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Bladder prolapse

I have had a bladder prolapse for last 2 months have been told by go to do pelvic floor exercises which I have been doing. My bladder is still coming down but not fully out as when it is uncomfortable I push it back up, if and when will it stay up on its own again and should I be worried about it?

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The answer

What you describe is one of the types of prolapse that women are prone to acquiring particularly, as we get older and partly due to the weakening of our pelvic floor muscles due to childbirth and other life style factors.

There are three different types of prolapse-

1. Cystocele- This is where the bladder protrudes through the vaginal wall. This can also be known as an anterior wall prolapse. 

2. Posterior vaginal wall prolapse- this is where the rectum protrudes through the vaginal wall. 

3. Prolapse of the Uterus and Cervix- This is where the uterus and cervix prolapses down into the vaginal vault.

The causes of prolapse include-

1. Poor pelvic floor muscle strength 

2. Excessive weight gain 

3. Damage to muscles from childbirth 

4. Straining due to constipation 

5. Incorrect lifting techniques when handling weighty items 

6. Previous pelvic region surgery

Symptoms of prolapse can include discomfort and heaviness in the vaginal area, difficulty passing urine, pain during sexual intercourse and a bulging of the organs on examination or moving about.

The treatment available to you will depend very much on the severity of the prolapse and this will be assessed by means of a vaginal examination by your GP or Gynaecologist.

Initially if the prolapse is not severe then you may well be encouraged to carry out pelvic floor muscle exercises. These should be done throughout the day on a regular basis in order to maximise the muscle strength and help prevent the organs bearing down into the vagina. You may well also be referred to a physiotherapist to help you with this. It should be noted that it can take a good three months of exercise and physiotherapy to see a marked improvement.

Pelvic Floor Exercises: To help strengthen your pelvic floor muscles, sit comfortably on a chair with your knees slightly apart. Squeeze the muscles eight times in a row and perform these contractions three times a day. Don't hold your breath or tighten your stomach, buttock, or thigh muscles at the same time.

When you get used to doing this, you can try holding each squeeze for a few seconds (up to 10 seconds). Every week, you can add more squeezes, but be careful not to overdo it and always have a rest in between sets of squeezes.

Other treatments that may be considered to help treat a prolapse are:

1. Vaginal Pessary Weights- these are weights that increase in size and weight, which are inserted into the vagina in order to help improve pelvic floor muscle tone. The aim of these is that you improve your tone by keeping the weights inserted in the vaginal for increasing lengths of time. 

2. Vaginal Pessary Ring- this is where a ring is inserted into the vaginal vault to keep the organs in place. This is not always considered as it depends on the severity of prolapse. The vaginal rings will need to be changed on a four to six month basis to help ensure correct use and also for infection/ safety purposes. 

3. Surgery- this involves the use of mesh or sutures to repair the area which organs are protruding through and to stabilise the organs. The sutures or mesh will be attached to the various muscles to provide a canopy or tighten the muscles so that everything is held in place. 

4. Lifestyle changes such as reducing weight and smoking can also help. 

5. HRT can sometimes be considered if this is appropriate as the progesterone levels effect muscle tone.

We can understand your concerns so would encourage you to visit your GP again if you feel that the prolapse is not improving or is very much impacting on your daily living. It may be appropriate for your GP to consider referring you for further investigations or treatment by means of physiotherapy, bladder function tests or even surgery.

Answered by the Health at Hand nurses  

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