Bladder prolapse (cystocele) symptoms & treatment

A bladder prolapse or cystocele is a common type of pelvic organ prolapse. When the pelvic floor muscles and ligaments that hold your bladder in place weaken or stretch, your bladder may drop or sag into your vagina.

Severely prolapsed bladder may impact your quality of life, but it’s treatable. Our experts provide a range of nonsurgical and surgical treatment options for you, depending on your stage of bladder prolapse.

Symptoms of bladder prolapse

Mild bladder prolapse is the most common type of pelvic organ prolapse. If you have a mild bladder prolapse you might not notice any symptoms. In severe cases, your bladder may bulge out of your vaginal opening, resulting in difficulty urinating.

Having a prolapsed bladder may feel like fullness, heaviness or pain in your pelvic area. Common bladder prolapse symptoms include:

• Having a slow urine stream
• Difficulty starting the flow of urine
• Frequent or urgent urination
• Feeling like you need to urinate even though you finished urinating
• Seeing a bulge out of your vagina
• Feeling like something is falling out of your vagina

These symptoms may worsen if you cough, lift heavy items or stand for long periods of time. Symptoms may improve or go away if you lie down.

Stages of bladder prolapse

The stage of the prolapsed bladder is determined by how far the bladder has dropped.

• Stage I: Mild bladder prolapse, where the bladder is still somewhat supported by the pelvic floor muscles and may have dropped into the upper part of the vagina.
• Stage II: The bladder has started to drop into the lower part of the vagina, close to the opening.
• Stage III: The bladder has fallen to or beyond the opening of the vagina and is protruding.
• Stage IV: The bladder has completely fallen through the vaginal opening.

Causes of bladder prolapse

A prolapsed bladder is caused by the weakening of the muscles that support and hold your bladder. Support may weaken due to several factors, including:

• Aging: Your pelvic floor muscles and tissues weaken over time.
• Pregnancy and childbirth: The strain and stretching from a vaginal childbirth weakens your pelvic floor muscles.
• Hysterectomy: A hysterectomy can put you at risk of developing the condition.
• Obesity, chronic constipation, chronic coughing and heavy lifting: Puts pressure and strain on the pelvic floor muscles, causing them to weaken.
• Genetics: A family history of pelvic organ prolapse can put you at risk of developing the condition.

Diagnosing bladder prolapse

To diagnose a prolapsed bladder, a urogynecologist will perform a pelvic exam, review your health history and ask about your symptoms. A CT scan or MRI may be needed so your provider can get a closer look at the prolapse. Bladder and urine tests may also be recommended for severe cases to rule out other complications, like urinary incontinence or a urinary tract infection (UTI).

Bladder prolapse treatments

A mildly prolapsed bladder that isn’t causing significant symptoms may correct itself with nonsurgical treatments. Surgery may be recommended for more severe stages of bladder prolapse.

Nonsurgical options for bladder prolapse treatment

• Biofeedback therapy: Sensors are used to study and improve muscle control.
• Bladder prolapse physical therapy: Physical and occupational pelvic floor therapy can strengthen the pelvic floor muscles. Methods include pelvic floor exercises and hands on therapy.
• Vaginal pessary: A soft, removable ring called a pessary can be inserted into the vagina to support the sagging bladder and provide stability and relief.

Surgical treatment for bladder prolapse

The most common type of surgery for a prolapsed bladder uses a surgical mesh to hold the bladder up in place. This minimally invasive surgery is usually done through a very small incision in your abdomen and results in less scarring and a faster recovery time than other surgeries.