• Childbirth: Especially when it involves vaginal delivery with forceps or a long period of labor, childbirth can significantly raise the risk of pelvic floor issues and prolapse. The risk appears to rise with each birth.
• Chronic strain: Ongoing pressure in your abdominal and pelvic area, whether due to frequent constipation, coughing, or obstructive pulmonary disease, may eventually cause a prolapse.
• Collagen issues: People with connective tissue conditions such as Ehlers-Danlos syndrome and Marfan syndrome have impaired collagen function that may weaken vital tissues and lead to prolapse.
• Prior pelvic surgery: Those who have had pelvic surgeries such as hysterectomies may have damaged tissues and nerves in the pelvic area that may cause issues such as cystoceles.
• Family history: Though experts don’t understand exactly how genes affect prolapse development, you’re more likely to experience a prolapse if someone in your family has had one.

How is bladder prolapse diagnosed?

To diagnose a bladder prolapse, your doctor may :

• Evaluate your medical history: They will collect information about your symptoms, pregnancy/childbirth history, past medical issues and surgeries, family medical history, medications, and urinary or bowel habits.
• Perform a physical assessment (including a pelvic exam): They will check for any signs of prolapse and grade the severity of the condition from 1 to 3.
• Perform any other necessary medical tests: They may order other tests, such as postvoid urine measurements, cystoscopy, and imaging tests like MRIs or ultrasounds.
• Rule out any differential diagnoses: They will diagnose any other conditions that may seem like prolapse symptoms, such as rectal or uterine prolapses, pelvic tumors, and vulvar cysts.

How is bladder prolapse treated?

In the early stages of bladder prolapse, lifestyle changes can often help improve the condition or prevent it from worsening.

In the later stages or if nonsurgical interventions fail to work, surgical treatment may be necessary.

Noninvasive treatments

Noninvasive treatments or preventive measures may include :

• Doing pelvic floor exercises: Exercises such as Kegels can strengthen your pelvic floor and reverse prolapse symptoms. Kegel balls or Kegel trainers may also help.
• Managing your weight: In some cases, weight loss can reduce pressure on your pelvis and may reverse prolapse symptoms or prevent the condition from worsening.
• Avoiding heavy lifting: Avoiding lifting heavy objects or using your legs when lifting can help prevent pelvic strain and prolapsing.
• Preventing or treating constipation: Treating constipation may help prevent pelvic-related strain and related issues.
• Treating chronic cough: This can help relieve symptoms.
• Inserting a vaginal pessary: A pessary is a small silicone device that can help keep your bladder in place.

Surgical intervention

The most common surgical treatment is called an anterior vaginal repair or an anterior colporrhaphy. During this procedure, a surgeon will shift your bladder back to its proper place and tighten up the surrounding muscles and tissues with stitches.

A surgical procedure to treat urinary incontinence may be necessary to repair the cystocele.

And in some cases, doctors may recommend obliterative surgery, which involves narrowing or closing off part of your vagina to permit more bladder support.

What’s the outlook for people with bladder prolapse?

Mild cases of bladder prolapse are very common, affecting about 34% of women. In its early stages, bladder prolapse often doesn’t significantly affect daily quality of life and doesn’t necessarily require treatment.

However, by doing Kegel exercises , avoiding heavy lifting, and making efforts to manage your weight, you may be able to help prevent the condition from worsening or even reverse it.

More severe cases can lead to complications such as:

• urinary incontinence
• urinary tract infections (UTIs)
• kidney damage
• vaginal ulcers
• pelvic pain
• reduced quality of life
• difficulty enjoying sex
• psychological issues

Prompt diagnosis and treatment are recommended to avoid these possible complications.

Surgical intervention has more possible complications, most commonly the recurrence of the prolapse and the need for additional surgery. An estimated 40% of women who undergo an anterior colporrhaphy need a repeat treatment.

For that reason, surgery is recommended only in severe cases or when noninvasive methods do not work.

Frequently asked questions

Can you reverse bladder prolapse?

It’s fairly common for prolapses to reverse, especially during stage 1. Pelvic floor therapy exercises are generally the first-line treatment. Surgery can also reverse a bladder prolapse.

Can you live a normal life with a prolapsed bladder?

You can have typical quality of life with a mildly prolapsed bladder. Prolapsed bladders are very common, especially among those with risk factors such as older age and previous pregnancies.

In the earliest stages, you may not have any symptoms. If you do, you may be able to reverse the symptoms by practicing Kegels and maintaining a healthy lifestyle. But if left untreated, the condition may affect your daily quality of life due to issues such as discomfort, urinary incontinence, and pain during sex.

Is it safe to live with a prolapsed bladder?

It’s generally safe to have a mild, untreated prolapsed bladder. But factors such as aging, weight gain, heavy lifting, and pregnancy may worsen the condition.

Because more severe cases come with risks such as UTIs, vaginal ulcers, and potential kidney damage, prompt treatment is recommended.

Takeaway

Bladder prolapse is a common condition, especially among women with risk factors such as advanced age and history of childbirth.

While mild cases can often be managed through conservative methods such as pelvic floor exercises, more severe prolapses may require surgery. Early diagnosis and proper treatment are recommended to reduce potential risks down the road.