Condition: Bladder Prolapse // Cystocele
Brief Overview: A prolapsed bladder, or cystocele, occurs when the bladder drops from its normal position and bulges into the anterior vaginal wall due to weakening of pelvic floor muscles and supporting tissues. It is the most common type of pelvic organ prolapse. Severity ranges from mild (asymptomatic) to severe (visible bulge and urinary symptoms).
Prevalence: Per NIDDK, “Experts estimate that nearly half of women who have given birth have some degree of pelvic organ prolapse.1 However, many other women with the condition do not have symptoms or do not seek care from a health care professional. As a result, the condition is underdiagnosed, and it is not known exactly how many women are affected by cystoceles.”
Etiology:
- Vaginal childbirth
- Menopause (decreased estrogen)
- Chronic straining (constipation, cough, heavy lifting)
- Pelvic surgery (e.g., hysterectomy)
- Aging and tissue laxity
- Obesity
- Family history of cystoceles
Risk Factors:
- Vaginal births
- Advancing age
- History of hysterectomy or pelvic organ prolapse repair surgery
- Overweight, obesity
- Family history of pelvic organ prolapse (POP)
Commonly Associated Conditions:
- Stress urinary incontinence
- Overactive bladder
- Urinary retention
- Recurrent UTIs
- Other pelvic organ prolapse types
Common Medications:
- Estrogen replacement therapy
Common Labs, Imaging, and Tests:
- Urodynamic testing
- Cystoscopy
- X-ray, MRI, ultrasound
Common Symptoms:
- Vaginal bulge sensation or visible protrusion
- Urinary urgency, frequency, or leakage
- Incomplete bladder emptying or retention
- Pelvic pressure that worsens with activity
- Recurrent UTIs
Common Treatments:
- Sometimes no treatment is needed
- Avoid heavy lifting and straining
- Weight management
- Estrogen replacement therapy
- Kegel exercises
- Pelvic floor physical therapy
- Pessary device
- Surgical intervention may be indicated
Physical Findings:
- Bulge at anterior vaginal wall
- Laxity of vaginal tissues
- Descent of bladder toward or beyond introitus
- Pelvic floor weakness
Potential Complications and Contraindications:
- Recurrent UTIs
- Urinary retention or incontinence
- Pessary irritation or ulceration
- Ureter, kidney damage
General Health and Lifestyle Guidance:
- Pelvic floor strengthening
- Weight management, if indicated
- Ask your healthcare provider if you need to avoid straining and heavy lifting
- Constipation prevention
- Smoking cessation (due to potential for chronic cough)
- Regular pessary care if applicable
Suggested Questions to Ask Patients:
- When did you first notice the bulge or urinary symptoms?
- Are symptoms worse at certain times of day or with activity?
- Any leakage, urgency, or retention?
- Have you had vaginal deliveries or prior pelvic surgery?
- Are you interested in pessary or surgical options?
Suggested Talking Points:
- This is a common condition and can often be managed without surgery.
- Pessary devices and pelvic floor therapy are effective for many women.
- Surgery is available in some cases if symptoms become severe or bothersome.
- Topical estrogen may help improve tissue support and reduce irritation.
- Always ask your healthcare provider for specific advice on when to call to report symptoms, and when to seek urgent/emergency care.
Sources:
- https://www.uptodate.com/contents/pelvic-organ-prolapse-in-females-epidemiology-risk-factors-clinical-manifestations-and-management?search=pelvic%20organ%20prolapse&source=search_result&selectedTitle=1~123&usage_type=default&display_rank=1
- https://www.niddk.nih.gov/health-information/urologic-diseases/cystocele#likely
- https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder
- https://www.urologyhealth.org/urology-a-z/b/bladder-prolapse-(cystocele)