Treatment for Prolapsed Bladder (Pelvic Organ Prolapse)
The first-line treatment for prolapsed bladder (pelvic organ prolapse) should be conservative management with pelvic floor physical therapy or pessary placement before considering surgical options. 1
Understanding Prolapsed Bladder
A prolapsed bladder, medically known as cystocele or anterior vaginal wall prolapse, occurs when the supportive tissues between the bladder and vaginal wall weaken, allowing the bladder to descend into the vagina. This is a common form of pelvic organ prolapse (POP).
Diagnostic Considerations
Symptoms typically include:
- Sensation of vaginal bulging or pressure
- Urinary symptoms (frequency, urgency, incontinence)
- Difficulty emptying the bladder
- Discomfort during physical activities or intercourse
Up to 60% of women with pelvic organ prolapse also experience urinary incontinence 2
Prolapse beyond the hymen may cause or mask lower urinary tract dysfunction 2
Treatment Algorithm
1. Conservative Management (First-Line)
All patients with symptomatic prolapse should be offered non-surgical treatment first 1:
A. Pelvic Floor Physical Therapy
- Supervised Kegel exercises to strengthen pelvic floor muscles
- Biofeedback training
- Lifestyle modifications:
- Weight loss if overweight
- Avoiding heavy lifting
- Managing chronic cough
- Treating constipation
B. Pessary Management
- Silicone or rubber devices inserted into the vagina to support prolapsed organs
- Various shapes available (ring, donut, Gellhorn)
- Requires regular follow-up for cleaning and examination
- Can be used long-term or temporarily
2. Surgical Management (When Conservative Measures Fail)
Consider surgical repair when:
- Conservative measures have failed
- Prolapse is severe and symptomatic
- Patient prefers surgical correction
Surgical options include:
- Anterior colporrhaphy: Repair of the anterior vaginal wall
- Mesh procedures: Using synthetic material to support the bladder (note: mesh has associated risks)
- Transvaginal repair: Anchoring support between the arcus tendineus of the endopelvic fascia 3
Special Considerations
Impact on Sexual Function
- Prolapse is more likely than urinary incontinence to result in sexual inactivity 4
- Surgical correction of prolapse can improve sexual function by reducing symptoms that interfere with intercourse 4
Associated Conditions
- Overactive bladder symptoms are more common in patients with POP than without POP 5
- Treatment of POP (both surgical and pessary) often results in improvement of overactive bladder symptoms 5
Treatment Efficacy
- Conservative management is effective for many patients and should be tried first
- Surgical success rates vary depending on technique and severity of prolapse
- Recurrence is possible with any treatment approach
Common Pitfalls to Avoid
- Treating asymptomatic prolapse unnecessarily
- Failing to address coexisting conditions (urinary incontinence, overactive bladder)
- Not providing adequate patient education about expectations and outcomes
- Overlooking the impact of prolapse on quality of life and sexual function
By following this treatment algorithm and considering individual patient factors, clinicians can effectively manage prolapsed bladder while prioritizing quality of life and minimizing complications.