What is bladder prolapse?

A bladder prolapse (also called a cystocele) is when your bladder bulges into your vaginal wall. The term 'prolapse' means 'to fall out of place'.

Normally, a group of muscles and tissues, including your pelvic floor muscles, supports your pelvic organs, which include your:

• bladder
• uterus (womb)
• rectum (back passage) and bowel

If your pelvic floor muscles and tissues become weak, these organs may not stay in place properly. They can start to bulge into the wall of your vagina.

What are the symptoms of bladder prolapse?

If your bladder prolapse is mild, you might not have any symptoms. Your doctor or nurse might notice it when you have a cervical screening test.

If your bladder bulges further down your vagina, you may notice:

• pressure or a 'dragging' feeling in your vagina
• a lump that bulges out of your vagina — it may go away when you lie down and come back when you stand up
• difficulty passing urine (doing a wee), such as needing to strain or a flow that stops and starts
• a feeling that you have not fully emptied your bladder
• urinary incontinence (leaking urine)
• problems or pain during sex
• frequent urinary tract infections (UTIs)

What causes bladder prolapse?

The most common causes of bladder prolapse are pregnancy and childbirth.

Hormonal changes and the extra weight of pregnancy can weaken your pelvic floor muscles. These muscles can also be stretched or torn during a vaginal birth. This is particularly so if your labour was very long or if you had a forceps or vacuum birth.

Your risk of bladder prolapse may be higher:

• after menopause
• if you have constipation and strain on the toilet
• if you have a chronic (ongoing) cough
• if you are overweight
• with repeated heavy lifting
• if you have a family history of pelvic organ prolapse

When should I see my doctor?

See your doctor if:

• you have symptoms of bladder prolapse that are bothering you
• lifestyle changes and pelvic floor exercises are not helping your symptoms
• you have problems, such as a chronic cough or constipation, that are making your prolapse worse

If you have urinary incontinence, talk to your doctor or a nurse continence specialist. To find your nearest continence clinic, use the healthdirect Service Finder tool below.

How is bladder prolapse diagnosed?

Your doctor will ask about your symptoms and medical history. They will examine you and, with your consent, perform an internal examination. This can help your doctor find out if you have a bladder prolapse and how severe it is.

Your doctor may refer you for some tests, including:

• an ultrasound scan of your pelvis
• a bladder function (urodynamic) test for incontinence
• a urine test to check for infection

They may also refer you to a specialist doctor — this may be a gynaecologist or urologist.

How is bladder prolapse treated?

There are different treatment options available for bladder prolapse. The treatment your doctor recommends will usually depend on how severe your prolapse is and how much it is affecting you.

If your symptoms aren't affecting your quality of life, you may choose not to have treatment. If your symptoms are mild, they may improve with self-care measures and pelvic floor exercises. Surgery and other treatments are also available.

If you choose not to have treatment, you can always change your mind if your symptoms get worse over time.

Self-care measures

Self-care or lifestyle measures that can help include:

• losing weight if you are overweight
• quitting smoking and vaping
• treating and avoiding constipation by eating a healthy diet
• avoiding heavy lifting
• choosing low-impact exercise

Pelvic floor exercises

Pelvic floor exercises help tighten your pelvic floor muscles and make them stronger. It's best to see a pelvic floor physiotherapist to make sure you are doing them correctly.

Continence Health Australia has produced this video on how to do pelvic floor exercises:

Learn more about the function and role of the pelvic floor muscles here.

Other treatments

Your doctor or specialist physiotherapist may recommend a pessary — a small plastic or silicone device. The pessary can be inserted high up into your vagina to provide support to your vaginal wall.

Oestrogen cream can make your vagina less dry and improve the tissue quality of the vaginal wall. This can be helpful if you have had repeated urinary tract infections.

Surgery

You might choose to have surgery if your symptoms are severe and other options have not worked.

There are several different procedures that can put your bladder back into place and provide support for it. Your doctor can discuss the best type of surgery for you. Your doctor should also talk with you about the risks and benefits of surgery.

What are the complications of bladder prolapse?

If you have a bladder prolapse, you might also have a rectal prolapse or a prolapsed uterus. This is where your rectum or uterus bulges into your vaginal wall. You may have problems with bladder or bowel control.

Can bladder prolapse be prevented?

There are some things you can do that may help prevent a bladder prolapse:

• Do pelvic floor exercises regularly.
• Avoid lifting heavy objects.
• Maintain a healthy weight to prevent extra stress on your pelvic floor.
• Eat foods rich in dietary fibre and drink plenty of water every day to help prevent constipation and straining.
• Get some exercise every day — include exercise that strengthens your core muscles and avoid high-impact exercise such as jumping and running.

Resources and support

Continence Health Australia has information and support for people with bladder problems. You can contact the National Continence Helpline on 1800 33 00 66 to speak to a nurse continence specialist for advice.

Visit the Pelvic Floor First website to find out more about strengthening your pelvic floor.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) has information on pelvic organ prolapse.

The Health Translations website has information on bladder prolapse in languages other than English.

See the Australian Commission on Safety and Quality in Health Care guide for more information about prolapse treatment options. This can help you talk to your doctor and decide what is right for you.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.