Fallen Bladder (Women) – Signs, Symptoms, Grades of Cystocele

Many cases of a fallen bladder in women are asymptomatic meaning that there are no apparent signs or symptoms. This can occur for years despite a mild droop being present and could remain asymptomatic throughout life. It is believed that almost all women who have undergone multiple vaginal deliveries have some degree of a prolapse after menopause but not all are diagnosed since it is asymptomatic or the symptoms are so mild that it is never reported.

A fallen bladder or cystocele is when the urinary bladder fails to remain in its normal position and protrudes through the vaginal wall. This arises when the support structures in the pelvic cavity, namely the pelvic floor muscles and pelvic ligaments, are weakened and stretch. This compromises the support necessary to maintain the various organs in its normal position. Refer to dropped bladder for more information on the causes of a prolapsed bladder.

Grades of Cystocele (Fallen Bladder)

The severity of a fallen bladder is classified according to different grades :

• Grade 1 is the mildest type where the bladder protrudes slightly into the vagina.
• Grade 2 is where the protruding bladder can push against the vaginal wall all the way to the opening of the vagina.
• Grade 3 is the most severe type of cystocele where the drooping bladder protrudes all the way out of the vagina.

Signs and Symptoms of Cystocele

Most women seek attention for urinary problems, urinary pain (dysuria), or a visible protrusion through the vagina and are then diagnosed with a fallen bladder. However the symptom that is most commonly reported – dull, bearing down pain/discomfort – may have been present for months or years prior.

The bearing down sensation in the pelvis or lower abdomen is also described as a feeling of fullness or pressure. In the early stages, it is often so mild that many women feel that it is unnecessary to seek medical attention for it. Generally the discomfort is worse when straining and standing for long periods. It momentarily exacerbates, even leading to pain, during coughing, sneezing, laughing, bending over and with sudden pressure to the abdomen. Lying down may help relieve the discomfort.

Urinary symptoms may vary from urinary incontinence, specifically stress incontinence, to difficulty urinating and incomplete emptying of the bladder. Other symptoms like episodes of burning during urination, cloudy urine and blood in the urine may be due to repeated bladder infections (cystitis) which is a risk with a fallen bladder. The incontinence, like the bearing down sensation, is exacerbated by coughing, sneezing, laughing or even during sexual intercourse.