A prolapsed bladder, medically known as a cystocele, occurs when the bladder drops from its normal position and bulges into the front wall of the vagina. This condition is caused by a weakening of the supportive tissues between the bladder and the vaginal wall. A prolapsed bladder does not typically impede the biological process of becoming pregnant, meaning conception is possible. While pregnancy can proceed, a pre-existing cystocele requires careful medical oversight to manage symptoms that will likely be affected by the growing fetus.
Anatomy of a Prolapsed Bladder
The pelvic floor is a complex network of muscles, ligaments, and fascia that acts like a supportive hammock for the pelvic organs, including the bladder, uterus, and rectum. When this supportive structure becomes stretched or damaged, the organs it holds can descend, resulting in a prolapse.
The severity of a cystocele is categorized into grades. A Grade 1 prolapse is mild, meaning the bladder has dropped only a short distance into the vagina. Grade 2, or moderate, indicates the bladder has descended far enough to reach the vaginal opening. Grade 3 is the most advanced form, where the bladder bulges noticeably out through the vaginal opening.
The weakening of the pelvic floor tissue is often attributed to factors that increase intra-abdominal pressure. These factors include chronic straining from constipation or persistent coughing, repeated heavy lifting, and the mechanical stress of previous vaginal deliveries.
Fertility and Early Conception
A prolapsed bladder does not have a direct biological impact on a person’s ability to conceive. The physical presence of the cystocele does not affect ovulation, the release of an egg from the ovary, fertilization, or implantation of an embryo in the uterine lining.
However, the physical changes associated with a prolapse can indirectly affect attempts at conception. Some individuals experience pain or discomfort during sexual intercourse, which may reduce the frequency of attempts to conceive. If a moderate or severe prolapse causes physical obstruction or pain, it can create a barrier to regular sexual activity. Addressing discomfort is often a focus for couples trying to become pregnant.
Managing Symptoms During Pregnancy
Pregnancy presents a challenge for individuals with a prolapsed bladder because symptoms often become more noticeable as the uterus expands. The increasing weight of the growing fetus places significant downward pressure on the already weakened pelvic floor. This added weight can exacerbate feelings of pelvic heaviness, pressure, or the sensation that something is falling out of the vagina.
One common complaint is the worsening of urinary issues, such as stress incontinence (involuntary leakage of urine when coughing, sneezing, or laughing). The prolapsed bladder may also prevent complete emptying, increasing the risk of recurrent urinary tract infections (UTIs). Frequent UTIs require prompt medical attention, as untreated infections can pose risks during pregnancy.
Management strategies involve lifestyle adjustments and physical support. Pelvic floor physical therapy, including targeted exercises, is recommended to strengthen supportive musculature. A pessary, a silicone device inserted into the vagina, can provide temporary mechanical support to reduce symptoms. Managing constipation through adequate hydration and a high-fiber diet is also advised to prevent straining.
Labor and Delivery Implications
When a person with a prolapsed bladder reaches the end of pregnancy, the method of delivery requires discussion with their obstetrician. A pre-existing cystocele does not automatically mandate a cesarean section; for many, especially those with mild to moderate prolapse, a vaginal delivery remains a safe option.
Vaginal birth carries the risk of further stretching and trauma to the pelvic floor, potentially worsening the prolapse. The intense pressure and straining during the pushing phase of labor can be taxing on the compromised support system. If severe prolapse or prolapsed tissue physically obstructs the birth canal, a planned cesarean section may be recommended to reduce the risk of further pelvic floor injury.
This planning involves consultation with both an obstetrician and a pelvic floor specialist, such as a urogynecologist. They assess the current state of the prolapse and discuss the risks versus benefits of each delivery method, creating a personalized birth plan. The decision depends heavily on the prolapse grade and the individual’s preferences.
Treatment After Childbirth
In the immediate postpartum period, many individuals experience a temporary improvement in prolapse symptoms as the pressure from the enlarged uterus is removed. Symptoms of heaviness and bulging may subside in the weeks following delivery, but the underlying physical weakness in the pelvic floor remains.
Non-surgical management, such as continued pelvic floor physical therapy and the use of a supportive pessary, is typically the first line of treatment. These methods aim to restore muscle function and provide mechanical support.
For individuals with persistent or severe symptoms, surgical repair may be considered once they are finished with childbearing. Procedures like an anterior colporrhaphy move the bladder back into position and tighten supportive tissues. Specialists recommend delaying surgery because subsequent pregnancies can undo the repair.