The term ‘prolapse’ refers to an organ that has shifted out of position, usually downwards. In the case of bladder prolapse, the bladder falls onto the front vaginal wall and in extreme cases, can even press that wall down and out of the vagina opening.
The illustration below shows the normal position of the bladder and a prolapse. Other names for this condition are cystocele, an anterior vaginal wall prolapse and ‘a fallen bladder’.
Gynaecologists will measure how far the bladder has pushed into the vagina for an accurate diagnosis. The degree of displacement is categorised in three stages or as mild, moderate or severe.
- Stage 1 - Mild
The bladder has pushed a small way into the vagina
- Stage 2 – Moderate
The bladder has pushed the anterior (front) vagina wall in and down, blocking the vagina opening
- Stage 3 – Severe
There is a protrusion outside the vagina. The surface of this isn’t the bladder itself, but the anterior vaginal wall that’s been pushed out by the bladder.
What are the symptoms of bladder prolapse?
Stress incontinence can be the first sign that something’s out of place. This is when you experience leaking from laughing, coughing, sneezing, lifting or otherwise putting pressure (or stress) on your pelvic floor muscle.
Other symptoms include:
- Difficulty starting or maintaining a urine flow
- Needing to urinate more often, having trouble emptying your bladder
- A sensation of pressure, described by some women as ‘dragging’, heaviness or fullness in the vagina and pelvic area
- Bulging in the vagina and, in severe cases, protruding from the vagina
- Discomfort during intercourse
- Difficulty keeping a tampon in
- Reoccurring infections such as UTIs
What causes a bladder to prolapse?
The leading cause of prolapse is a weakened or damaged pelvic floor. That’s the muscle that sits in the base of the pelvis like a sling, attached to the pubic bone at the front and coccyx at the back. This muscle supports and helps keep all the pelvic organs in place. It also assists with bladder and bowel control.
There are many ways the muscle can become weak or damaged, such as:
- Pregnancy and vaginal childbirth
- Straining from persistent constipation
- A chronic cough – often associated with smoking
- Repeated lifting of heavy weights – at the gym, at work or of small children
- The jarring of high impact sport like running
- Being overweight or obese
- Pelvic surgery or injury
Who is at risk of developing a bladder prolapse?
Some factors increase your chances of developing this type of prolapse, including:
- Being postmenopausal. The reduction of oestrogen can lead to the vaginal wall becoming thinner, allowing an out-of-place bladder to push into the space more easily. A lack of oestrogen can also lead to the weakening of the pelvic floor muscle if it’s left unexercised.
- Family history. Some women are genetically more predisposed to developing a prolapse.
- Lifestyle. Factors that lead to the weakening or damage of the pelvic floor as described above – obesity, constipation, pregnancy, lifting heavy weights, etc.
- Surgery. Pelvic surgery can damage tissue, and a hysterectomy can contribute to the changing position of other pelvic organs, including the bladder.
Does a prolapsed bladder fix itself?
Unfortunately, no. It does need to be dealt with proactively and shouldn’t be ignored. Many women assume surgery is their only option, but depending on the stage of the prolapse, correction may be possible through lifestyle changes, including exercises that strengthen the pelvic floor muscles.
Treatment for a bladder prolapse
As mentioned, treatment will vary according to the extent of the prolapse. If your condition is moderate or severe, you may require an insert into the vagina to support the bladder, or you may need surgery. If the condition is mild, then lifestyle adjustments such as losing weight, quitting smoking, addressing constipation and pelvic floor exercises are likely to be recommended. In all cases, it’s best to consult with your doctor or gynaecologist to determine the extent of the prolapse and the right treatment for your circumstances.
Pelvic floor exercises for the treatment of mild bladder prolapse
Because a weak pelvic floor is often behind a prolapse, it makes sense that keeping it strong provides prevention as well as part of the treatment for mild or Stage 1 cases. To locate the right muscle, try stopping your urine mid-stream, paying close attention to where you’re clenching to do it – that’s your pelvic floor! While this is a great exercise to identify the right muscle, regularly stopping your urine flow isn’t recommended, so don’t repeat the exercise unnecessarily. When clenching (or engaging) the pelvic floor correctly, you should have a sensation of drawing in (towards a central point from front and back) and upwards.
If you’re having difficulty finding the muscle, are unable to stop your urine stream or clench, make an appointment with your doctor and ask for a referral to a continence physiotherapist who’ll be able to assist.
How to do pelvic floor exercises
When first starting exercises, pay extra attention to keep your pelvis in a neutral position (neither tipped forward or backwards) and your buttocks, stomach and thighs relaxed. You can do the exercises sitting, standing or lying down.
Clench the pelvic floor and hold for a slow count of six. If you don’t have the sensation of ‘letting go’ when you reach six, the grip has slipped away before the end. If that happens, shorten the count. Don’t worry if your count is only one or two – you’re making a start and, with persistence, the muscle’s condition will improve, and you will be able to hold for longer.
Aim for six ‘clench and hold’ exercises in a row, with a slow count of six in between to allow the muscle to recover.
Next, do six, strong clenches in rapid succession – then rest. If you can’t do six, do as many as you can.
The combination of slow and fast exercises makes a ‘set’, and you should try and do six sets across the day. However, if your muscle feels fatigued, give it a rest and do more later.
As the pelvic floor becomes stronger and the exercises easier, start to increase the ‘hold’ time for slow clenches, as well as the number of repetitions and sets, aiming to take both up to ten.
It’s also good to get into the habit of clenching and holding your pelvic floor when you sneeze, cough, laugh or lift anything heavy. This not only keeps you dry but braces the muscle against the stress of these activities, protecting it from damage.
How to know if the exercises are working?
You should notice the exercises becoming easier within two to three weeks. If you’ve not experienced any change, make an appointment with your GP and ask for a referral to a continence physiotherapist, who’ll be able to check your technique.
Managing incontinence associated with a bladder prolapse
If you’re experiencing incontinence from a bladder prolapse, you may feel more comfortable with a disposable, absorbent product while you seek treatment or as you’re strengthening your pelvic floor muscle.
All products in the TENA range
have been designed to handle the thinner, faster flow of a weak bladder, locking fluid away and keeping you dry. They’re soft, made of breathable fabric and are highly absorbent to minimise bulk and maximise discretion. They all contain odour-control which doesn’t mask but prevents odours from developing.
To find the best product for your needs, head to the TENA Product Finder Tool, where you can also order free samples.
Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.