Anterior Prolapse: Causes, Symptoms, Treatment, Prevention, Lifestyle Changes

Anterior prolapse can also be referred to as cystocele and it occurs when the tissues that are present between the vaginal wall and bladder weaken. When these supportive tissues stretches, the bladder bulges into the opening in the vagina. Prolapsed bladder is another name for anterior prolapsed.

Anterior prolapse is caused when the muscles that are supporting the pelvic organs undergo a lot of strain. This strain on the muscles can be caused due to heavy lifting, violent coughing or chronic constipation. Anterior prolapse also causes issues when a woman is in her menopause where there is a decrease in the estrogen levels.

Nonsurgical treatment will prove to be effective when one is suffering from moderate or mild anterior prolapse. When cases are severe, there may be surgery required to keep the pelvic organs in place.

Anterior Prolapse

Causes of Anterior Prolapse

The pelvic organs and the bladder are supported by connective tissues, ligaments and muscles that are in the pelvic floor. The connections that are present between all these components tend to weaken as the age advances that result from trauma or childbirth which causes strain in the pelvic muscles. This can cause the bladder to slip down and bulge into the vagina.

Following can be the causes of anterior prolapse:

  • Vaginal childbirth and pregnancy.
  • Being obese or overweight.
  • A chronic cough or bronchitis.
  • Lifting heavy objects repeatedly.
  • Straining with bowel movements.

Symptoms of Anterior Prolapse

When you are suffering from mild anterior prolapse there may not be any kind of symptoms or signs. The following signs may be seen in some patients:

  • Pressurized feeling or fullness in the vagina and pelvis.
  • Increased discomfort when you cough, strain, lift or bear down.
  • Feeling of passing less urine at once.
  • Repeated infections in bladder.
  • Urinary leakage or pain during coitus.
  • You may feel like you are sitting on an egg when the tissue bulges through the vaginal opening.

When to See a Doctor for Anterior Prolapse?

When prolapsed bladder is severe, it may cause discomfort and you may feel it difficult to empty the bladder which may lead to infections. Be sure to see a gynecologist or family doctor if you notice any signs of anterior prolapse and it interferes with the daily activities.

The following information may be of great help and prepare you while visiting your doctor to get examined.

What You Can do before Visiting the Doctor for Anterior Prolapse?

  • Make a note of the symptoms that you have noticed along with the duration
  • Write down about all the medicines, supplements or vitamins that are a part if your daily routine.
  • Take a trusted family member or friend along. When you do this, it will be easier for you to speak about all the things and not miss anything.
  • Make a list of all the questions that you would like to ask to the doctor.

While you are being examined, the doctor may ask several questions like:

  • When did these symptoms appear initially?
  • Did you notice any inconsistency in urine lately?
  • Do you suffer from infections in the bladder?
  • Do you feel any kind of pain or urinary leakage during sexual intercourse?
  • Are you suffering from severe or chronic cough?
  • Do you have to strain to cause any bowel movements or feel constipated?
  • Does anything help in improving these symptoms?
  • Do your symptoms worsen when you do anything?
  • Is there any history of pelvic floor problem in the family?
  • Have you undergone vaginal childbirth? How many times?
  • Are you willing to have any kids in the near future?
  • Are you concerned about anything else?

Risk Factors for Anterior Prolapse

The following factors may amplify the risk of suffering from anterior prolapse:

  • Childbirth: Women who undergo vaginal childbirth are more prone to suffering from anterior prolapse.
  • Aging: The risk of suffering from anterior prolapsed elevates when your age progresses. The chances increase after menopause when the body produces less estrogen.
  • Hysterectomy: The pelvic floor may be weakened when the uterus is removed.
  • Genetics: Some women have weaker connective tissues that can lead to anterior prolapse.
  • Obesity: Anterior prolapse can be caused to women who are obese or overweight.

Tests to Diagnose Anterior Prolapse

The following tests may be involved in anterior prolapsed diagnosis.

  • An examination of the pelvis. The doctor may examine when you stand up or lie down. The doctor will inspect for any kind of tissue bulge that can show signs of pelvic organ prolapse. You will also be asked to contract the pelvic floor muscles to check for its strength.
  • Questionnaire filling. You may be asked to answer a few questions that may help the doctor is an easy assessment about the prolapsed. Filling the correct information will help in making appropriate decisions for the treatment.
  • Tests for checking the bladder strength and urine. If you have anterior prolapse, the doctor may ask you to urinate to see how the bladder has emptied itself. The urine sample may be tested for bladder infection.

Treatment for Anterior Prolapse

The procedure for treatment depends upon the condition of your anterior prolapse, for example if you have any related conditions like the uterine prolapse where the uterus slips into the vaginal canal.

Mild case with little or no obvious symptoms— such mild case does not require treatment. You can also choose the wait and see approach. If the prolapse is worsening then you can visit your doctor. It is better to take self-care measures like exercises, which can strengthen the pelvic floor muscles.

Anterior prolapsed treatment might involve below therapy if the self-care measures are not effective:

  • Supportive Device (Pessary) for Treating Anterior Prolapse. It is a rubber or plastic ring, which is inserted in your vagina so that it supports the bladder. The expert or doctor will fit the device as well as will show you how to clean it and reinsert it on your own. Most of the women use the pessaries in a form of temporary alternative to the surgery whereas some women use them when the surgery is too risky.
  • Estrogen Therapy for Anterior Prolapse. The doctor may recommend using the estrogen – generally a vaginal pill, ring or pill- especially if the woman has experienced the menopause. It is because estrogen that helps in keeping the pelvic muscles strong reduces after menopause.

When Surgery is Necessary for Anterior Prolapse?

If you observe uncomfortable and noticeable, symptoms than the anterior prolapsed might need surgery.

  • How surgery is done: Most of the surgeries are performed vaginally and includes lifting of the prolapsed bladder back to its place, removal of extra tissues as well as tightening the muscles and the ligament in the pelvic floor. The doctor may also use a special type of tissue graft that will reinforce the vaginal tissues and provides support if the women’s vaginal tissue is very slim.
  • If you have a prolapsed uterus: For the anterior prolapse, which is related to the prolapsed uterus, the doctor might also recommend removal of hysterectomy (uterus). Moreover, it will repair the damaged pelvic floor muscles other tissues and ligaments.

If you are planning to become pregnant, then your doctor will recommend that you delay the surgery until you are done having children. In the meantime, the pessary might help get relief from your symptoms. You will observe the benefit of surgery for many years, but there is some risk of the recurrence- that might mean another surgery after some time.

Dealing with Incontinence

If the anterior prolapse is accompany by the stress incontinence- you will observe involuntary loss of urine when you do strenuous activity- the doctor might recommend a procedure that will provide support the urethral suspension (urethra) and your incontinence symptoms will ease out.

Lifestyle Changes for Anterior Prolapse

Your pelvic floor muscle will strengthen by Kegel exercise that will support the bowel, bladder and uterus. A strengthened pelvic floor gives better support to the pelvic organs as well as relief from the symptoms that are related to anterior prolapsed.

To perform Kegel exercises, follow these steps:

  • Contract (tighten) pelvic floor muscles- they are the muscle that you use to stop urinating.
  • Workout to hold up the contraction for 10 seconds at a single time.
  • Each day does three sets of these exercises- 10 repetitions.

You can ask your doctor or health provider for the feedback about the muscle you are using is right. If you learn Kegel exercises from the physical therapist then it can be more successful and reinforced with a biofeedback. The biofeedback includes use of monitoring devices, which will help in tightening of the proper muscles with the length of time and optimal intensity.

Prevention of Anterior Prolapse

In order to decrease the risk of developing anterior prolapsed, you can try below self-care measures:

  • Do Kegel exercise regularly: It will strengthen your pelvic floor muscles and it is important when you have a baby.
  • Treat as well as prevent constipation: In such cases, the high fiber food can be really helpful.
  • Lift correctly as well as you should avoid heavy lifting. Make use of your legs rather than back or waist when you are lifting.
  • Control your coughing: Instantly get treatment for a chronic bronchitis or cough, and stop smoking.
  • Avoid weight gain: Discuss with your doctor to determine the ideal weight for you and ask the doctor for weight loss strategies, if require.

Also Read:

Pramod Kerkar, M.D., FFARCSI, DA
Pramod Kerkar, M.D., FFARCSI, DA
Written, Edited or Reviewed By: Pramod Kerkar, M.D., FFARCSI, DA Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:April 23, 2019

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