A cystocele or prolapsed bladder occurs when the support structures of the pelvic cavity are compromised. The contents of the pelvic cavity cannot maintain its normal anatomical position and herniate into surrounding hollow viscera like the vagina. This is commonly known as a dropped bladder and the process by which this occurs is explained further under fallen bladder in females.
Most weakening of the pelvic floor muscles and the pelvic ligaments occur due to straining and increased pressure within the pelvic cavity. The pelvic floor provides a supportive base for the pelvic contents while the pelvic ligaments hold the organs in its position. Weakening of these structures allows it to stretch so it cannot maintain its function as a means of support. This is known as a pelvic floor disorder.
Causes of a Dropped Bladder
Pregnancy and Childbirth
This is the most common cause of pelvic floor disorders. Increased pressure within the abdominopelvic cavity in pregnancy and straining during vaginal delivery weakens the pelvic floor muscles and ligaments. This does not immediately lead to a dropped bladder or pelvic floor disorders.
Multiple vaginal deliveries increases the weakening and over years leads to a point where a prolapse of the bladder or even other organs like the rectum, small intestine or uterus may arise. Pelvic floor weakening may also be seen with cesarean sections (C-section) but the risk is usually lower than with vaginal deliveries.
Menopause itself does not lead to a dropped bladder. The lower levels of estrogen weakens the pelvic muscles further and compounds a pre-existing disorder. The menopausal years is also the time when the pelvic floor weakening has progressed far enough to manifest as a prolapse that is severe enough to cause signs and symptoms.
In constipation, a person strains excessively to have a bowel movement. This also weakens the pelvic floor and in chronic constipation, the strain is ongoing for years. It eventually leads to pelvic floor disorders that can result in a prolapse.
Various other conditions may also lead to pelvic floor weakening and many of these risk factors are the same as that of an abdominal hernia. This includes :
- Lifting heavy objects on a regular basis
- Chronic cough as is seen with COPD (chronic bronchitis)
- Congenital defects
- Advancing age
- Pelvic surgery
Prevention of Bladder Prolapse
Understanding the causes and risk factors is important when considering preventing a dropped bladder. Early diagnosis and adopting preventative measures can help minimize the extent of the condition in the long term. Kegel exercises are usually advised for strengthening of the pelvic floor but other preventative measures are equally important.
As mentioned above, multiple pregnancies and vaginal deliveries is the most common cause. Some women do opt for elective cesareans citing the risk of prolapse as a motivating factor but this is not the clinical intention of a C-section.
Avoiding constipation by eating a high fiber diet, identifying causative and trigger factors and seeking medical attention is important. Even if constipated, excessive straining during a bowel movement should be avoided and other measures should be sought to restore bowel functioning.
Constant lifting of heavy objects, as is seen in work-related manual labor and weight-lifting, may also contribute to weakening of the pelvic floor. Proper technique in lifting and carrying heavy objects is important to minimize the strain on the pelvic floor.
Healthy eating and exercise is imperative to avoid weight gain as being overweight or obese can contribute to pelvic floor disorders. Women who are overweight or obese should consider proper weight management techniques as discussed under medical weight loss.
Cigarette smoking is never advisable but cessation is an immediate priority in a woman with a persistent cough, especially if it is associated with COPD like chronic bronchitis and there is a risk of pelvic floor disorders.