Bladder collapse

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Overview

The bladder is a hollow organ in the pelvis that stores urine. The pressure created when the bladder fills with urine is what causes the urge to urinate. During urination, the urine travels from the bladder and out the body through the urethra.


In women, the front wall of the vagina supports the bladder. This wall can weaken or loosen with age. Significant bodily stress such as childbirth can also damage this part of the vaginal wall. If it deteriorates enough, the bladder can prolapse, meaning it is no longer supported and descends into the vagina. This may trigger problems such as urinary difficulties, discomfort, and stress incontinence (urine leakage caused by sneezing, coughing, and exertion, for example).


Prolapsed bladders (also called cystoceles or fallen bladders) are separated into four grades based on how far the bladder droops into the vagina.


Grade 1 (mild): Only a small portion of the bladder droops into the vagina.

Grade 2 (moderate): The bladder droops enough to be able to reach the opening of the vagina.

Grade 3 (severe): The bladder protrudes from the body through the vaginal opening.

Grade 4 (complete): The entire bladder protrudes completely outside the vagina; usually associated with other forms of pelvic organ prolapse (uterine prolapse, rectocele, enterocele).


Prolapsed bladders are commonly associated with menopause. Prior to menopause, women’s bodies create the hormone estrogen, which helps keep the muscles in and around the vagina strong. Women’s bodies stop creating as much estrogen after menopause, and those muscles tend to weaken as a result.


Symptoms

Mild cases of pelvic organ prolapse often don’t cause any symptoms. But if the organs drop down further, the following problems may arise:


feeling like something is pushing down

feeling like there’s a foreign object in your abdomen

a weak bladder, needing to urinate (pee) often, or difficulties urinating

a “dragging” pain in the abdomen

pain during sex

problems with bowel movements

back pain

pressure sores and bleeding in the vagina

Pain, pressure and the feeling that there’s something inside you mainly occur when walking, standing or during bowel movements. They often go away when you lie down. If the vagina and womb bulge out of the vaginal opening and can be seen from the outside, it’s usually particularly distressing. That greatly affects your sex life too. Many women who have a severe prolapse feel ashamed and it can take an emotional toll on them.

Illustration: Above: normal position of organs in the abdomen; Below: left: bladder prolapse, middle: uterine prolapse, right: posterior vaginal prolapse (rectocele)

Above: normal position of organs in the abdomen; Below: left: bladder prolapse, middle: uterine prolapse, right: posterior vaginal prolapse (rectocele)


Causes

Pelvic organs drop down if the muscles and connective tissue that hold them in place are no longer firm enough. This is referred to as pelvic floor weakness. Some women are more likely to have weak connective tissue because of their genes. Other risk factors include the following:


Childbirth: Giving birth can damage and weaken the pelvic floor.

Age: Muscles and connective tissue become weaker over time. This can destabilize the support structures in the pelvic floor.

Weight: Vaginal or uterine prolapse is more common in women who are very overweight.

It is also thought that the pelvic floor can become weaker due to pressure caused by things like lifting and carrying heavy objects, a chronic cough or frequent constipation. But there isn’t much research in this area, so it’s not clear what role these factors play. It’s also not clear whether surgery to remove the womb (a hysterectomy) increases the risk of prolapse. It is assumed that the bladder and bowel have less support following a hysterectomy, and are therefore more likely to slip down.


Risk factors

These factors may increase your risk of anterior prolapse:


Pregnancy and childbirth. Women who have had a vaginal or instrument-assisted delivery, multiple pregnancies, or whose infants had a high birth weight have a higher risk of anterior prolapse.

Aging. Your risk of anterior prolapse increases as you age. This is especially true after menopause, when your body's production of estrogen — which helps keep the pelvic floor strong — decreases.

Hysterectomy. Having your uterus removed may contribute to weakness in your pelvic floor, but this is not always the case.

Genetics. Some women are born with weaker connective tissues, making them more susceptible to anterior prolapse.

Obesity. Women who are overweight or obese are at higher risk of anterior prolapse.

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Complications

If it deteriorates enough, the bladder can prolapse, meaning it is no longer supported and descends into the vagina. This may trigger problems such as urinary difficulties, discomfort, and stress incontinence (urine leakage caused by sneezing, coughing, and exertion, for example).

Prevention

Regular pelvic floor exercises (sometimes called Kegel exercises) can strengthen the pelvic floor muscles and the pelvic floor. Doing special postnatal exercises can help your pelvic floor to recover after giving birth. Sometimes people are advised to avoid lifting and carrying heavy objects in order not to overstrain their pelvic floor. If someone has a chronic cough or regular constipation, treating that condition is also thought to help reduce pelvic floor problems. But there isn’t enough good research in this area to know whether these measures or losing weight can actually prevent prolapse.