Here at Recharged PT, we help a lot of people with a *lot* of different problems: different types of incontinence, Vestibulodynia, Diastasis Recti, and recovery from pregnancy to name a few.

Today, we are going to talk about Anterior Vaginal Prolapse (Bladder Prolapse). The Bladder holds our urine and exists in a “sling” or “hammock” of pelvic floor muscles and ligaments. Cystocele (SIS-toe-seel) is when the bladder drops from its usual position and presses on the vaginal wall. A type of pelvic organ prolapse, cystocele or anterior vaginal prolapse, can occur if the pelvic floor muscles are weak, the organ is not in the correct spot in the pelvis in general (especially post child birth) or if there is too much pressure put on the pelvic floor. Common causes of a prolapsed bladder include repetitive stress over time (e.g., coughing, improper lifting) or during vaginal childbirth. 

Details & Symptoms:

Just as with other pelvic floor conditions, the severity of cystocele vary: from a grade 1 (the bladder only drops a short way into the vagina) to a grade 4 (the bladder is completely out past the vaginal opening). Bladder prolapse may be more common than you realize. Medical professionals estimate that up to 50% of women may have some degree of cystocele; it’s just a matter of whether or not they experience symptoms. Signs and symptoms may get worse as the day goes on and are often provoked with standing.

This includes:

• A feeling of fullness or pressure in your pelvic area, which may increase when you “bear down” or strain (cough)

• Difficulty with initiating urination and/or completely emptying your bladder

• Going to the bathroom more frequently than usual

• Frequent UTIs

• Difficulty inserting period products (like tampons) and/or pain with sex

• Urinary incontinence

• A bulge of tissue in your vagina that you can see or feel (in moderate to severe cases)

• Relief from symptoms when lying down

Risk factors for a bladder prolapse include pregnancy and vaginal childbirth, aging, a history of hysterectomy, genetics and obesity. The good news is that a healthcare provider can diagnose a bladder prolapse with certain special tests. Urodynamic testing measures the bladder’s ability to retain and empty urine. A cystoscopy occurs when a tube with a camera on the end passes into your urethra and then your bladder, looking for malformations, blockages, or stones. Your healthcare provider may also perform a general pelvic exam. Pelvic Floor PTs can examine and diagnoses this visually as well as with a pelvic exam in order to determine severity and muscular components to the issue.

Treatment:

How a cystocele is treated depends on the severity of the prolapse and symptoms, if any. Many patients with a mild to moderate prolapse without symptoms may not require treatment at all, electing to adopt a “wait and see” approach with their healthcare provider. Other conservative management can include seeing a pelvic floor therapist and/or wearing a pessary (a device that provides vaginal support). Your provider may also place you on estrogen replacement drugs to assist with tissue healing especially after childbirth and in peri/menopause. In cases of severe prolapse (grade 4), surgery may be necessary. 

But don’t despair! Either way, a pelvic floor PT is the perfect person to assist with your symptoms. The most important part is to see a pelvic specialist that can perform an individual assessment of you and your body. Many experts will recommend people do Kegel exercises (which we’ve also talked about here) to strengthen the pelvic floor. However, not everyone needs to strengthen their pelvic floor, but rather relax it.

In fact, doing Kegels may make symptoms worse. For the vast majority of people, their pelvic floor is too tight!

Overall, bladder prolapse may be a common pelvic floor issue that many people deal with, sometimes with and sometimes without symptoms. If it begins to impact you on a day to day basis, it is important to get it assessed sooner rather than later. As with anything related to pelvic floor dysfunction, you do not have to suffer with your symptoms. There is help out there! And we at Recharged PT are here for you! 

<3 The Recharged Performance Therapy Team

321-802-1630

www.rechargedperformancetherapy.com

References

https://my.clevelandclinic.org/health/diseases/15468-cystocele-fallen-bladder

https://www.mayoclinic.org/diseases-conditions/cystocele/symptoms-causes/syc-20369452

https://www.urologyhealth.org/urology-a-z/b/bladder-prolapse-(cystocele)