Bladder collapse

Diagnosis of anterior prolapse may involve:

A pelvic exam. You may be examined while lying down and possibly while standing up. During the exam, your provider looks for a tissue bulge into your vagina that indicates pelvic organ prolapse. You'll likely be asked to bear down as if during a bowel movement to see how much that affects the degree of prolapse. To check the strength of your pelvic floor muscles, you'll be asked to contract them, as if you're trying to stop the stream of urine.

Filling out a questionnaire. You may fill out a form that helps your provider assess your medical history, the degree of your prolapse and how much it affects your quality of life. This information also helps guide treatment decisions.

Bladder and urine tests. If you have significant prolapse, you might be tested to see how well and completely your bladder empties. Your provider might also run a test on a urine sample to look for signs of a bladder infection, if it seems that you're retaining more urine in your bladder than is normal after urinating.

Treatment depends on whether you have symptoms, how severe your anterior prolapse is and whether you have any related conditions, such as urinary incontinence or more than one type of pelvic organ prolapse.

Mild cases — those with few or no obvious symptoms — typically don't require treatment. Your provider may recommend a wait-and-see approach, with occasional visits to monitor your prolapse.

If you do have symptoms of anterior prolapse, first line treatment options include:

Pelvic floor muscle exercises. These exercises — often called Kegel exercises or Kegels — help strengthen your pelvic floor muscles, so they can better support your bladder and other pelvic organs. Your provider or a physical therapist can give you instructions for how to do these exercises and can help you determine whether you're doing them correctly.

Kegel exercises may be most successful at relieving symptoms when the exercises are taught by a physical therapist and reinforced with biofeedback. Biofeedback involves using monitoring devices that help ensure you're tightening the proper muscles with optimal intensity and length of time. These exercises can help improve your symptoms, but may not decrease the size of the prolapse.

A supportive device (pessary). A vaginal pessary is a plastic or rubber ring inserted into your vagina to support the bladder. A pessary does not fix or cure the actual prolapse, but the extra support the device provides can help relieve symptoms. Your doctor or other care provider fits you for the device and shows you how to clean and reinsert it on your own. Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.

When surgery is necessary

If you still have noticeable, uncomfortable symptoms despite the treatment options above, you may need surgery to fix the prolapse.

How it's done. Often, the surgery is performed vaginally and involves lifting the prolapsed bladder back into place using stitches and removing any excess vaginal tissue. Your doctor may use a special type of tissue graft to reinforce vaginal tissues and increase support if your vaginal tissues seem very thin.

If you have a prolapsed uterus. For anterior prolapse associated with a prolapsed uterus, your doctor may recommend removing the uterus (hysterectomy) in addition to repairing the damaged pelvic floor muscles, ligaments and other tissues.

If you have incontinence. If your anterior prolapse is accompanied by stress incontinence — leaking urine during strenuous activity — your doctor may also recommend one of a number of procedures to support the urethra (urethral suspension) and ease your incontinence symptoms.