What is a Fallen Bladder?

A fallen bladder, also known as a cystocele, is a condition in which the bladder drops down or protrudes into the vagina. It occurs when the muscles and supportive tissues that hold the bladder in place become weakened or stretched.

The bladder is a hollow organ located in the lower abdomen that stores urine produced the kidneys. It is held in place a complex network of muscles, ligaments, and other supportive tissues. When these structures become weakened, the bladder may lose support and descend into the vagina, leading to a fallen bladder.

There are several factors that can contribute to the development of a fallen bladder. One common cause is age-related weakening of the pelvic floor muscles and tissues. As women age, the hormonal changes associated with menopause can lead to a decrease in collagen production, which in turn weakens the supportive tissues of the bladder and pelvic floor.

Childbirth is another common cause of a fallen bladder. The act of giving birth puts significant strain on the pelvic floor muscles and can stretch or damage the supportive tissues. Women who have had multiple vaginal deliveries or delivered large babies are particularly at risk for developing a cystocele.

Obesity is also a risk factor for a fallen bladder. Excess weight puts additional pressure on the pelvic organs, including the bladder, which can lead to its descent. Chronic constipation, chronic coughing, and heavy lifting are other factors that can contribute to the weakening and descent of the bladder.

In some cases, a fallen bladder may be caused connective tissue disorders or genetic predisposition. Certain conditions, such as Ehlers-Danlos syndrome, Marfan syndrome, or a family history of pelvic organ prolapse, can increase the risk of developing a cystocele.

The symptoms of a fallen bladder can vary depending on the severity of the condition. Some women may experience no symptoms at all, while others may have bothersome symptoms that affect their quality of life. Common symptoms include:

1. A bulge or pressure sensation in the vagina. This is often described as a feeling of something “falling out” or a bulge that can be felt or seen.
2. Difficulty emptying the bladder completely. Women with a fallen bladder may have to strain or push to empty their bladder fully, or they may feel like they haven’t emptied completely after urination.
3. Urinary incontinence. A fallen bladder can lead to stress urinary incontinence, which is the involuntary leakage of urine during activities such as coughing, laughing, sneezing, or exercising.
4. Frequent urinary tract infections. The descent of the bladder can disrupt the normal flow of urine, creating pockets where bacteria can grow and leading to an increased risk of urinary tract infections.
5. Pain or discomfort during sexual intercourse.
6. Lower back pain or pelvic pain. Some women with a fallen bladder may experience chronic pain in the lower back or pelvic region.

If you suspect that you have a fallen bladder, it is important to seek medical evaluation and diagnosis. A healthcare provider, typically a gynecologist or urologist, can perform a physical examination to assess the position of the bladder and identify any associated pelvic floor disorders.

Treatment options for a fallen bladder depend on the severity of the condition and the impact on a woman’s quality of life. Mild cases of cystocele may not require treatment and can be managed through lifestyle modifications and pelvic floor exercises.

Pelvic floor physical therapy, which includes exercises to strengthen the pelvic floor muscles, can help improve bladder support and control. Kegel exercises, in particular, are often recommended and involve contracting and relaxing the pelvic floor muscles in a specific way.

Behavioral modifications such as weight management, avoiding heavy lifting, and treating chronic constipation or coughing can also help alleviate symptoms and prevent further descent of the bladder.

In some cases, a healthcare provider may recommend using a vaginal pessary. A pessary is a device that is inserted into the vagina to provide support for the bladder and prevent it from descending further. Pessaries come in different shapes and sizes and can be fitted a healthcare provider.

Topical estrogen therapy may be prescribed for women who are experiencing vaginal dryness or atrophy, as hormonal changes can contribute to the weakening of the supportive tissues. Estrogen can help improve the elasticity and thickness of the vaginal tissues, providing additional support for the bladder.

For more severe cases of a fallen bladder, or for women who do not find relief from conservative measures, surgery may be recommended. There are various surgical approaches, including traditional open surgery, laparoscopic surgery, and robotic-assisted surgery. The specific procedure will depend on factors such as the severity of the cystocele and the presence of other pelvic floor disorders.

During a cystocele repair surgery, the supportive tissues of the bladder and pelvic floor are tightened and repositioned to restore normal anatomy and function. This may involve a variety of techniques, such as an anterior or posterior colporrhaphy, where the vaginal wall is strengthened using stitches. In some cases, a synthetic mesh may be used to add additional support to the pelvic organs.

In more complex cases, a procedure called sacrocolpopexy may be performed. This involves using a piece of mesh to attach the top of the vagina to the sacrum, a bone at the base of the spine. This provides long-lasting support for the bladder and other pelvic organs.

In certain situations, obliterative procedures may be recommended. These procedures involve narrowing or closing off the vaginal canal to provide support for the pelvic organs. Although effective in relieving symptoms, obliterative procedures are irreversible and may impact sexual function.

It is important to note that the treatment approach for a fallen bladder should be individualized based on the patient’s specific condition, symptoms, and preferences. A healthcare provider will discuss the options and help determine the most appropriate course of action.

A fallen bladder, or cystocele, is a condition in which the bladder drops down or protrudes into the vagina due to weakened or stretched supportive tissues. It can be caused factors such as age-related hormonal changes, childbirth, obesity, and connective tissue disorders. Symptoms may include a bulge in the vagina, difficulty emptying the bladder, urinary incontinence, frequent urinary tract infections, and pain during intercourse. Treatment options include lifestyle modifications, pelvic floor exercises, vaginal pessary, topical estrogen therapy, and surgery. The choice of treatment depends on the severity of the condition and the impact on a woman’s quality of life. Consulting with a healthcare provider is essential for proper evaluation and individualized management of a fallen bladder.