Ask An Expert: Bladder Prolapse

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Ask An Expert: Bladder Prolapse

Question:

What is the best way to treat mild bladder prolapse, and how can I ease the discomfort quickly?

Answer:

Bladder prolapse, also known as a cystocele, occurs when the lowest part of the bladder is not well supported by a woman's pelvic ligaments and pelvic muscles. The bladder settles downward within the pelvis, creating a bulge in the front of the vagina. Frequently, urine leakage can occur when there is bladder prolapse, and sometimes women complain of pain or a pulling sensation as well.

There are three things that can be helpful for treating bladder prolapse, and the fastest way to improve symptoms is a pessary.

A pessary is a firm rubbery ring that is about three inches wide. The pessary can be pinched to narrow its shape, allowing your doctor to place the pessary into your vagina. The front edge of the pessary is supported by your pubic bone. The pessary provides a firmer "floor" beneath your uterus and bladder, helping to lift your bladder back into a more normal position. A pessary can be removed at any time.

Some pessaries are specially designed to help prevent urine leakage in the case of a bladder prolapse. These pessaries have a small knob at the front end of the pessary ring, which puts additional pressure against the bladder's draining tube, the urethra. This knob helps to keep the urethra from leaking urine unless you are making an effort to urinate.

If your symptoms are mild, pelvic muscle exercises can make a difference. By strengthening your pelvic muscles, your bladder can regain support. To do pelvic muscle exercises (also called Kegel exercises), tighten the muscles that help you to pull your anus firmly closed and that create a lifting sensation within your vagina. You can hold your squeeze for several seconds, and repeat your squeeze about 10 times. If you do sets of Kegel exercises several times a day, you may notice improved symptoms within several weeks.

A prolapsed bladder may need to be corrected with surgery, which can be done through the vagina or the abdomen.

Mary Pickett, M.D., is a lecturer for Harvard Medical School and an assistant professor of medicine at Oregon Health & Science University in Portland, OR. At OHSU, she practices general internal medicine and teaches medical residents and students.

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Last updated:	January 24, 2007