Prolapse


Urinary bladder is located in the pelvis between the pelvic bones. When the muscles that support the pelvic region are strained, in cases such as, during vaginal childbirth or chronic constipation, then it may result in anterior prolapse. What is it? An anterior prolapse also called bladder prolapse or cystocele is a condition where the bladder is herniated into the vagina making it appear like a bulge. This occurs when the supportive tissues of the vagina becomes weak and stretched.


Causes of anterior prolapse:

The muscles, ligaments and connective tissues in the pelvic floor support the bladder and other pelvic organs. Any damage to these muscles or ligaments present between the pelvic floor and bladder may weaken and stretch the bladder and vaginal walls which ultimately results in the displacement of the bladder into the vagina.

Below are certain factors that may weaken the pelvic muscles:
Pregnancy and vaginal delivery
Overweight or obesity
Heavy lifting of the objects
Repetitive straining during bowel movements
Inappropriate gym exercises
Chronic or violent coughing

Symptoms

The symptoms of moderate to severe anterior prolapse would include:
Sensation of fullness or pain in the pelvic region
Feeling of incomplete urination
Increased frequency and urge to urination
Recurrent urinary tract infections
Protrusion of vagina and bladder through the vaginal opening

Diagnosis

A physical examination and certain laboratory tests are prerequisite. These allow the doctor to grade the prolapse and assess the pelvic floor muscle. The doctor may recommend bladder and pelvic ultrasound to rule the presence of any masses applying pressure on the bladder and also evaluate the muscle function. Urinalysis may be suggested to look for any symptoms of infection in the bladder.
Ultrasound of the pelvis
Imaging tests
Blood tests
anterior prolapse

Treatment options

In cases of asymptomatic bladder prolapse, no treatment is required. However, incorporating certain lifestyle modifications could help in preventing or worsening the condition. In moderate anterior prolapse, the following therapies are recommended:
Vaginal pessaries: A vaginal pessary is a plastic ring that should be inserted into the vagina to support the vaginal wall and holds the bladder.
Estrogen therapy: Your doctor may prescribe estrogen therapy that keeps the pelvic floor muscles strong and healthy preventing further prolapse.

Risk factors

Some of the factors that may increase the risk of developing anterior prolapse or cystocele are:
Age: The risk of anterior prolapse increases with your age. Mostly, the risk increases after menopause when there is a decreased production of estrogen.
Surgical procedure: The surgical techniques such as hysterectomy may weaken the pelvic floor muscles leading the bladder to prolapse into the vagina.
Increased intra-abdominal pressure: Chronic lung disease, straining with chronic constipation, persistent cough caused by smoking, and repeated heavy lifting might increase the pressure in the abdomen and result in weakened pelvic floor muscles.
Obesity: Overweight or obesity may increase your risk of anterior prolapse.

Prevention and Self-management:

Refraining from lifting heavy objects.
Performing regular exercise such as walking, swimming or bike riding, instead of running, jumping or high-impact aerobics.
Increasing the amount of fiber consumption and water intake to prevent constipation.
Practicing pelvic floor exercises to strengthen the muscles that support the organs in the pelvic cavity.
Managing the weight in a healthy range because obesity may worsen the condition.

cystocele

Dealing with urinary incontinence during the prolapse

If the anterior prolapse or cystocele is associated with urinary incontinence, your doctor may recommend a procedure that supports the urethra and resolving the incontinence symptoms.



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