Anterior prolapse

The urinary bladder is located in the pelvis between the pelvic bones. When the muscles that support the pelvis are strained, which usually occurs during vaginal childbirth or chronic constipation, it may lead to anterior prolapse.

An anterior prolapse also known as bladder prolapsed or cystocele is a condition where the bladder is herniated into the vagina causing it to bulge. This occurs when the supportive tissues of the vagina become weak and stretched.

Causes

The muscles, ligaments and connective tissues in the pelvic floor support the bladder and other pelvic organs. A damage of these muscles and ligaments present between the pelvic floor and bladder may weaken and stretches the bladder and vaginal walls. The weakened muscles result in the displacement of the bladder into the vagina. Certain factors that weaken the pelvic muscles are listed below:

  • Pregnancy and vaginal delivery

  • Overweight or obesity

  • Heavy lifting of the objects

  • Repetitive straining during bowel movements

  • Inappropriate gym exercises

  • Chronic or violent coughing

Risk factors

The following factors may increase your risk of developing anterior prolapse or cystocele:

  • Age: The risk of anterior prolapse increases with your age. Mostly, the risk increases after menopause when there is a decreased production of estrogen (a hormone that keeps the pelvic floor strong and healthy).

  • Surgical procedure: The surgical techniques such as hysterectomy may weaken the pelvic floor muscles causing the bladder to prolapse into the vagina.

  • Increased intra-abdominal pressure: Chronic lung disease, straining with chronic constipation, persistent cough caused by smoking, and repeated heavy lifting might increase the pressure in the abdomen and result in weakened pelvic floor muscles.

  • Obesity: Overweight or obesity may increase your risk of anterior prolapse.

Diagnosing an anterior prolapse may require a physical examination and certain laboratory tests. The physical examination allows your doctor to grade the prolapse and assess the pelvic floor muscle.

Your doctor may recommend bladder and pelvic ultrasound to exclude the presence of any masses applying pressure on the bladder and also evaluate the muscle function.

Urinalysis may be suggested to look for any symptoms of infection in the bladder.

If the bladder prolapse is asymptomatic, then you may not require any cystocele treatment. However, you must incorporate certain lifestyle changes to prevent the worsening of the condition.

In moderate anterior prolapse, your doctor may recommend any one of the following therapies:

Vaginal pessaries: A vaginal pessary is a plastic ring that should be inserted into the vagina to support the vaginal wall and hold the bladder.

Estrogen therapy: Your doctor may prescribe estrogen therapy that keeps the pelvic floor muscles strong and healthy preventing further prolapse.

If you’re diagnosed with severe anterior prolapse, cystocele surgery may be recommended. The surgery involves repositioning the protruded bladder back to its normal position and making the muscles and ligaments strong. A particular type of tissue graft is used to strengthen the pelvic floor muscles.

If the anterior prolapse or cystocele is associated with urinary incontinence, your doctor may recommend a procedure that supports the urethra and resolving the incontinence symptoms.

Your doctor may suggest you the following lifestyle changes to prevent further worsening of anterior prolapse:

  • Avoid lifting heavy objects.

  • Perform regular exercise such as walking, swimming or bike riding, instead of running, jumping or high-impact aerobics.

  • Increase the amount of fiber consumption and water intake to prevent constipation.

  • Prefer pelvic floor exercises to strengthen the muscles that support the organs in the pelvic cavity.

  • Maintain a healthy weight because obesity may worsen the condition.

You may experience no symptoms in case of mild anterior prolapse. The cystocele symptoms of moderate to severe anterior prolapse include the following:

  • Sensation of fullness or pain in the pelvic region

  • Feeling of incomplete urination

  • Increased frequency and urgency of urination

  • Recurrent urinary tract infections

  • Protrusion of vagina and bladder through the vaginal opening

Grades of bladder prolapse: The extent of severity of the bladder prolapse can be measured by classifying it as stage 1, stage 2, and stage 3.

Stage 1 or mild

A little prolapse of bladder into the vagina

Stage 2 or moderate

Protrusion of the bladder into the vagina that is close to the vaginal opening

Stage 3 or severe

Protrusion of the bladder out of the vaginal opening