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How to Diagnose and Treat Prolapsed Bladder

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A condition in which a woman’s bladder moves out of position and swoops down into the vagina is called “prolapsed bladder.” Anatomically, the bladder is located between the pubic bone (anterior) and the uterus (posterior) and above the vagina. Bladder prolapse, also known as bladder hernia, occurs when the vaginal wall muscles weaken and are not able to hold the pelvic organs in place. In this case, the bladder protrudes or retracts into the vagina. [1] About 11% of women need surgery to correct bladder prolapse. [2] Bladder prolapse can be uncomfortable and uncontrollable, so it’s important to diagnose and correct symptoms as quickly and effectively as possible. [3]

Know the symptoms of bladder prolapse

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Feel for the presence of a lump in the vagina. In some severe cases, you may feel your bladder descending into your vagina. When you sit down, you feel like you are sitting on a ball or an egg; This feeling should go away when you get up or lie down. This is the most recognizable symptom of bladder prolapse, and you need to see a specialist or gynecologist as soon as possible. [4] [5]

  • This sensation is considered a sign of serious bladder prolapse.
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Note pelvic pain or discomfort. If you experience pain, pressure, or discomfort in your lower abdomen, pelvis, or vagina, you should see your doctor. Certain medical conditions, including bladder prolapse, can cause these symptoms. [6] [7]

  • If you have a prolapsed bladder, you’ll feel more pain, pressure, or discomfort when you cough, sneeze, exert yourself, or put pressure on your pelvic floor. Then you need to clearly describe to the doctor.
  • If you have a prolapsed bladder, you will feel as if something has fallen out of your vagina.
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Observe urinary tract symptoms. If you frequently leak urine when you cough, sneeze, laugh, or exert yourself, you’re experiencing “pressure incontinence.” Women who have just given birth are often at risk, and the main cause may be bladder prolapse. You need to see a doctor to solve this problem. [8] [9]

  • Watch for any changes in urination, including difficulty initiating urination, inability to urinate (also known as urinary retention), and frequent urination.
  • Observe the frequency of bladder infections or urinary tract infections (UTIs). “Frequent” was defined as having more than one UTI in a six-month period. Women with bladder prolapse are also more likely to have bladder infections, so you need to be very mindful of the frequency of UTIs.
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Note the pain during sex. Pain during intercourse is called “painful intercourse” and can be caused by a number of physical causes, including bladder prolapse. If this happens, you need to see a general practitioner or gynecologist as soon as possible. [10] [11]

  • If painful intercourse is new, and you recently gave birth vaginally, the cause is likely to be bladder prolapse. In this case, you need to see a doctor as soon as possible.
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Observe back pain. Some women with prolapse of the bladder often experience low back pain, pressure, or discomfort. Back pain is a common symptom of many medical conditions — or nothing serious at all. However, you still need to see a doctor if you have other symptoms. [12] [13]
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Note that some women have no symptoms at all. If it is a mild case, you will not notice any of the above symptoms. Some cases of bladder are detected during gynecological examination.

  • However, if you notice any of the above symptoms, you should see your general practitioner or gynecologist.
  • Usually, you don’t need treatment if you don’t have symptoms.
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Find out what causes bladder prolapse

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Know that pregnancy and childbirth are the main causes of bladder prolapse. During pregnancy and delivery, the pelvic muscles and supporting tissues are often stretched. These are the muscles that hold the bladder in place, so if they are overstretched or weakened, the bladder will drop into the vagina. [14] [15]

  • Women who have been pregnant, especially women who have had multiple vaginal deliveries, are at increased risk for prolapse. Even women who have had a caesarean section can experience this condition.
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Recognize the role of menopause. Women who have passed menopause are often at risk of bladder prolapse due to decreased levels of the female hormone estrogen. Estrogen’s main job is to maintain the strength, firmness and elasticity of the vaginal muscles. So the drop in estrogen levels that accompanies the transition to menopause can make the muscle group thinner and less elastic, causing overall weakness. [16]

  • Note that the drop in estrogen persists even if you enter menopause in an unnatural way, such as by having your uterus and/or ovaries removed. These surgeries not only damage the pelvis but also affect estrogen levels. So even if you’re younger than menopausal women and in good health, you can still be at risk for bladder prolapse. [17]
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Realize that muscle tension is also a factor in bladder prolapse. Excessive straining or lifting heavy objects sometimes also contributes to bladder prolapse. When you stretch your pelvic floor muscles, you run the risk of bladder prolapse (especially if the vaginal wall muscles are weakened by menopause or childbirth). Here are some stretching activities that can cause bladder prolapse: [18]

  • Lifting very heavy objects (including children)
  • Chronic and severe cough
  • Constipation and straining when going to the toilet
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Note the weight. If you are overweight or obese, you are more likely to develop bladder prolapse. Excess weight puts extra pressure on the pelvic floor muscle groups. [19]

  • You can tell if a person is overweight or obese by their body mass index (BMI), a measure of body fat. BMI is calculated by dividing body mass in kilograms by the square of height in meters. A BMI between 25-29.9 is considered overweight, and greater than 30 is considered obese. [20]

Diagnosis of bladder prolapse

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Go to the doctor. If you think you have a prolapsed bladder, you should see a general practitioner or gynecologist.

  • Provide complete information to the doctor, including medical history and detailed description of symptoms of the disease.
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Go to a gynecologist. First, your doctor will perform a routine gynecological exam. During the exam, the doctor can detect bladder prolapse by pressing the back of the vagina with a speculum (gynecological instrument) while you lie flat with your knees bent and your feet on the stirrups. Your doctor will ask you to “push” (like you would when a fetus or stool is passed out) or cough. If you have a prolapsed bladder, your doctor will see or feel a soft bulge in front of the vaginal wall when you stretch. [21]

  • Bladder prolapse was diagnosed as prolapse. [22]
  • In some cases, in addition to a regular gynecological exam, your doctor may have to do additional tests while you’re standing. This helps the doctor accurately assess the state of bladder prolapse in each different position.
  • If you notice bladder prolapse in the back wall of your vagina, your doctor will perform a rectal exam. This step helps the doctor determine the strength of the muscle. [23]
  • You don’t need to prepare for this test in advance, and it doesn’t take long. You’ll only feel some discomfort during your pelvic exam, but for many women this is just a routine check-up like taking a Pap smear.
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Get a few more tests done if you have bleeding, urinary incontinence, or impaired sexual function. Your doctor will usually recommend a bladder pressure or urodynamic test.

  • Bladder manometry measures the amount of urine in the bladder when you start to feel the urge to urinate, when the bladder feels “full,” and when the bladder is actually full [24]
  • Your doctor will ask you to urinate into a container connected to a computer that takes the measurement. You will then lie down on an examination table where the doctor will place a thin, flexible urinary catheter into your bladder.
  • A urodynamic measurement is a series of different tests that include measuring urine flow, i.e. the time it takes to urinate, the time it takes to complete, and the amount of urine released. In addition, urodynamic measurement also includes a bladder pressure test as described above, an excretory test, and a urine discharge phase.
  • During most urodynamic tests, your doctor will place a thin, flexible urinary catheter in place while you urinate. Special sensors will collect data for the doctor to analyze.
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Talk to your doctor about some additional testing. In some cases, your doctor will recommend further testing if the prolapse becomes more severe. Some additional tests include:

  • Urinalysis – In this test, the urine will be tested to detect an infection (such as a UTI). The doctor will also check the bladder to see if the bladder is completely empty after urinating by inserting a urinary catheter into the urethra to drain urine and measuring the amount of urine remaining after voiding (PVR). If the PVR is more than 50-100 ml, it is considered as urinary retention, one of the symptoms of bladder prolapse. [25] [26]
  • PVR Ultrasound – An ultrasound test that emits sound waves that, when reaching the bladder, bounce off the ultrasound machine, creating an image of the bladder. The image also shows the amount of urine remaining in the bladder after excretion. [27]
  • Urethroscopy X-ray (VCUG) – This is a test that uses X-rays during urination to look at the bladder and assess its condition. VCUG displays bladder shape and analyzes urine flow to detect obstruction if present. This test can also be used to diagnose urinary incontinence that is masked by prolapse. The physician needs to make these two diagnoses, as the patient also needs surgical treatment for urinary incontinence in addition to treatment for prolapse (if surgery is needed). [28] [29]
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Specific diagnosis. After the doctor concludes the prolapsed bladder, you need to ask for more detailed diagnostic information. Bladder prolapse is divided into several grades depending on the severity. Treatment will depend on the type of bladder prolapse, as well as the symptoms present. Bladder prolapse can be of one of the following “grades”: [30] [31]

  • Grade 1 bladder prolapse is mild. If you have grade 1 prolapse, only part of your bladder prolapses into your vagina. You may experience some mild symptoms such as mild discomfort and urinary discharge, but some women have no symptoms at all. Some remedies include Kegel exercises, rest, avoidance of heavy lifting and overstretching. If you’re post-menopausal, you may want to consider estrogen replacement therapy.
  • Grade 2 bladder prolapse is moderate. At this point, the entire bladder prolapses into the vagina. They can drop down near the vaginal opening. Symptoms such as discomfort and urinary incontinence are moderate. This may require surgery to correct the position of the bladder, but you can still correct symptoms with a vaginal lift (a small plastic or silicone device that is inserted into the vagina to fix the vaginal wall). [32]
  • Grade 3 bladder prolapse is severe. During this stage, part of the bladder protrudes from the vaginal opening. Symptoms of discomfort and urinary incontinence become severe. Treatment includes surgical correction of prolapse and/or the use of a vaginal lift similar to grade 2 prolapse.
  • Grade 4 prolapse is extremely severe. At this point, the entire bladder prolapses outside the vaginal opening. Then you may experience some other more serious problems including uterine and rectal prolapse.

Bladder prolapse treatment

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Ask your doctor about treatment. Grade 1 prolapse usually does not require medical treatment, as long as it does not cause pain or discomfort to the patient. You need to talk to your doctor about whether you need medical treatment or just monitoring. If symptoms do not affect much, the doctor will recommend some basic treatments including Kegel exercises and physical therapy. [33]

  • Keep in mind that your doctor may recommend that you stop certain activities, such as weightlifting or those that strain your pelvic muscles. However, you can still exercise regularly. [34]
  • You should also consider how your symptoms affect your quality of life in order to make treatment decisions. For example, you may have severe bladder prolapse but not be affected by the accompanying symptoms. In this case, you can talk to your doctor about some gentler treatments. In other cases, you may have a mild prolapse, but the symptoms are very painful or inconvenient. You can then consult your doctor about some stronger treatment methods.
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Exercise Kegels. This exercise is done by stretching the pelvic floor muscles (like when you stop urinating), holding for a certain amount of time and then releasing it completely. You can regularly work out to strengthen your muscles, as this exercise requires no special equipment and can be done anywhere (including while waiting in line, sitting at your desk, or relaxing in the office). stretch on a cushioned chair). In some mild cases, this exercise can help reduce bladder prolapse. Here’s how to do Kegel exercises: [35]

  • Stretch, or contract, the pelvic floor muscles. This is the muscle group used to stop the flow of urine while excreting.
  • Squeeze for about five seconds, then relax for about five seconds.
  • Gradually increase the time by ten seconds.
  • The goal is to do 3 to 4 reps with 10 repetitions each
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Use a vaginal lift. This type of ring is small, made of plastic or silicone material that is inserted inside the vagina to hold the bladder (and other parts of the pelvis) in place. Some are designed for you to insert yourself into your vagina; Others need to be ordered by a medical professional. Vaginal lifts come in a variety of shapes and sizes for your doctor to choose the one that’s best for your patient. [36]

  • Vaginal lifts can be uncomfortable, and some women experience the ring falling out. In addition, they can cause ulcers (if not sized properly) and vaginal infections (if not removed and cleaned monthly). You need to use an estrogen cream to avoid damaging the vaginal wall.
  • Despite some limitations, a vaginal lift is an effective alternative, especially if you want to delay or can’t have surgery. Talk to your doctor, and consider the pros and cons in your case
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Try estrogen replacement therapy. Declining estrogen levels often weaken vaginal muscles, so your doctor may recommend estrogen therapy. Your doctor may prescribe estrogen in the form of a pill, vaginal cream, or vaginal ring to strengthen weakened pelvic floor muscles. Creams do not penetrate effectively, so they only work maximum in the area of direct contact. [37]

  • Estrogen therapy poses some risks. Women with certain cancers should not use estrogen, and you should discuss the potential risks and benefits of this method with your doctor. In general, topical estrogen treatments are generally less risky than “systemic” oral estrogen treatments.
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    Perform surgery. If other treatments don’t work, or the prolapse becomes particularly severe (grade 3 or 4), your doctor may recommend surgery. This method is more effective in some women. For example, if you’re trying to have children, you may want to delay surgery after giving birth to prevent bladder prolapse from recurring after childbirth. Older women are often at higher risk for surgery. [38]

    • Vaginal cosmetic surgery is a common surgical treatment. The doctor will reposition the bladder, then may tighten or strengthen the vaginal muscle group so that the organs are in the correct position. You may want to consider several other types of surgery, and your doctor will recommend the best type of surgery for you. [39]
    • Your doctor will explain the surgical procedure, the risks and benefits, and some potential complications before surgery. Potential complications include UTI, urinary incontinence, bleeding, infection, and in rare cases, damage to the urinary tract that requires surgery. Additionally, you may experience burning or pain during intercourse after undergoing surgery due to stitches or scar tissue inside the vagina. [40]
    • Depending on the specific case, you will be given local, regional, or general anesthesia. Many patients are able to leave the hospital one to three days after surgery, and most are able to return to their usual activities after about six weeks. [41]
    • If you have uterine prolapse, your doctor may recommend a hysterectomy. If bladder prolapse is associated with pressure incontinence, your doctor may perform a parallel urethral suspension procedure.

    • Advice

    • Although it can be painful, uncomfortable, and inconvenient, prolapse is curable and is not life-threatening. Don’t panic when you think you have a prolapsed bladder; You just need to go to the doctor and talk to your doctor about the right treatment. Then your condition will be in complete remission.

    A condition in which a woman’s bladder moves out of position and swoops down into the vagina is called “prolapsed bladder.” Anatomically, the bladder is located between the pubic bone (anterior) and the uterus (posterior) and above the vagina. Bladder prolapse, also known as bladder hernia, occurs when the vaginal wall muscles weaken and are not able to hold the pelvic organs in place. In this case, the bladder protrudes or retracts into the vagina. [1] About 11% of women need surgery to correct bladder prolapse. [2] Bladder prolapse can be uncomfortable and uncontrollable, so it’s important to diagnose and correct symptoms as quickly and effectively as possible. [3]

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