The bladder is a dynamic organ that stores the urine formed in the kidneys. The urine comes through channels called the ureter, and after the bladder is filled, it drains this urine out through a channel called the urethra. The normal position of the bladder is in the lower part of the abdomen, behind the anterior abdominal wall, and in the front part of the uterus. The lowest part of our abdomen is actually a hammock-shaped structure made up of ligaments and muscles, and it is quite sturdy.

Figure 1: Bladder prolapse.

There are three natural holes in this hammock-shaped structure. There is the urethra, which allows the urine from the bladder to flow out through the hole in the front. The hole in the middle contains the vaginal cavity that connects the uterus with the outside. From the hole in the back, there is the rectum (the last part of the large intestine), which provides the continuity of the intestine to the outside and therefore makes it possible to defecate. The bladder is normally located at the top of the hammock-shaped structure described above. While the bladder should be on the upper part of this hammock-shaped structure, the situation where it hangs down (displacement) is called bladder prolapse (cystocele). The prolapse occurs from the area where the anterior vaginal wall is. In other words, the urinary bladder moves with the anterior wall of the vagina and moves downwards from the anterior part of the vagina.

How does Bladder Prolapse Occur?

Bladder prolapse is usually seen in cases where the abdomen is constantly high, chronic coughing, heavy lifting, etc., and the hammock-shaped pelvic floor weakness described above. For example, the birth of a large baby vaginally may cause weakness in the pelvic floor area surrounding the vagina. In this way, if a person who has had a vaginal delivery is constantly lifting heavy weights, coughing, straining (for example, due to constipation), prolapse may occur. Although there are strong ties that keep the uterus in its normal place, such strong ties are not in question for the urinary bladder, and in the above-mentioned risk situations, the prolapse of the bladder will be seen. Vaginal deliveries, difficult deliveries, giving birth to a large baby, obesity, smoking, chronic cough, asthma and chronic constipation, and conditions where constant intra-abdominal pressure increases, such as straining, are risk factors for bladder prolapse.

What are the Symptoms of Bladder Prolapse?

A feeling of fullness in the vagina, a feeling of pressure, chronic pain, discomfort and pain during sexual intercourse, a mass that becomes more evident when walking, lifting heavy, coughing, or pushing on the toilet are the most frequently expressed symptoms for prolapse. In some of the cases where the bladder prolapse is mild, there is slack in the neck of the bladder, and in cases such as coughing, sneezing, straining, laughing, and heavy lifting, the neck of the bladder changes place. If the prolapse of the bladder is severe and the bladder is protruding from the vein in normal daily life, it becomes difficult to empty the bladder due to the improper angulation between the urinary bladder and the urethra. In this case, patients try to urinate in the toilet by pushing the urine bag that has come out with their hands and trying to return it to its normal position, correcting the angle between it and the urethra, and they also express this to the doctor. In the bladder, which is always outside and in an unsuitable condition, there is usually some urine left after urination (the bladder cannot be fully emptied), which often paves the way for urinary tract infections. In severe cases that last for a long time and become chronic, the continuous fullness of the urinary bladder may cause the accumulation of urine towards the upper kidneys and kidney failure.

How is Bladder Prolapse Diagnosed?

The diagnosis of bladder prolapse is easy, and it is easily diagnosed by gynecological examination in patients with the above complaints. In cases where prolapse is obvious, the diagnosis is made by seeing an egg-shaped or orange-shaped mass hanging down from the front part of the vagina while the patient is on the gynecological examination table. In cases where the prolapse is not obvious and the bladder is not completely outside, the diagnosis is made by pushing the patient or lifting him to his feet and increasing the intra-abdominal pressure. To help patients with urinary incontinence complaints during operation planning, additional physical, biochemical, or urodynamic tests should be performed according to the patient's condition and needs to help determine the cause of urinary incontinence and the possible treatment method. One of the main difficulties in the diagnosis of bladder prolapse is that patients see this condition as a natural result of old age and childbirth, accept it as natural, are ashamed to express their complaints and do not seek treatment. If they are aware of many effective treatment methods in current medicine, there will be a possibility of applying to more doctors and being diagnosed more.

Treatment of Bladder Prolapse