A bladder prolapse occurs when the supportive tissue between the bladder and the vaginal wall weakens. This allows the bladder to sag or bulge into the vagina, causing symptoms like pelvic pressure, a feeling of fullness, or difficulty emptying the bladder. For individuals with mild to moderate symptoms, the condition can be managed effectively without surgery. Non-surgical approaches focus on reducing downward pressure and strengthening the underlying support structures of the pelvic floor.
Daily Lifestyle and Behavioral Changes
Reducing strain on the pelvic floor begins with maintaining a healthy body weight. Excess abdominal weight increases downward pressure on the pelvic organs. Even moderate weight reduction can decrease this pressure, lessening the load on weakened tissues.
Managing chronic constipation is also crucial, as repetitive straining during bowel movements severely stresses the pelvic floor muscles. Increasing dietary fiber intake and ensuring adequate fluid consumption helps keep stools soft and easy to pass. Using a toilet footstool can promote a natural squatting posture, which further reduces the need to strain.
It is important to address sources of constant pressure, such as a chronic cough. Conditions causing persistent coughing, like smoking or bronchitis, should be treated to prevent repeated downward forces on the bladder. When lifting objects, proper technique involves squatting by bending the hips and knees while keeping the back straight. Bracing the pelvic floor by performing a gentle Kegel before the lift is also recommended.
Targeted Pelvic Floor Strengthening
Strengthening the pelvic floor muscles is a core non-surgical strategy to improve support for the prolapsed bladder. These exercises, commonly called Kegels, involve intentionally contracting and relaxing the muscles that support the bladder, uterus, and rectum. Correct technique requires isolating these muscles, often described as trying to stop the flow of urine, without engaging the abdomen, buttocks, or thighs.
A comprehensive routine should include both slow and quick contractions to train different muscle fibers. Slow contractions, where the muscle is held for up to ten seconds and then relaxed, build endurance. Quick contractions, or “quick flicks,” involve rapidly tightening and relaxing the muscles. This trains the fast-twitch fibers necessary to resist sudden pressure from a sneeze, cough, or laugh.
Consistency is necessary for improvement, with a typical goal of performing at least three sets of 10 to 15 repetitions daily. Individuals who struggle to identify the correct muscles can benefit from biofeedback, where a pressure sensor provides real-time monitoring of muscle activity. Consulting a specialized pelvic floor physical therapist ensures the technique is correct and the exercise program is tailored.
Utilizing Mechanical Support Devices
A vaginal pessary is a removable medical device, typically made of soft silicone, inserted into the vagina to provide direct support to the prolapsed organs. Pessaries restore the bladder to a more normal anatomical position, alleviating symptoms such as pressure and urinary leakage. This mechanical support is effective for women with mild to advanced prolapse.
Pessaries are classified as either support or space-occupying devices and come in a variety of shapes and sizes, including the ring, Gellhorn, donut, and cube. The ring pessary is often used for mild to moderate prolapse, while space-filling types like the Gellhorn are reserved for more advanced cases. The initial fitting must be done by a healthcare provider, and finding the smallest effective size may take several attempts.
Maintenance varies depending on the device type. Support pessaries, such as the ring, can remain in place for several months before being removed, cleaned, and checked by a professional. Space-occupying devices, like the cube, must be removed and cleaned daily by the user, requiring manual dexterity. Consistent follow-up every three to six months is necessary to monitor the health of the vaginal tissue and ensure the device is still properly fitted.
When Conservative Treatment is Insufficient
While non-surgical methods are highly effective for many, there are clear indicators that conservative management may be insufficient, suggesting the need to consult a healthcare provider about other options. The progression of the prolapse itself, particularly to Grade III or IV where the organ descends to or past the vaginal opening, often warrants a discussion about surgical intervention. Severe, unmanageable symptoms that significantly compromise daily function are also a sign that conservative treatment is failing.
Specific functional problems, such as the inability to completely empty the bladder (urinary retention) or the occurrence of recurrent urinary tract infections, indicate that the prolapse is causing an obstruction. Persistent pain, a heavy dragging sensation that is not relieved by a pessary or exercises, or severe discomfort during sexual activity are also reasons to re-evaluate the treatment plan. In these situations, surgical options aim to reconstruct supportive tissues and restore the bladder to its proper position.