Prolapsed Bladder: Stages, Causes, Symptoms, Treatment & Surgery

What Is Prolapsed Bladder?

The bladder is the urine reservoir of the body. It is an organ which has muscle tissues which have the ability to expand and contract as the urine collects and is released from the bladder respectively. The urine is made in the kidney and is transported to the bladder where it starts getting collected. Making of urine is a continuous process as is transportation of urine to the bladder.

Once the bladder is filled to its capacity the brains sends signal to the bladder to start contracting. This is when an individual gets the urge to urinate. The bladder now contracts and releases the urine to the urethra from where it is eliminated from the body.

Prolapsed Bladder is a condition seen in females. This is because in females the bladder is supported from the vaginal wall. This wall tends to get weak and loose as an individual gets older. Extreme stress to the vaginal wall sometimes like in the instances of childbirth can also loosen the vaginal wall. If the wall becomes extremely weak or loose, this is when the bladder starts to descent towards the vagina. This is what is called as a Prolapsed Bladder.

A Prolapsed Bladder can cause a variety of symptoms like problems with urination, pain and discomfort along the upper area of the vagina, urinary dribbling even with little things such as coughing or sneezing.

What Is Prolapsed Bladder?

Stages Of Prolapsed Bladder

Prolapsed Bladder has been categorized into four stages. These stages are:

Grade-1: In this stage of prolapsed baldder, there is only a small portion of the bladder which descends towards the vagina.

Grade-2: In this stage, the bladder descends down to reach the opening of the vagina.

Grade-3: This is the most severe form of Prolapsed Bladder and in these cases a part of the bladder is exposed to the environment through the vaginal opening.

Grade-4: In this stage of prolapsed bladder, the entire bladder protrudes out through the vagina.

What Causes A Prolapsed Bladder?

In majority of the cases, postmenopausal females tend to develop Prolapsed Bladder. This is because during the reproductive age the females make a hormone called estrogen which keeps the vaginal wall supporting the bladder strong to keep the bladder in its anatomical position. Once a female reaches menopause, they do not produce enough estrogen to keep the vaginal wall muscles strong causing the wall to get weak leading to Prolapsed Bladder.

Some of the common causes of a Prolapsed Bladder are:

Childbirth: This is perhaps the most common cause of a Prolapsed Bladder. Childbirth causes extreme stress on the vaginal wall during delivery. This ultimately loosens the vaginal wall leading to Prolapsed Bladder.

Menopause: This is yet another cause for a female to have Prolapsed Bladder. As stated, young women produce a hormone called estrogen which supports the muscles of the vaginal wall and keeps it strong which in turn supports the bladder and keeps it in its anatomical position. After menopause, there is a reduction in the production of estrogen which makes the vaginal wall weak leading to Prolapsed Bladder.

Excessive Straining: If a female is involved in a work where she has to lift heavy items repetitively either at work or at home this can also put excessive stress on the vaginal wall and the pelvic floor muscles making them weak and causing Prolapsed Bladder.

What Are The Symptoms Of Prolapsed Bladder?

In cases where the bladder prolapse is minimal then the female may not notice any symptoms at all. In severe forms of Prolapsed Bladder, there may be visible tissue in the form of a ball which can be noticed by the female. This is the first sign that the bladder has prolapsed.

Additionally, some of the other symptoms that a female with Prolapsed Bladder will experience are:

  • Pain and discomfort in and around the pelvic and bladder region
  • Problems with urinating
  • Incomplete voiding
  • Urinary dribbling with even slight stress like coughing or sneezing
  • Frequent infections of the bladder
  • Dyspareunia
  • Pain in the back

Diagnosis Of Prolapsed Bladder

The physician will examine the genital areas of the female and perform a pelvic examination to help diagnose Prolapsed Bladder. Category III and IV types of Prolapsed Bladder can be easily diagnosed with a pelvic examination as in these cases the bladder completely descends down and protrudes through the vagina.

For moderate cases of Prolapsed Bladder, a cystourethrogram is done in which a series of x-ray films are taken while the patient is voiding. This will allow the physician to identify the cause of difficulty with urination for the patient and also determine the shape of the bladder.

If the bladder is not in its normal anatomical position then the images of the bladder will be distorted proving that the bladder has descended towards the vagina thus confirming the diagnosis of a Prolapsed Bladder.

Treatment Of Prolapsed Bladder

For Grade I prolapsed bladder, there is no treatment required as only a small portion of the bladder descends down towards the vagina and is basically asymptomatic. Certain activity modifications may be recommended in the form of no heavy lifting or straining so as to prevent worsening of the condition.

For more severe cases of a Prolapsed Bladder, the treatment plan is formulated based on the patient’s overall age, health status, severity of the condition, and what type of treatment is preferred by the patient as Prolapsed Bladder can be treated both conservatively and surgically.

Some of the conservative treatments for a Prolapsed Bladder include:

Pessary Placement: Pessary is elastic type of device which can be implanted in the vagina to support the vaginal wall and prevent further descend of the bladder into the vagina. Since pessary is an external device thus it is prone to infections and hence must be cleaned at regular intervals.

Placement of a pessary is quite easy and the patient can do it herself after receiving instructions from the healthcare provider as to how to do so. The pessary will be coated with estrogen cream to avoid any infection. Pessary placement is quite an easy way to keep the bladder in its position but some females find this device quite uncomfortable and thus are reluctant to use this form of treatment.

Estrogen Replacement Therapy: For females who are not too comfortable with pessary placement, estrogen replacement therapy is suggested. Once estrogen which is depleted in females with Prolapsed Bladder is replenished, it makes the vaginal wall stronger and prevents any further deterioration of the condition. However, this therapy cannot be used for individuals with cancer. This therapy works extremely well for mild cases of prolapsed bladder, although in severe cases this therapy may be used in combination with other treatment methods for treatment of Prolapsed Bladder.

Estrogen is available in the patch or a cream form, although estrogen pills are also easily available in the market. Topical form of estrogen such as cream has been found to be extremely efficacious in treating symptoms like urinary urgency and frequency which is prevalent in cases of Prolapsed Bladder.

Surgical Treatment of Prolapsed Bladder

If Estrogen Replacement Therapy is not beneficial or if the Bladder has completely prolapsed then surgery is the most preferred form of treatment. The main aim of the surgery is to reposition the bladder back into its normal anatomical position. An incision is made in the vaginal wall and the bladder is repositioned and the incision is closed and vaginal wall strengthened. In most of the cases, a female is discharged within a couple of days after the surgery for a Prolapsed Bladder.

Once the bladder is repositioned, various materials like a mesh are used to strengthen the vaginal wall. However, the success of a mesh has not been proven and there are quite a bit of risk and complications associated with it.

Thus in most cases, once surgery is done to reposition the bladder the patient is given some pelvic strengthening exercises to do after the wounds have healed to strengthen the vaginal wall and pelvic floor muscles so as to prevent recurrence of a Prolapsed Bladder.

Normally it takes around 6-8 weeks for an individual to recover from surgery, although in some cases it may take up to six months for an individual to completely recover from a surgery for a Prolapsed Bladder.

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:October 26, 2018

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