How to Treat Bladder Prolapse

What is Bladder Prolapse?

A bladder prolapse generally occurs when the tissue and muscle network that holds this and other pelvic organs in place (the pelvic floor muscles) become stretched or weak, resulting in the bladder descending or bulging down into the vagina. This is ‘bladder prolapse’ is referred to medically as a ‘cystocele’.

In particularly severe instances, a bladder prolapse will appear at the vaginal opening, and can even protrude through the vaginal opening. It can be very uncomfortable and frightening to see an internal organ protruding out of the body, but it can be treated.

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What Causes Bladder Prolapse?

The pelvic floor and other tissue that supports the bladder can become stretched and weakened as a result of stress on the body, such as pregnancy and childbirth. Deliveries that include forceps or episiotomy may increase the risk of bladder prolapse due to the associated bodily trauma.

Bladder prolapse can also be triggered during Menopause, when oestrogen levels that help keep the pelvic floor and supporting tissues strong drop, resulting in these muscles losing their tone and strength, and ability to adequately support the pelvic organs.

Severe exertion and strain can also result in bladder prolapse such as heavy lifting, coughing attacks, and straining when using loo as this can also cause pelvic floor damage.

Prevention Steps for a Bladder Prolapse

Prevention strategies for bladder prolapse primarily focus on maintaining pelvic floor health and minimizing factors that contribute to weakening of the pelvic floor muscles and connective tissues. Some preventive measures include:

1. Pelvic Floor Exercises (Kegels): Regularly performing pelvic floor exercises like kegels can help strengthen the muscles that support the bladder and other pelvic organs. Kegel exercises involve contracting and relaxing the pelvic floor muscles to improve tone and function.

Pelvic floor exercises, like any kind of exercise, strengthens the muscles for improved strength and control. A strong pelvic floor provides better support for your pelvic organs, prevents prolapse from worsening and relieves symptoms associated with uterine prolapse1.

But pelvic floor exercises are tricky to do correctly, especially when these muscles are so weak they result in a prolapse.

2. Maintaining a Healthy Weight: Excess body weight can put added strain on the pelvic floor muscles and tissues, increasing the risk of prolapse. Maintaining a healthy weight through a balanced diet and regular exercise can help reduce this risk.

3. Proper Lifting Techniques: When lifting heavy objects, it's essential to use proper lifting techniques to avoid straining the pelvic floor muscles. This includes bending at the knees, keeping the back straight, and engaging the core muscles.

4. Avoiding Chronic Constipation: Straining during bowel movements can weaken the pelvic floor muscles over time. Consuming a high-fiber diet, staying hydrated, and maintaining regular bowel habits can help prevent constipation and reduce strain on the pelvic floor.

5. Pelvic Floor Physical Therapy: A physical therapist specializing in pelvic floor rehabilitation can provide personalized exercises and techniques to strengthen and support the pelvic floor muscles.

6. Avoiding Smoking: Smoking is associated with decreased tissue elasticity and blood flow, which can contribute to pelvic floor weakness. Quitting smoking can help improve overall pelvic floor health and reduce the risk of prolapse.

When to Seek Medical Care for a Prolapsed Bladder

Seek medical care for a prolapsed bladder if you experience symptoms like pelvic pressure, urinary incontinence, or difficulty emptying your bladder. Prompt evaluation by a healthcare professional can help prevent complications and guide appropriate treatment.

Symptoms of Bladder Prolapse

A bulging feeling in the vagina is a common symptom of severe cases of bladder prolapse. Other symptoms include:

• Discomfort or pain in the pelvis
• A feeling of heaviness around your lower tummy and vagina
• Urinary Incontinence, either Stress or Urge Incontinence
• Not being able to fully empty the bladder when urinating
• Painful intercourse
• Tissue protruding from the vagina (The tissue may be tender and may bleed.

Mild instances of bladder prolapse may not have any symptoms at all. If you’re experiencing the above symptoms and suspect you may have a prolapsed bladder, you should seek medical advice as soon as possible to prevent these symptoms from worsening.

Common Exams and Tests for a Prolapsed Bladder

Non-Invasive Exams:

Pelvic Exam: This initial exam involves the healthcare provider examining the vagina and pelvis to visually assess for signs of a prolapsed bladder. If the bladder is found to protrude into the vagina, it confirms the diagnosis. 

Voiding Cystourethrogram (VCUG): In cases where the prolapse is less obvious, a VCUG may be used. It consists of a series of X-rays taken during urination to visualize the shape of the bladder and identify any urinary difficulties. 

Invasive Exams:

Urodynamics: Also known as video urodynamics, this test evaluates bladder function by measuring pressure and volume relationships.

Cystoscopy: This procedure involves inserting a scope into the bladder to visually examine its interior. It is performed to identify treatment options and may be displayed on a screen for patient visualization. 

Nerve and Muscle Testing: After diagnosis, the healthcare provider may conduct tests to assess the function of nerves, muscles, and the intensity of the urine stream. 

How to Treat Bladder Prolapse

There are a few common treatment options for bladder prolapse, and the best treatment route will depend on the severity of the condition.

Non Surgical Treatment:

Pelvic Floor Exercises: pelvic floor muscle strengthening. Regularly performing pelvic floor exercises can help strengthen the muscles that support the bladder and other pelvic organs. 

Vaginal pessary: They work by providing structural support to the pelvic floor, helping to hold organs such as the bladder, uterus, or rectum in their proper positions.Pessaries can be a conservative treatment option for managing pelvic organ prolapse, particularly in cases where surgery is not desired or appropriate. Device inserted into the vaginal to help keep the bladder in place. Requires frequent removal and cleaning to prevent infections.

Pelvic floor physiotherapy: Pelvic floor physical therapy involves working with a specialized physical therapist to learn exercises and techniques aimed at strengthening and supporting the pelvic floor muscles. This may include biofeedback, manual therapy, and behavioral strategies.

Oestrogen Replacement Therapy: won’t be suitable for everyone (there are risk factors), but generally this treatment option helps to restore the levels of oestrogen that have dropped due to Menopause, which can reverse prolapse symptoms in mild cases

Behavioral Techniques: Techniques such as timed voiding and bladder training can help manage urinary symptoms associated with bladder prolapse, such as urgency and frequency.

Continence Pads or Liners: For individuals experiencing urinary incontinence as a result of bladder prolapse, the use of continence pads or liners can help manage leakage and provide comfort and confidence.

Incontinence Devices: Products like INNOVO help treat the root cause of bladder prolapse issues including strengthening the pelvic floor without the need for invasive procedures. 

Surgical Treatments:

Commonly a general surgery is used where a surgeon secures the bladder in place via a surgery performed through the vagina.

Anterior Colporrhaphy: This procedure involves repairing the weakened tissues of the anterior vaginal wall using sutures or synthetic mesh to support the bladder. It is often performed through an incision in the vaginal wall.

Mesh-Augmented Repair: In cases of severe or recurrent prolapse, synthetic mesh may be used to provide additional support to the anterior vaginal wall. This procedure may be performed vaginally or abdominally.

Sacrocolpopexy: This surgical technique involves attaching the top of the vagina (cervix) to a strong ligament or tissue near the sacrum (tailbone) using mesh or other materials. Sacrocolpopexy provides long-term support for the anterior vaginal wall and is often performed laparoscopically or robotically.

Robotic-Assisted Laparoscopic Surgery: Utilizing minimally invasive techniques, robotic-assisted laparoscopic surgery allows for precise manipulation of surgical instruments to repair the prolapse while minimizing trauma to surrounding tissues.

Urethral Sling Procedures: In some cases, bladder prolapse may be accompanied by stress urinary incontinence. Urethral sling procedures involve placing a supportive sling under the urethra to prevent urinary leakage, often performed concurrently with prolapse repair.

Colpocleisis: For older or medically frail individuals who are not candidates for more extensive surgeries, colpocleisis may be considered. This procedure involves closing off a portion of the vagina to provide support and alleviate symptoms of prolapse.

When to Use Medication

Medication for bladder prolapse is utilized to manage symptoms such as urinary urgency, frequency, discomfort, and to improve vaginal tissue health, offering relief and support to individuals experiencing this condition. Here are some common medications your doctor may prescribe. 

Estrogen Therapy: Topical estrogen creams or tablets improve vaginal tissue health, alleviating discomfort from vaginal atrophy. 

Anticholinergic Medications: Drugs like oxybutynin relax bladder muscles, reducing urgency and frequency of urination. 

Alpha-Blockers: These medications ease bladder neck and urethral muscle tension, aiding in complete bladder emptying. 

Topical Estrogen Creams: Applied to vaginal walls, they enhance tissue tone and elasticity, supporting the bladder. 

Pain Medications: Over-the-counter or prescription drugs alleviate discomfort associated with bladder prolapse. 

INNOVO Is a Compelling Alternative

Easy to use and comfortable to wear, INNOVO helps you safely and effortlessly strengthen and re-educate the entire network of pelvic floor muscles through gentle muscle stimulation. INNOVO is a truly non-invasive pelvic floor exerciser used in the comfort and privacy of home.

INNOVO is clinically proven to treat Stress Urinary Incontinence. Consult your GP to find out whether INNOVO might be able to help you with pelvic floor strengthening for bladder prolapse.