Genital prolapse (dropped bladder)
Einstein Health Glossary
ICD 10 - N81
What is genital prolapse (dropped bladder)?
Genital prolapse, commonly known as a “dropped bladder,” is a condition in which not only the bladder but all pelvic organs may lose support and “drop,” forming a bulge in the vaginal area.
In addition to discomfort and the sensation of a “ball in the vagina,” it can affect quality of life and have social impacts, leading to embarrassment, reduced social interactions, decreased physical activity, and even isolation.
Prevalence
Prevalence has increased with the aging population. It is estimated that 11.1% of women will undergo some type of surgery for pelvic floor dysfunction, which includes genital prolapse and incontinence.
Types
The main types of genital prolapse are:
- cystocele (bladder prolapse): when the bladder loses support and forms a bulge in the vaginal area
- rectocele / Enterocele (intestinal prolapse): when the intestine loses support and forms a bulge in the vaginal area
- uterine prolapse: when the uterus loses support and descends through the vagina
- perineal rupture: although not technically a prolapse, it is a condition commonly associated with prolapse due to weakening of one of the pelvic support points
Causes
- increased intra-abdominal pressure: pregnancy, obesity, chronic coughing, chronic constipation, intense or improperly guided physical exercise
- trauma: vaginal delivery (natural or forceps-assisted), perineal injury, or even previous surgeries such as hysterectomy
- collagen deficiency: genetic, smoking, menopause
Symptoms
A feeling of heaviness or a “ball” in the vagina. It may be accompanied by urinary symptoms such as frequent urge to urinate, urinary incontinence (stress or urgency), or difficulty urinating.
There may also be intestinal symptoms such as tenesmus (urgent need to defecate), difficulty with bowel movements, or fecal incontinence. It may also be associated with difficulty having sexual intercourse or a sensation of a “wide vagina.”
Diagnosis
The patient’s history may suggest the condition, but confirmation is through a specialized physical exam, especially using the POP-Q method (Pelvic Organ Prolapse Quantification). Sometimes additional tests are needed, such as transperineal ultrasound or MRI.
Treatment
- lifestyle changes: weight loss through a balanced diet and properly guided physical activity.
- clinical treatment for genital prolapse: pelvic floor physical therapy, treatment of genital hypotrophy (topical estrogen and/or laser therapy), use of a pessary (a device inserted into the vagina that can be managed by the patient).
- surgical treatment for genital prolapse: site-specific surgeries (correction of diagnosed pelvic defects such as fascia reconstruction to “lift” the bladder and intestines, reconstruction of uterosacral ligaments to support the uterus, or even hysterectomy with ligament shortening and perineal reconstruction) or mesh surgeries (using mesh instead of ligaments and fascia to “lift” the pelvic organs).
Prevention
Weight control, properly guided physical exercise, or pelvic floor physical therapy.