Pelvic organ prolapse (bladder prolapse): symptoms and treatment

1What is bladder prolapse?

Pelvic organ prolapse is when the womb, bladder or bowel bulges into the vagina, according to the NHS. Bladder prolapse (cystocele) happens when the tissues that support the bladder and the front wall of the vagina weaken and stretch, so the bladder drops into the vaginal canal. The US NIDDK calls it the most common type of pelvic organ prolapse, also known as anterior vaginal wall prolapse.

According to the NHS and NIDDK, doctors usually grade prolapse from 1 to 4, with grade 1 the mildest.

🧩Types of pelvic organ prolapse

A patient leaflet from University Hospitals Sussex NHS Foundation Trust describes prolapse by the part that drops:

🔍Causes and risk factors

The NHS and Mayo Clinic list factors that weaken pelvic floor support:

• Pregnancy and childbirth: especially vaginal birth, forceps delivery, several pregnancies and large babies, according to Mayo Clinic.
• Ageing and menopause: risk rises after the menopause, when estrogen levels are lower.
• Chronic straining: long-term constipation, a persistent cough and repeated heavy lifting.
• Being overweight and previous pelvic surgery such as a hysterectomy.
• Inherited factors: weaker connective tissue, and conditions such as joint hypermobility syndrome, Marfan syndrome and Ehlers-Danlos syndromes, according to the NHS.

The NHS says prolapse is common in women over 50, and NIDDK estimates that nearly half of women who have given birth have some degree of prolapse, although many have no symptoms. Pelvic floor weakness after birth is also linked to incontinence after childbirth.

🩺Symptoms and effects on the bladder

Mild prolapse may cause no symptoms. When symptoms occur they can include:

• Heaviness or pressure in the lower tummy or vagina, often worse after long standing and better lying down.
• A bulge in or coming out of the vagina.
• Trouble starting to urinate or a feeling that the bladder has not emptied.
• Needing to pass urine more often, or urgency.
• Leaking urine when coughing, sneezing or lifting, which overlaps with urinary incontinence in women.
• Repeated bladder infections, which Mayo Clinic links to poor emptying.
• Discomfort during sex, and constipation with posterior prolapse.

NIDDK explains that a cystocele can cause urinary retention, where the bladder cannot empty fully, and in rare cases can kink the ureters so urine backs up into the kidneys. Some symptoms resemble an overactive bladder, so a medical assessment is important.

🔬How bladder prolapse is diagnosed

The doctor asks about your symptoms and births, then examines the pelvis. According to the NHS, this may be done lying on your side or standing, sometimes with a speculum; NIDDK notes you may be asked to strain so severity can be judged. You can ask for a chaperone or a female doctor.

With bladder symptoms, tests may include a urine test for infection, a check of urine left after voiding and sometimes bladder function tests (urodynamics). The doctor decides which tests are needed. Learn more about urology for women.

💊Treatment options

The NHS and NIDDK say treatment is usually not needed if there are no symptoms or the prolapse is not bothering you. Otherwise the choice depends on the organ affected, severity, age, health and pregnancy plans, decided with your doctor.

• Pelvic floor muscle training: ideally guided by a specialist women’s health physiotherapist. The Sussex leaflet says it can help mild prolapse and may help moderate prolapse. See our guide to Kegel exercises.
• Vaginal pessary: a plastic or silicone device placed in the vagina to support the organs. The Sussex leaflet notes it needs regular changing to avoid vaginal ulceration.
• Local hormone treatment: the NHS lists vaginal hormone options; your doctor decides whether they are suitable.
• Surgery: considered when prolapse is severe or other measures have not helped.

❓Surgery and the question of mesh

According to NIDDK, the most common operation for a cystocele is anterior vaginal repair (anterior colporrhaphy), which repositions the bladder and tightens support with stitches. Obliterative surgery closes the vagina and ends vaginal intercourse, so suits only selected women. MedlinePlus states that a urinary catheter usually stays in for 1 or 2 days after anterior repair, and that the repair alone does not treat stress incontinence.

MedlinePlus lists risks including bleeding, infection, clots, injury to the bladder or urethra, worsening incontinence, lasting pain and fistula. On mesh: the NHS says vaginal mesh surgery is no longer done on the NHS unless there is no alternative, and MedlinePlus notes that the US FDA has banned synthetic material and animal tissue in the vagina for this condition.

To ease symptoms, NIDDK and the NHS advise a healthy weight, enough fibre and fluids, treating chronic cough, not smoking and lifting with your legs.

⏰When to see a doctor urgently

See a doctor about a vaginal lump or bothersome symptoms, or about unusual bleeding or discharge if you use a pessary. Seek urgent care for:

• Inability to pass urine with a full bladder: NIDDK states that acute urinary retention can cause severe pain and be life threatening, and that you should seek emergency treatment right away.
• Fever, chills or pain in the side with urinary symptoms, which may signal infection.
• A bulge that suddenly cannot be pushed back, especially with pain.

❓Frequently asked questions

10Sources

1. Pelvic organ prolapse – NHS
2. Cystocele (Prolapsed Bladder) – NIDDK
3. Anterior vaginal prolapse (cystocele) – Symptoms and causes – Mayo Clinic
4. Anterior vaginal wall repair – MedlinePlus Medical Encyclopedia
5. Definition & Facts of Urinary Retention – NIDDK
6. Pelvic organ prolapse – University Hospitals Sussex NHS Foundation Trust (patient leaflet)