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The bladder is an important bodily organ that stores and expels urine. In women, the bladder is held in place by supportive pelvic floor muscles and other tissues. Those muscles may weaken with age, or after major events like childbirth, which can cause the bladder to essentially fall down and onto the vagina – a condition known as bladder prolapse, otherwise called fallen bladder or cystocele.

This guide explores bladder prolapse symptoms, causes, and treatment options.

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What is bladder prolapse (cystocele)?

The medical term prolapse refers to cases where organs fall or slip out of their usual position. A prolapsed bladder, therefore, is when the bladder drops out of place and, in women, puts pressure on the vaginal wall creating a bulge or swelling in the vagina. This happens when the pelvic floor muscles, which support multiple pelvic organs – including the bladder, uterus, and rectum – weaken or get damaged.

Cases of bladder prolapse can vary in severity, with three distinct bladder prolapse stages or grades in total:

  • grade 1 is mildest kind, in which the bladder drops only a short way into the vagina,
  • grade 2 is a moderate form of prolapse, with the bladder sitting by the opening of or just outside the vagina,
  • and grade 3 is the most severe variety, with the bladder bulging beyond the opening of the vagina.

Depending on the grade (severity) of the prolapse, the patient may experience different symptoms and require different treatments.

How common is it?

Bladder prolapse is a common condition, impacting around half of women. Some are at higher risk than others. The risk rises with age, for example, and prolapses are more common in menopausal women, as well as those who give birth vaginally.

What causes bladder prolapse?

The underlying cause of any bladder prolapse is when the pelvic floor muscles become weak or damaged, but this can happen due to various reasons:

  • Vaginal childbirth, which puts lots of pressure on the pelvic floor muscles and surrounding tissue
  • A history of prolapses in the family
  • Obesity, or having a body mass index above 30
  • After a hysterectomy
  • Excessive straining, such as when passing stool
  • Excessive coughing, often associated with conditions like bronchitis
  • Lifting heavy objects repeatedly
  • Low levels of oestrogen, which may be caused by ageing, menopause, or certain medical conditions – oestrogen is a hormone that helps the muscles and walls around the vagina stay strong and flexible

Risk factors

Some women are at greater risk of suffering a bladder prolapse due to the following factors:

  • Genetics: Some people simply have weaker pelvic floor muscles and connective tissue due to their genetics. If your mother, grandmother, or other women in your family have had prolapses in the past, you may be at higher risk.
  • Multiple Children: Vaginal childbirth, especially when assisted with instruments such as forceps, is one of the leading causes of prolapse and related issues, as it causes trauma to the pelvic floor muscles, resulting in long-term weakness of those muscles. The more children you deliver, the higher the risk of prolapse. Risks also arise with particularly large and heavy babies or multiple births.
  • Lifestyle: Certain lifestyles, such as hobbies or occupations that involve continued pressure on the pelvic floor, for example, women who spend much of their time on their feet and lifting or straining. Being overweight or suffering a chronic cough associated with smoking, or chronic constipation contributes to the risk of prolapse.
  • Disorders: Certain specific health conditions, like connective tissue disorders, can also put a woman in the “high risk” category for bladder prolapse.
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What are the most common bladder prolapse symptoms?

The symptoms of a bladder prolapse depend on its severity. In mild cases, patients may not notice any symptoms, and their prolapse could go undetected until their next cervical screening or inspection. In other cases, the symptoms are clear and numerous, and they may include:

  • A feeling of pressure or “dragging” sensation in the vagina
  • A visible lump or bulge from the vagina, which might be more or less prominent in certain positions, like lying or standing
  • Difficulty when urinating, such as having to strain or having a stop-start flow, as well as frequent UTIs (urinary tract infections)
  • A regular feeling that your bladder is not empty, even after using the toilet
  • Urinary incontinence (not being able to hold urine in when needed)
  • Problematic or painful sexual intercourse or activity
  • Lower back pain

Can a cystocele be prevented?

You cannot necessarily remove any possible risk of suffering a bladder prolapse, but there are steps you can take to reduce your risk. These include:

  • Following healthy lifestyle habits. Eat a balanced diet, stay hydrated, exercise, refrain from smoking or drinking excessively, and maintain a healthy body weight.
  • Preventing constipation and not straining when using the toilet. Drinking plenty of water daily and eating a lot of fibre will help with this.
  • Avoiding heavy or intense physical activities, like lifting heavy objects on your own. If you have to lift something heavy, ask for help and make sure to bend your knees.

Unfortunately, even with these preventative measures, you could still suffer a prolapse due to factors beyond your control, like genetics, health conditions, or ageing.

How is a prolapsed bladder diagnosed?

Urogynaecologists will take a history of your symptoms and perform a vaginal examination, which may involve a straining manoeuvre or when standing, to diagnose bladder prolapse. If there are any associated urinary symptoms, further tests may be carried out including a flow and residual test, urodynamics, or a cystoscopy tests, in which a thin, lighted tube is inserted into the urethra to examine the bladder from within for any abnormalities.

A bladder prolapse can be mistaken for a prolapse of the womb (uterus) or a bowel prolapse. If you feel a bulge in your vagina, or heaviness and a dragging feeling, for an accurate diagnosis and proper care, it is important to seek advice and assessment from a urogynaecologist.

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Bladder prolapse treatment options

Various treatment options exist for prolapsed bladders, including pelvic floor exercises that patients can learn to do at home or under the supervision of a women’s health physiotherapist, vaginal devices such as a ring pessary and bladder prolapse surgery for the most serious cases. Discussing your situation and needs with a specialist urogynaecologist is important to get a customised treatment plan that is right for you.

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Lifestyle and home remedies

In most cases, patients will be encouraged to try a range of lifestyle adjustments and at-home remedies before considering surgical intervention. Simple ways to help manage your symptoms include:

  • Kegel or pelvic floor exercises can help you strengthen and rebuild your pelvic floor muscles after they have been weakened or damaged by childbirth or other causes. A woman’s health physiotherapist can oversee and guide you when doing these exercises.
  • If you regularly lift heavy items or do a lot of manual work or exercise, you may have to adapt your lifestyle to reduce the strain on your pelvic floor, which leads to weakening. As mentioned earlier, obesity is a contributing factor in many cases of bladder prolapse. Aiming to reach and maintain a healthy body weight through a combination of diet and exercise, can help you live more comfortably.
  • Bladder prolapses sometimes occur when patients repetitively strain to pass stool. A high-fibre diet can reduce your risk of constipation and make bowel movements easier.
  • In some cases, particularly in women with low levels of oestrogen production, specialists may recommend the use of vaginal oestrogen creams, rings, or tablets to boost oestrogen levels.

Pessary for bladder prolapse

A pessary is a device, such as a ring, that can be inserted into the vagina to essentially do the job that your pelvic floor muscles may no longer be able to do. It supports the bladder from below. This will reduce the prolapse, and it should ease the symptoms. Some women opt for pessaries as a long-term supportive measure if they prefer to avoid surgery.

When is bladder prolapse surgery necessary?

If the above treatments fail to provide the necessary relief, or in cases of severe prolapse, with painful or difficult symptoms impacting the patient’s quality of life, or if it is the patient’s preference, surgery may be the only viable option. Urogynaecologists recommend that you defer surgery until you have completed your family, as further pregnancies or births may lead to recurrence of the prolapse.

The procedure is carried out within the vagina, and the bladder will be repositioned and secured with stitches.

As with any type of surgery, bladder prolapse surgery has risks, and it is not guaranteed to permanently fix the problem. Patients may suffer a subsequent prolapse in the future and may require repeat operations to fix it. Recovery times vary depending on the type of surgery used, but they typically range from two to six weeks.

If you also have prolapse of your womb or bowel, this can also be addressed at the same time.

Why choose London Women’s Centre for bladder prolapse treatment?

London Women’s Centre aims to be your first choice for all women’s health care issues and treatments, including bladder prolapse treatment. Our expert team can create a customised healthcare plan to suit your specific situation, needs, and objectives by offering a range of treatment options, including physiotherapy, medication, and surgery.

Our pelvic floor specialist and urogynaecologist provides the highest standards of personalised care and support for every woman who walks through our doors. Our clinic provides access to the latest and most effective treatments, medications, and medical equipment, so you are guaranteed the finest levels of care every time.

Contact the London Women’s Centre team today to learn more.