Omission of the bladder

Omission of the bladder (cystocele) is the result of a decrease in the musculoskeletal system that supports it. As a result, there is a change in the position of the bladder down with the anterior wall of the vagina and the formation of protrusion 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 estrogen responsible for the condition of the pelvic floor muscles.

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Causes of the bladder

The causes of bladder omission are as follows: 

1. Pregnancy and childbirth are the most frequent causes of the onset of bladder eruption. Ligaments and muscles supporting the vagina are subjected to overstrain and stretching during labor activity. The risk of this pathology increases after several pregnancies, completed by birth through natural ways, and also after the use of obstetric forceps during labor. Cystocele in women after caesarean section is extremely rare. 
2. The postmenopausal period, when there is a drop in the level of estrogens that support the tone of muscle tissue. 
3. Excess body weight or obesity. 
4. Frequent lifting of weights. 
5. Chronic constipation, accompanied by constant straining. 
6. Severe chronic cough. 
7. Tumor process in the pelvic area.

Together with the causes for the onset of bladder oppression, the risk factors also influence: 

• Genetic predisposition - the presence of a woman initially weak muscles and connective tissue structures, including in the pelvic region. 
• Surgical intervention to remove the uterus - a hysterectomy, the consequence of which is the weakness of the muscles and ligaments of the pelvic floor. 
• Omission of the uterus, due to the general omission of the organs. 
• Asthenia, severe exhaustion, multiple and many-water 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 genera through the natural birth canal, especially complicated.

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

[12], [13], [14]

Symptoms of the bladder

Symptoms of bladder omission develop gradually. At the very beginning of the disease, there may not be clinical symptoms, but over time, discomfort occurs during intercourse and urination becomes more frequent. With the progression of the pathological process, the following symptoms of bladder omission appear: 

• feeling of not completely emptying the bladder; 
• frequent, perhaps, painful and involuntary urination, and in advanced cases, complete inability to retain urine; 
• soreness during intercourse, which makes it impossible; 
• frequent urinary tract infections (cystitis); 
• feeling of pressure and heaviness in the pelvic region and in the vagina, especially when standing for a long time in an upright position; 
• increased discomfort in the vagina and lumbar region during coughing, sneezing, tilting, exercise; 
• in severe cases, the bladder can go beyond the limits of the sexual slit together with the wall of the vagina, which is determined visually by gynecological examination.

Omission of the bladder in women

Omission of the bladder in women is noted in twenty-five percent of cases and occurs primarily after two or more births, and can also occur as a result of a regular increase in the severity and age changes in the hormonal background of a woman (more often after fifty years). It is important to seek advice from a doctor (gynecologist) in time to diagnose and start treating this pathology as soon as possible, namely at the stage when conservative therapy is still possible. In general, bladder dipping is a rather dangerous disease, because if it is not treated, then in later stages there is a change in the angle between the urethra and the bladder, and as a result - the termination of urination. The result of this process is severe pain, infection of the urinary system and general intoxication of the body.

[15], [16]

Diagnostics of the bladder

Diagnosis of bladder omission is based on: 

1. Complaints.
2. Data of the medical history.
3. Examination (general and gynecological).
4. Conducting additional survey methods: 
   • ultrasound examination or magnetic resonance imaging; 
   • X-ray contrast cystoureterography; 
   • cystoscopy, with the purpose of exclusion of other pathology of the bladder; 
   • urodynamic examination to evaluate the functioning of the sphincter of the bladder.

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

[17], [18], [19], [20]

Treatment of the bladder

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

1. At an early stage of the process, in the light cases, conservative therapy is used, which consists of: 
   • Performing special exercises to strengthen the muscular apparatus of the pelvic floor - exercises according to Kegel's method. 
   • Use of vaginal pessaries, which are injected into the vagina and provide support for the bladder. The doctor selects the appropriate pessary size individually 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 indication. 
   • The appointment of hormonal drugs - estrogens, in the form of vaginal suppositories or cream (estriol, ovestin), which provide the tone of the pelvic muscles. Therapy with estrogens is used, mainly in the postmenopausal period.

If conservative therapy is ineffective and symptoms of bladder collapse progress, which adversely affects the quality of life of a woman, then they resort to prompt intervention. 

2. At a late stage, in advanced cases, as a rule, surgery is used, in which the plastic and strengthening of the musculoskeletal apparatus of the bladder and the anterior wall of the vagina. Whenever possible, laparoscopic procedures are used.

Operation when bladder is down

The operation for bladder dilation is performed with the aim: 

• reduction and / or elimination of the severity of clinical symptoms of the disease, especially the inability to retain urine; 
• improving the quality of life of women; 
• restoration of the normal anatomical position of the pelvic organs; 
• improve sexual function, 
• prevent the progression of the disease and the formation of new defects.

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

If a reconstructive operation of the anterior part of the pelvis - the anterior wall of the vagina, the urethra and the bladder - is required, then this operation is performed in a transvaginal way, i.e. Through the vagina. This operation is called colporaphy, in which the vagina is pulled up, a certain loop is made, with which the bladder is fixed and maintained in the necessary position. Colporaphasia is performed under local anesthesia or by spinal anesthesia. 

• If a reconstructive operation of the middle part of the pelvis - the uterus, its necks is required, then they fix them to the region of the sacrum or to the ligaments that connect with it. Access can be either transvaginal or transabdominal (through the abdomen).
• The scope and method of surgical intervention is determined by the surgeon, depending on the severity and neglect of the pathological process. 
• Women who are in the postmenopausal period before the surgery for six weeks are prescribed estrogens. Since they contribute to improving blood circulation in the walls of the vagina, 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 a lifetime of surgery, lifting weights of more than ten kilograms is not recommended.

In the recovery period after surgery for four to six weeks is not recommended: severely cough, lift weights (more than five seven kilograms), stay in a vertical position for a long time, strain down during the act of defecation, sex life.

Exercises for the lowering of the bladder

Exercises for the lowering of the bladder 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 dysfunction in the early stages of the process, as well as in light and medium-heavy cases. 

• It is necessary to maximally involve the muscles of the pelvic floor, as if you stop the process of urination. Then you need to keep them in this tone for three seconds, then relax them for three seconds. Gradually, the time of tension of the pelvic muscles is increased to ten seconds. Exercise should be repeated ten to fifteen times, three times throughout the day.

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

Determine the strength of the tension of the pelvic muscles can be independently with the help of a special device - a perineum or contact your doctor-gynecologist. Gymnastics with the lowering of the bladder.

Gymnastics in the lowering of the bladder - a complex exercise, which include a combination of compression, contraction and relaxation of the pelvic muscles in different positions and different pace. 

• You can perform therapeutic gymnastics according to Yunusov, which consists in voluntary contraction of the pelvic muscles during urination until the urine flow stops and again it is restored. 
• It is necessary to pull the pelvic muscles up and back at a rapid pace and rhythmically. 
• To carry out a gradual raising of the pelvic muscles from the bottom up, it is necessary to begin with the lifting of the muscles of the entrance to the vagina. Lifting is desirable to be divided into a couple of stages and on each of them to stop for a few seconds. 
• Exercise is a pushing out, which identifies the effort at the time of labor. Perform it with a little effort, rhythmically and regularly.

This gymnastics is performed three times a day with repetitions of ten times one exercise. All the exercises do not necessarily have to be done, you can select several and perform regularly to achieve the desired result.

It is recommended to perform classical exercises for strengthening the pelvic muscles, such as regular walking, swimming, climbing stairs, riding a bicycle or simulating it, lying on your back.

[21],

Bandage in the lowering of the bladder

The bandage when lowering the bladder should be worn on underwear and it is recommended to wear it after a preliminary consultation with a doctor who will assess the feasibility of wearing a bandage and help determine his model and size. As a rule, the bandage is effective in conjunction with gymnastics. It is necessary to wear a bandage no more than six to eight hours a day. If there is pain, discomfort or compression of the bladder when wearing the bandage, then it is likely that the bandage is not properly dressed and it is necessary to check the ties, they may be tightened and need to be weakened. If prolonged wearing of the bandage together with gymnastics is not effective, then the question of surgical intervention is raised.

[22], [23], [24], [25], [26]

Prevention

Prevention of bladder omission is as follows: 

• Do regular gymnastics, even during pregnancy. 
• Before childbirth, negotiate with an obstetrician-gynecologist about the sparing and careful management of labor. 
• Do not raise the severity, especially in the postpartum period. When lifting, even minor weights, distribute the load evenly. 
• To treat and prevent constipation, prolonged and severe cough. 
• Follow the weight to avoid obesity. 
• Avoid stress, asthenia, severe weight loss.

Prevention of cystocele is an attentive attitude towards oneself and one's health.

[27], [28], [29]

Forecast

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

[30]