Do you have a bulge inside or outside of your vagina and you’re worried it could be a prolapsed bladder?
If you answered yes, you’ll be pleased to know you’re in the right place. In this post, we’re going to explain what a prolapsed bladder is, what symptoms to look out for, and the various causes and treatments. A prolapsed bladder won’t go away on its own, so it’s important to reach out to your doctor and get the right advice and treatment, so you can get back to living life on your terms.
What is a prolapsed bladder?
Here comes the biology lesson… The bladder is a triangle-shaped (We bet you wouldn’t have guessed it was triangle-shaped) hollow organ which sits lower down in the stomach. When the bladder is full, the walls relax and stretch to hold wee. When you need a wee, the bladder will shrink, allowing wee to flow through the urethra (the tube that carries the wee out of your body) (1). The bladder sits below the uterus and the front wall of the vagina supports the bladder.
So, what is a prolapsed bladder? When the pelvic floor muscles that normally hold the bladder (and other organs) in place becomes too weak, the bladder can drop down and sit in or outside of the vagina(2). Your doctor may use other names for a prolapsed bladder such as a cystocele, hernia, dropped or fallen bladder. Having a prolapsed bladder can cause you to struggle to wee or feel uncomfortable when you go to the toilet. It can also lead to stress urinary incontinence, which is when you leak wee when you laugh, cough, sneeze (bless you), or lift heavy items.
There are four different types, or grades, of prolapse and when your doctor takes a look at your prolapse, they’ll decide how severe it is and what grade it is. The four grades are(3):
- Grade 1 (Mild) - a small part of the bladder sits at the top of the vagina
- Grade 2 (Moderate) - The bladder droops far enough down to reach the opening of the vagina
- Grade 3 (Severe) - The bladder hangs outside of the vagina, so it can be seen from outside the body
- Grade 4 (Complete) - The whole bladder is completely outside of the vagina
Symptoms of a prolapsed bladder
In some mild cases, it’s possible to not know that you have a prolapsed bladder and you may only find out if you have an internal exam such as a smear test. However, you may find that you(4,5):
- Have pressure on your pelvis or vagina.
- Have a bulge of tissue that you can feel or see in or outside your vagina.
- Have pressure across the bottom of your back, your tummy, or pelvis when you go to the toilet, cough, or lift something.
- Struggle to start to wee or may feel as though your bladder isn’t fully emptying.
- Need to use the loo regularly.
- Have a pain in your lower back or pelvis that may feel worse after you’ve been standing for a long time and may go away when you lie down.
- Find sex painful.
- Struggle to use a tampon.
- Have a dry vagina.
- Find spots of blood in your underwear as the exposed skin has rubbed against your pants.
- Have urinary tract infections.
- Strain or push on the vagina to be able to have a poo.
Side note: It’s possible for symptoms of a prolapsed bladder to get worse over time, so it’s important to make a note of any changes and let your doctor know.
What causes a prolapsed bladder?
There are a handful of common causes of a prolapsed bladder. What are the most common reasons for prolapse? We’ve popped them below for you.
Pregnancy and childbirth
Pregnancy and childbirth are the two main reasons why women develop a prolapsed bladder. This happens because the pressure of the baby during pregnancy on the bladder, and the strain and pressure on the vaginal tissues and muscles during childbirth, can weaken the pelvic floor and make the bladder bulge down(3).
There are times during pregnancy and childbirth where the pressure is increased to your pelvic floor muscles, for example:
- The more children you have.
- If your baby was delivered using forceps or a vacuum as this can injure the pelvic floor muscle.
- If you have twins, triplets (or other multiple births).
- If your baby has a heavy birth weight.
Leading up to, and during the menopause, estrogen levels take a dip, which can lead to weak pelvic floor muscles. Because the muscles are weak, this can cause the bladder to drop down into the vagina.
Straining or heavy lifting
Straining when you’re going for a poo, or repetitively lifting heavy objects, can lead to your pelvic floor muscles weakening and you having a bladder prolapse.
Women who are obese have a 40 - 75% higher risk of a pelvic organ prolapse due to the extra weight adding more pressure to the pelvic floor and weakening the muscles(4).
Having a hysterectomy
A hysterectomy is when the uterus is removed. If you’ve had your uterus removed, the vaginal wall can prolapse at the top of the vagina where the uterus would’ve sat. This happens because the bladder’s supportive tissue becomes weak, loosens, or detaches from the ligaments that are securing it to the pelvic bones(6).
Certain genetic disorders cause tissues in the body to weaken because of a lack of collagen proteins in the body. Not having enough collagen proteins can mean that the pelvic floor muscles and tissues can’t support the bladder and other organs in the pelvis. This can then affect how the bladder works, cause bladder leaks, and the bladder to prolapse (7,8). Three conditions that cause the tissues to weaken are:
Joint hypermobility syndrome
When to see a doctor
If you think you’ve got a prolapsed bladder, it’s not going to go away on its own (frustrating we know), so our advice is to go and speak to your doctor. We know the thought of being examined can be embarrassing but there’s often treatments your doctor can offer to stop your prolapse from getting worse, or options such as surgery to put your bladder back into place.
So when you pop to see your doctor it’s likely that they’ll want to run some tests to find out if your prolapse is mild or more severe, so they may(2,5,9):
- Take a look inside your vagina to see if they can see how far your bladder has fallen.
- Carry out a urine test to see if you have an infection.
- Ask you how you feel your symptoms are affecting you on a day-to-day basis.
- Run a test to see how well your bladder is emptying after you’ve had a wee.
- Take an X-ray of your pelvis while you’re peeing so they can take a look at the shape of your bladder (Yes, that’s actually a thing).
- Do a little procedure where they look into your bladder using a tiny scope (cystoscopy).
- Send you for an MRI or ultrasound.
Prolapsed bladder treatment
Treatment for a prolapse bladder will depend on the severity of the prolapse and how much it is impacting your wellbeing. If your prolapse is mild (grade 1) and it’s not bothering you, your doctor may tell you that you don’t need any treatment for the time being and will tell you to keep an eye on your symptoms and come back if it gets worse.
If treatment is needed, the good news is that you have a range of possible options to try. For example(10):
- Practise Kegel exercises (pelvic floor exercises).
- Losing weight can help.
- Try estrogen replacement therapy.
- Pessaries can be popped inside the vagina to hold the bladder in place.
- If your prolapse is moderate to complete (grade 2, 3, or 4), surgery may be needed to move your bladder back into its right place.
If you have a prolapsed bladder, you may find that you also have bladder leaks when you laugh, cough, sneeze, or lift heavy objects (stress urinary incontinence). For a mild bladder prolapse and bladder leaks, practising Kegel exercises can strengthen your pelvic floor muscles and get you back to living life on your terms. But doing pelvic floor exercises for a prolapsed bladder can be easier said than done. You may struggle to find the right muscles to squeeze and trying to remember to do them and doing them regularly can be time-consuming, and annoying.
If you want an effective way to improve your mild bladder prolapse and stop bladder leaks, INNOVO is for you. INNOVO is an easy and successful option in reducing bladder leaks. Research shows that 87% of INNOVO users were defined as dry, or almost dry, after 12 weeks(11).
How do you use INNOVO? You pull on the shorts, connect the cables, and wear them for 30 minutes a day, 5 days a week whilst doing something you enjoy (It’s the perfect opportunity to put your feet up and start reading that book). INNOVO does 180 pelvic floor exercises for you, taking the guesswork out of those Kegels. Find out how INNOVO works and how it can treat your bladder leaks.
- Johns Hopkins Medicine. Anatomy of the Urinary System. Accessed July 2021.
- Urology Care Foundation. What is bladder prolapse? Accessed July 2021.
- WebMD. Prolapsed Bladder. October 2020.
- Voices For PFD. Symptoms & Types - Pelvic Organ Prolapse. Accessed July 2021.
- Mayo Clinic. Anterior prolapse (cystocele). Published April 2020.
- UCLA Health. Pelvic Organ Prolapse. Accessed July 2021.
- Ehlers-Danlos News. Bladder Issues in EDS. August 2020.
- NHS Inform Scotland. Pelvic Organ Prolapse. Updated May 2021.
- NHS. Pelvic Organ Prolapse. March 2021.
- Cleveland Clinic. Cystocele (Fallen or Prolapsed Bladder). Reviewed July 2019.
R. Dmochowski – Novel external electrical muscle stimulation device for the treatment of female stress urinary incontinence: randomized controlled noninferiority trial versus intravaginal electrical stimulation. ICS Conference 2018.