Patient's Complete Guide to Bladder Prolapse

Overview of Bladder Prolapse

Bladder Prolapse also known as (Pahkna Fataq/ پھکنا فتق)is one of the leading diseases among women. About 40% of women over 50 years of age suffer from pelvic organ prolapse, and almost up to 10% recommend surgery for pelvic organ prolapse and urinary incontinence. (Urine leakage)

A hollow organ in the pelvic area is known as a bladder that retains urine. When a bladder is full of urine, it creates a pressure that releases the urine from the bladder. During urination, the urine moves to the  bladder that comes out of the body through the urethra.

In females, the bladder is supported by the front wall of the vagina. Typically, this wall loses its strength along with age as well as in:

  • Pregnancy and childbirth
  • Hysterectomy (pelvic surgery)

But if this supporting vaginal wall of the bladder has been damaged then it can cause bladder prolapse. Bladder prolapse means that this wall has loosened its motility and is no longer supported enough, due to this, it descends into the vagina. From this action, it can stimulate some difficulties such as urinary difficulties, discomfort, and stress incontinence (urine leakage caused by sneezing, coughing, exertion, etc.). Along with it, other organs can also be affected by bladder prolapse, that is, the uterus, the small intestine, and the rectum (rectocele).

Bladder Prolapse is also known as cystoceles or fallen bladders. It is further categorized into four grades depending on how much the bladder descends into the vagina, which are:

  • Grade 1 (mild): Just a small region of the bladder descends into the vagina.
  • Grade 2 (moderate): The adequate portion of the bladder descends to reach the opening of the vagina.
  • Grade 3 (severe): The bladder comes out from the body through the vaginal opening.
  • Grade 4 (complete): The entire bladder comes out of the vagina. It is usually associated with other pelvic organ prolapse forms (uterine prolapse, rectocele, enterocele).

Signs and Symptoms of Bladder Prolapse

The first symptom is the sign of acquiring the disease, but a person should observe it on their own. The first symptom of the women with the prolapsed bladder is a feeling of pressure in the vagina or bladder.

Other symptoms of a prolapsed bladder are mentioned below:

  • Discomfort or pain in the pelvis, lower abdomen, and during sitting
  • Protrude tissue from the vagina (The tissue may tender and bleed)
  • Heavy bulge in the vagina
  • Difficulty during urination
  • A feeling that the bladder is not empty immediately after urinating
  • Stress incontinence (urine leakage during sneezing, coughing, exertion, etc.)
  • Constant bladder infections
  • Painful intercourse (dyspareunia)
  • Urinary Incontinence during intercourse
  • Low back pain

Causes of Bladder Prolapse

Factors affecting the bladder prolapse are associated with weakened pelvic floor muscles and ligaments supporting the bladder, urethra, uterus, and rectum. That results in the detachment of these organs from the ligaments and pelvic bone muscles.

These are the major causes of developing bladder prolapse:

  1. Pregnancy – It affects more on those women who have multiple pregnancies. During pregnancy, the fetus becomes bigger and heavier that causes more pressure on the pelvic muscle. Some muscles cannot handle the adequate weight that causes stretching and losing muscle strength.
  2. Giving childbirth – During labour and delivery, the extra pressure is being put on the pelvic muscle and ligament that support the vagina resulting in muscle strain. Due to which bladder muscles cannot provide enough support and lose their position.
  3. Menopause – Estrogen is a hormone released into the body. It helps to strengthen the vaginal muscle. When women are undergoing their menopausal period, the body itself stops producing the estrogen and ultimately makes the vaginal muscle weaker.
  4. Vigorous activities– Activities such as lifting heavy objects, straining during the bowel movement, the forceful cough may cause damage to the pelvic muscle.
  5. Overweight or Obesity – Being the heavyweight is also considered as one of the top risks in causing bladder prolapse.

Other risk factors that may involve and increase the pelvic muscle pressure are:

  • Chronic Obstructive Pulmonary Disease (COPD)
  • Obesity
  • Constipation
  • Heavy manual exercises (for example, heavy lifting and straining).

Risk Factors of Bladder Prolapse

Some of the risk factors for bladder prolapse include;

  • Being overweight
  • Family history of the disease
  • Pelvic surgery that makes your pelvic floor weak
  • Gynecological procedure
  • Workout that weak your pelvic floor
  • Chronic cough
  • Connective tissue disease
  • Forcefully emptying your bladder
  • Menopausal women

Prevention

Some of the tips that can help you to prevent bladder prolapse include:

  • Maintaining a healthy weight
  • Consuming foods rich in fiber to keep your bowel movement regulated
  • Avoiding intense physical activity
  • Getting your chronic cough treated
  • Addressing your digestive health problems i.e., constipation

Diagnosis

Initially, the physical examination of the female genitalia and pelvis is usually required to check the bladder bulges into the vagina. Additionally, a urologist or general physician will ask some questions to identify the extent of bladder prolapse, as well as determine the cause of increased pressure of urinary leakage.

These are the diagnostic tests that a urologist will recommend for a complete diagnosis, which includes:

  • Voiding Cystourethrogram – The test is performed to examine the bladder and urethra impairment in appearance or function when the bladder fills and empties. It is conducted through a radiopaque liquid placed via the catheter; different radio-graphs are captured before, during, and after voiding.
  • Cystoscopy –This test is a non-invasive procedure. It is practiced to examine the inside view of the urinary tract. This will assist the doctor to determine any abnormalities in the bladder, ureter, and urethra. It is tolerable for most people and has minor risks.

After diagnosis, a urologist or general physician may recommend the tests of nerves, muscles, and the intensity of the urine stream that helps decide on the appropriate line of treatment.

  • Urodynamics or Video Urodynamics tests can be performed at the doctor's consultation. Urodynamics measures pressure and volume of the urine in the bladder and can also assess the urethra functionality whether it is working properly or not.

Treatment of Bladder Prolapse | When to Consult a Doctor

Nonsurgical treatments are based on conservative management and the use of mechanical devices.

  • Behavioral Therapy and Pelvic Floor Muscle Exercise(PFME): These are conservative therapies for the management of bladder prolapse. The aim of conservative treatments is the reduction of symptoms, prevention of severe pelvic organ prolapse, increased support of the pelvic floor muscles, and delaying surgery. Behavioral therapy is required to treat constipation, weight loss (for obese people), and quit smoking if COPD/cough, etc. PFME is beneficial for strengthening the pelvic floor muscles. This exercise should be performed regularly several times a day. Generally, a person can take a set of 10 sustained contractions for about 20 minutes two to three times a day. It is preferable for mild to moderate pelvic organ prolapse.
  • Mechanical Devices: Pessaries are prescribed to those patients who are unwilling to surgery or who refuse surgery. It is not suitable for a too small or too big vagina because the pessary may be difficult to fit properly. If the pessary fits well then one is enough to insert and remove it after the usage. According to the studies, more than 50% of people are continuing to use it for at least a year.

These are some complications that is caused by the usage of pessaries, that include:

  • Pessary disruption into the vagina
  • Pelvis pain
  • Vaginal discharge
  • Stress urinary incontinence
  • Troubles with urination and bowel movement

The pessary is cheaper as compared to the pelvic floor muscle exercises.

  • Estrogen Replacement Therapy: As you know, estrogen is good for vaginal muscle strengthening that's why this therapy is required. Generally, the ovaries release the estrogen, but it stops after menopause that weakens the muscles of the vagina. Estrogen replacement therapy may be contraindicated in people who have a high risk of ovary cancer.

In mild cases of bladder prolapse, a urologist may prescribe estrogen to reverse its symptoms, such as vaginal weakening and incontinence. For more severe cases of the prolapse, estrogen replacement therapy may be highly recommended along with other types of treatment.
Estrogen can be administered in many ways such as giving orally, as a pill, or topically as a patch or cream. The cream has very little systemic absorption and has a potent effect on the specified area of application.
Topical administration is more tolerable and less risky than oral preparations.
The application of estrogens to the anterior vagina and urethral region may alleviate the urinary symptoms, such as urgency and frequency, even in the face of a prolapsed bladder.

Note: Do not use any estrogen medications without doctor’s consultation.

Surgery

If the bladder prolapse is not treated properly through conservative treatments then surgery is recommended for the prolapsed treatment. After the surgery, a woman is coming back into routine activities after 6 weeks.

In case you exhibit any concerning signs and symptoms for bladder prolapse, consult a medical professional as soon as possible.

Speciality for Bladder Prolapse

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