Bladder prolapse

Prolapse of the bladder (cystocele) is the result of a decrease in the muscular-ligamentous apparatus that supports it. As a result, the position of the bladder changes downwards with the anterior wall of the vagina and a protrusion forms in it.

This pathology occurs most often in women, which is associated with pregnancy, childbirth, and menopause, during which there is a significant drop in estrogens, which are responsible for the condition of the pelvic floor muscles.

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Causes bladder prolapse

The causes of bladder prolapse are as follows:

1. Pregnancy and childbirth are the most common causes of bladder prolapse, as the ligaments and muscles that support the vagina are subject to overstrain and stretching during labor. The risk of this pathology increases after several pregnancies that ended in vaginal delivery, as well as after the use of obstetric forceps during labor. Cystocele in women after cesarean section is extremely rare.
2. The postmenopausal period, when there is a drop in the level of estrogens, which maintain muscle tone.
3. Being overweight or obese.
4. Frequent heavy lifting.
5. Chronic constipation accompanied by constant straining.
6. Severe chronic cough.
7. Tumor-like process in the pelvic area.

Along with the causes, the occurrence of bladder prolapse is also influenced by risk factors:

• Genetic predisposition – the presence in a woman of initially weak muscles and connective tissue structures, including in the pelvic area.
• Surgical intervention to remove the uterus is hysterectomy, which results in weakness of the muscles and ligaments of the pelvic floor.
• Prolapse of the uterus due to general prolapse of the organs.
• Asthenia, severe exhaustion, multiple and polyhydramnios pregnancies, accompanied by a decrease in the tone of the abdominal muscles.
• Age – after forty-five to fifty years the risk of cystocele increases.
• More than three births through the natural birth canal, especially complicated ones.

Prolapse of the bladder is accompanied by a shortening of its neck and the formation of residual urine after urination in a pocket (protrusion) formed by the bladder in the vaginal wall. These changes determine the clinical picture of the disease.

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Symptoms bladder prolapse

Symptoms of bladder prolapse develop gradually. At the very beginning of the disease, there may be no clinical symptoms, but over time, discomfort during sexual intercourse and increased urination occur. As the pathological process progresses, the following symptoms of bladder prolapse appear:

• a feeling of incomplete emptying of the bladder;
• frequent, possibly painful and involuntary urination, and in advanced cases, complete inability to hold urine;
• pain during sexual intercourse, making it impossible;
• frequent urinary tract infections (cystitis);
• a feeling of pressure and heaviness in the pelvic area and vagina, especially when staying in an upright position for a long time;
• increased discomfort in the vagina and lumbar region during coughing, sneezing, bending, and physical activity;
• In severe cases, the bladder may extend beyond the boundaries of the genital slit along with the vaginal wall, which is determined visually during a gynecological examination.

Prolapse of the bladder in women

Bladder prolapse in women is observed in twenty-five percent of cases and occurs mainly after two or more births, and can also occur as a result of regular lifting of heavy objects and age-related changes in the hormonal background of a woman (usually after fifty years). It is important to promptly consult a doctor (gynecologist) in order to conduct diagnostics and begin treatment of this pathology as early as possible, namely at the stage when conservative therapy is still possible. In general, bladder prolapse is a rather dangerous disease, since if it is not treated, then in the later stages there is a change in the angle between the urethra and the bladder, and as a result - cessation of urination. The result of this process is severe pain, urinary tract infections and general intoxication of the body.

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Diagnostics bladder prolapse

Diagnosis of bladder prolapse is based on:

1. Complaints.
2. Medical history data.
3. Examination (general and gynecological).
4. Conducting additional examination methods:
   • ultrasound examination or magnetic resonance imaging;
   • X-ray contrast cystourethrography;
   • cystoscopy, to exclude other pathologies of the bladder;
   • urodynamic study to assess the functioning of the urinary bladder sphincters.

If necessary, general clinical tests can be carried out - blood, urine and others.

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Treatment bladder prolapse

Treatment of bladder prolapse depends on the stage of the pathological process.

1. At an early stage of the process, in mild cases, conservative therapy is used, which consists of:
   • Performing special exercises to strengthen the pelvic floor muscles – Kegel exercises.
   • Using vaginal pessaries, which are inserted into the vagina and provide support for the bladder. The doctor selects the appropriate size of the pessary on an individual basis and explains how to use it. Pessaries are used if it is necessary to postpone surgical intervention, or it is contraindicated for a woman for some reason.
   • Prescription of hormonal drugs - estrogens, in the form of vaginal suppositories or cream (estriol, ovestin), which provide pelvic muscle tone. Estrogen therapy is used mainly in the postmenopausal period.

If conservative therapy is ineffective and the symptoms of bladder prolapse progress, which negatively affects the woman’s quality of life, then they resort to surgical intervention.

2. At a late stage, in advanced cases, as a rule, surgical intervention is used, in which plastic surgery and strengthening of the muscular-ligamentous apparatus of the bladder and the anterior wall of the vagina are performed. Whenever possible, laparoscopic surgical intervention techniques are used.

Surgery for prolapsed bladder

Surgery for prolapse of the bladder is performed for the purpose of:

• reducing and/or eliminating the severity of clinical symptoms of the disease, primarily the inability to hold urine;
• improving the quality of life of women;
• restoration of the normal anatomical position of the pelvic organs;
• improving sexual function,
• preventing the progression of the disease and the formation of new defects.

Depending on which structures are involved in the pathological process in cystocele, corrective operations are divided into several groups:

If reconstructive surgery of the anterior pelvis is required - the anterior wall of the vagina, urethra and bladder, then such surgery is performed transvaginally, i.e. through the vagina. This surgery is called colporrhaphy, during which the vagina is pulled up, a certain loop is made, with the help of which the bladder is fixed and supported in the required position. Colporrhaphy is performed under local anesthesia or by means of spinal anesthesia.

• If a reconstructive operation of the middle section of the pelvis is required - the uterus, its cervix, then they are fixed to the sacrum area or to the ligaments connecting to it. Access can be either transvaginal or transabdominal (through the abdomen).
• The scope and method of surgical intervention are determined by the surgeon, depending on the severity and neglect of the pathological process.
• Women in the postmenopausal period are prescribed estrogens for six weeks before surgery. Because they improve blood circulation in the vaginal walls, which has a beneficial effect on the recovery period after surgery.
• In the postoperative period, antibacterial drugs (ceftriaxone, cefepime, etc.) are prescribed to reduce the risk of infectious complications.
• After surgery, lifting weights over ten kilograms is not recommended for the rest of your life.

During the recovery period after surgery for four to six weeks, it is not recommended to: cough heavily, lift heavy objects (more than five to seven kilograms), remain in an upright position for a long time, strain during bowel movements, or have sexual intercourse.

Exercises for prolapsed bladder

Exercises for bladder prolapse are called Kegel exercises and are aimed at strengthening the muscular apparatus of the pelvic floor. These exercises will be effective for the prevention and treatment of bladder prolapse in the early stages of the process, as well as in mild and moderate cases.

• It is necessary to pull in the pelvic floor muscles as much as possible, as if you were stopping the process of urination. Then you need to keep them in this tone for three seconds, after which you relax them for three seconds. Gradually, the time of tension of the pelvic muscles is increased to ten seconds. The exercise should be repeated ten to fifteen times, three times throughout the day.

Kegel exercises can be performed unnoticed by others, in any position and in any position (standing, sitting, lying), and these exercises also increase sensitivity during sexual intercourse. Breathing during the exercises is free, even and deep. According to statistics, a positive result is noted after four to six weeks of performing Kegel exercises. And if the pelvic floor muscles are very weak, you will have to wait longer for the result - about three months.

You can determine the tension of your pelvic muscles yourself using a special device - a perineometer, or consult your gynecologist. Gymnastics for prolapsed bladder.

Gymnastics for prolapse of the bladder are complex exercises that include a combination of compression, contraction and relaxation of the pelvic muscles in different positions and at different speeds.

• You can perform therapeutic exercises according to Yunusov, which consists of voluntary contraction of the pelvic muscles during urination until the urine flow stops and then restores it again.
• It is necessary to pull the pelvic muscles up and back at a fast pace and rhythmically.
• Gradually lift the pelvic muscles from the bottom up, starting with lifting the muscles of the entrance to the vagina. It is advisable to divide the lift into a couple of stages and stop for a few seconds at each of them.
• Exercise - pushing, which identifies pushing during labor. It should be done with little effort, rhythmically and regularly.

Such gymnastics is performed three times a day with repetitions of one exercise ten times. It is not necessary to do all the exercises at once, you can choose several and perform them regularly to achieve the desired result.

It is also recommended to perform classic exercises to strengthen the pelvic muscles, such as regular walking, swimming, climbing stairs, cycling or imitating it by lying on your back.

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Bladder prolapse bandage

A prolapsed bladder bandage should be worn over underwear and is recommended to be worn after a preliminary consultation with a doctor, who will assess the advisability of wearing a bandage and help determine its model and size. As a rule, a bandage is effective in combination with gymnastics. The bandage should be worn for no more than six to eight hours a day. If pain, discomfort or compression of the bladder is noted when wearing the bandage, then most likely the bandage is not worn correctly and the ties should be checked, perhaps they are too tight and need to be loosened. If long-term wearing of the bandage together with gymnastics is not effective, then the question of surgical intervention arises.

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Prevention

Prevention of bladder prolapse consists of the following:

• Do regular exercise, even during pregnancy.
• Before giving birth, agree with your obstetrician-gynecologist about gentle and attentive management of the birth.
• Do not lift heavy objects, especially after childbirth. When lifting, even light objects, distribute the load evenly.
• Treat and prevent constipation, prolonged and severe cough.
• Monitor your weight to avoid obesity.
• Avoid stress, asthenia, and sudden weight loss.

Prevention of cystocele means being attentive to yourself and your health.

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Forecast

The prognosis of bladder prolapse with timely prevention and treatment is favorable for both health and work activity. In advanced and untreated cases of bladder prolapse, the prognosis worsens, both for work activity and for health and quality of life. Since as the disease progresses, the angle between the ureter and the bladder changes, which leads to the cessation of urine flow and, as a result, kidney infection and general intoxication of the body, which is extremely unfavorable for life.

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