The idea of"bladder prolapse" can be intimidating. After all, the definition of prolapse is "the displacement of an organ, usually downward or outward, that can result in protrusion from the body." Cue images of your organs literally falling out. So before we dive in further, we first want to tell you that a bladder prolapse is rarely harmful — many people who have a bladder prolapse may not even know it. If you have a bladder prolapse and it's creating uncomfortable symptoms, it can usually be successfully treated with pelvic floor physical therapy.
With that out of the way, let's talk about what bladder prolapse is, what causes it, and how to get the care you need.
What is a Bladder Prolapse?
Your bladder, as you no doubt already know, is an organ located just behind your pubic bone and in front of your vaginal canal. It rests on top of your pelvic floor and works to collect and store your urine. In people with vaginal anatomy, the bladder can usually hold a max of about 2-3 cups of liquid.
A bladder prolapse, also known as a cystocele, happens when the structures that support and hold the bladder in place are compromised in some way. This leads to the bladder slipping downward in the pelvis — hence the term 'prolapse.' For those with vaginal anatomy, when the support structures between the vagina and bladder become weakened, the bladder can start to lean against the front wall of the vagina and can bulge towards, or even slightly outside of, the vaginal opening.
What Causes a Bladder Prolapse or Cystocele?
Many different factors can contribute to a bladder prolapse or cystocele. One major factor is increased abdominal pressure that pushes on the bladder. For example, excess pressure due to chronic coughing, chronic constipation, or regularly lifting heavy weights. Advanced age, obesity, and vaginal childbirth can all increase the risk of a bladder prolapse.
What Are the Symptoms of a Bladder Prolapse?
If one or more of the risk factors discussed above (advanced age, obesity, vaginal childbirth, chronic coughing or constipation, or regular heavy lifting) apply to you, and you're concerned that you may have a bladder prolapse, there are symptoms you can look out for.
Signs of a potential bladder prolapse or cystocele include:
Changes in how you pee
- It can be hard to start the flow of pee or fully empty your bladder
- Applying pressure to the anterior wall of the vagina helps you empty your bladder
- You have to go more frequently and feel like you can barely hold it
- You have bladder leaks
Changes in your sex life
- You experience pain or bleeding at the vagina due to exposed tissue
- You experience vaginal dryness and/or painful intercourse
- Your bladder leaks during intercourse
- You feel bulging, pressure, or heaviness in your vagina
- It feels as if your vagina could be falling out
- Symptoms feel worse as the day goes on and as your bladder fills with urine
If you're experiencing any of these symptoms and think you may have a prolapse, reach out to a doctor, gynecologist, or urogynecologist. They will be able to let you know if you have a bladder prolapse and the severity of your prolapse, as well as provide you with treatment options, which may include a referral to a pelvic floor PT.
What Are the Stages of a Bladder Prolapse?
The severity of a bladder prolapse is described via 4 stages (also known as 'levels' or 'grades'). For people with vaginal anatomy, each stage describes how far the unsupported bladder has 'collapsed' into the vaginal canal.
Stage 0 - No bladder prolapse.
Stage 1 - Lowest part of the prolapse is 1cm above the vaginal opening.
Stage 2 - Lowest part of the prolapse is between 1cm above and 1cm below the vaginal opening.
Stage 3 - Most but not all of the prolapse is 1cm below the vaginal opening.
Stage 4 - Prolapse is entirely below the vaginal opening.
Bladder Prolapse Treatment
Depending on your symptoms, the stage of your prolapse, your lifestyle, and your personal preferences, your doctor may recommend any of the following treatment strategies.
Improve symptoms with pelvic floor physical therapy.
The bladder is supported by ligament and fascial support, but it is also supported by the muscles of the pelvic floor. Research has shown that improving pelvic floor muscle strength and endurance can reduce the size and symptoms of a prolapse. A pelvic floor physical therapist can provide guidance for how to manage bladder prolapse symptoms in your day-to-day life and can teach you how to build strength in your pelvic floor for long term success.
Support your bladder with a pessary.
A pessary is a brace for your vaginal canal. It is inserted like a tampon or menstrual cup and, once in place, it helps reduce how far your bladder can lean into your vagina. This is a terrific option for many people. Once inserted, symptoms can completely resolve or they can become manageable enough to not interfere with your everyday tasks. Some people will wear a pessary all day and others might wear it just when they feel symptoms, like when going for a jog or lifting weights.
If all else fails, consider surgery.
Surgery is typically considered if other treatments are not successful and if your bladder prolapse or cystocele is more severe. Most surgeons just recommend waiting until you no longer plan to become pregnant since childbirth can damage any surgical repairs. The type of surgery your doctor might recommend will depend on the type of prolapse (or prolapses) that you may have. Unfortunately, as many as 40% of people will need a repeat procedure due to a return of symptoms following surgery. Be sure to speak with your surgeon about their recommendations and any post-surgical precautions in order to avoid any post-op complications.
Whether you've been diagnosed with a bladder prolapse, have already had surgery for a bladder prolapse, or if you are just concerned that you may develop a bladder prolapse, reach out to a pelvic floor physical therapist. No matter where you are in your pelvic health journey, a physical therapist who specializes in the pelvic floor will be a crucial member of your healthcare team.