Prolapsed bladder is a midlife condition for many women, causing pain and embarrassment. Naturopath Lyn Craven explains its cause, symptoms and some treatment options
A number of women experience prolapse of the bladder, a condition that can be due to many reasons and be quite embarrassing and painful in some cases. It can, in fact, have an impact on their social activities and personal life creating stress and ultimately relationship problems, particularly when it comes to intimacy.
The bladder is a hollow organ in the pelvis that stores urine. When the bladder fills, pressure creates the urge to urinate. Urine travels from the bladder, leaving the body via the urethra.
In women, the front wall of the vagina supports the bladder and can weaken or loosen with age. Physical stress, such as childbirth, can damage this part of the vaginal wall. If it deteriorates, it will no longer give support so the bladder can prolapse, descending into the vagina. This may trigger urinary difficulties, discomfort, pain during sex and stress incontinence such as urine leakage.
• Prolapsed bladders (known also as cystoceles or fallen bladders) are graded based on how far the bladder droops into the vagina.
• Grade 1 - mild: small portion of the bladder droops into the vagina.
• Grade 2 - moderate: bladder droops enough to reach the opening of the vagina.
• Grade 3 - severe: bladder protrudes from the body through the vaginal opening.
• Grade 4 - complete: entire bladder protrudes completely outside the vagina; often associated with other pelvic organ prolapses (uterine, rectocele, enterocele)
Prolapsed bladders are commonly associated with menopause. Prior to menopause, women's bodies create the hormone oestrogen, which helps keep the muscles in and around the vagina strong. The ovaries stop creating oestrogen after menopause, and those muscles tend to weaken as a result. However, oestrogen production shifts from the ovaries to the fat cells and estrone (E1), the chief oestrogen, is converted from androgens (androstenedione) and produced mainly by the adrenal glands, but in lesser amounts.
Causes of bladder prolapse
Childbirth is the most common cause of prolapsed bladder due to the delivery process that is stressful on vaginal tissues and muscles. Another significant cause is menopause as described above. Other common causes are fibroids poking into the bladder and creating pressure, and straining. Lifting heavy objects, straining during bowel movements, having a long term condition that involves coughing, or long term constipation may weaken muscles of the pelvic floor.
The first symptom noticed is the presence of tissue in the vagina often described as feeling like a ball. Others are
• Discomfort or pain in the pelvis
• Tissue protruding from the vagina (may be tender and may bleed.)
• Difficulty urinating
• Feeling that the bladder is not empty immediately after urinating
• Stress incontinence (urine leakage during sneezing, coughing, exertion)
• More frequent bladder infections
• Painful intercourse
• Low back pain
Medical diagnosis and treatment
Once the diagnosis ascertains the grade of the prolapsed bladder, various medical treatments are offered, such as surgery for more severe cases, and instructions on pelvic floor exercises.
Some women have had repeated surgeries - it really depends on the individual and how they manage their activities after surgery.
Oestrogen replacement therapy (ORT) may be used to help the body strengthen the muscles in and around the vagina. ORT may be contraindicated in a woman with cancer. In mild cases of prolapsed bladder, oestrogen may be prescribed to help reverse symptoms such as vaginal weakening and incontinence. In severe degrees of prolapse, ORT may be used along with other treatments such as electrical stimulation and biofeedback to help strengthen pelvic muscles. It is important you are aware of potential side effects from synthetically derived hormonal medication and research has confirmed that cancer can result from conventional hormonal remedies.
Oestrogen can be administered orally or topically as a patch or cream. The cream has a potent effect when applied locally and less effect systemically. Topical administration has less risk than the oral. The application of oestrogens to the anterior vagina and urethral area is helpful in alleviating urinary symptoms, such as urgency or frequency of urination.
A high fibre diet and daily intake of water are recommended to help reduce constipation. Avoid straining during bowel movements, and heavy lifting. Being obese can be a risk factor, contributing to a prolapsed bladder.
If you have fibroids do get them checked out. Question your gynecologist as to the exact location and discuss surgery if the fibroid is causing too much pressure on the bladder. On some occasions, stubborn heavy fibroids that do not shrink with treatment can, in fact, create a heavy bulky uterus if they are growing in the muscle of the uterus. This, in turn, can prolapse and place additional pressure on the bladder which could then also prolapse.
Acupuncture and Bowen Therapy are excellent for lifting prolapsed bladders, depending on the severity of the condition. Herbal and homeopathic remedies help strengthen the mucosa of the bladder and vaginal tissues. Mineral/vitamin deficiencies play a huge role in imbalances with hormones. If you are peri-menopausal, you need to address your diet and nutritional intake to ensure your body can adjust easily to the natural hormonal change that occurs as we age. Natural remedies can be taken for lengthy periods safely (unlike synthetic or chemically derived hormones) to stablise hormonal fluctuation and help with counteracting unpleasant symptoms. Remedies need to be changed over time, so giving clear feedback to the practitioner can help them help you, along with being compliant and following through with the regime which is important.
If your mineral profile is inadequate due to faulty diet or poor digestive function, then these things need to be improved to encourage healthier hormonal production and organ function. General blood tests do not always show accurate levels of minerals. Many naturopaths use functional lab tests; I also find hair mineral analysis more effective in illustrating mineral levels including toxic elements.
Avoid foods or beverages that contain malic acid, such as apple juice, apple cider and concentrates, which weakens the bladder. Eating apples, though, is fine.
The underlying cause of constipation needs to be addressed since a high fibre diet is not necessarily the answer. Stress plays an enormous role here and no amount of fibre or laxatives will help. In fact, the latter will make the situation worse and if used habitually could result in ulceration, colitis or diverticulitis of the bowel.
Here's a hint to ease the strain: place a small box or two telephone books under your feet which causes the bottom to tilt while sitting on the toilet. This puts the descending colon/rectum at a different angle, making it easier to eliminate without straining. When you strain, you can push the bladder and vaginal muscles too hard and weaken them.
Cold sitz baths are popular in Europe to help with circulation to the pelvic floor region. Yoga and especially pilates teach you to strengthen your core and pelvic floor muscles during many of the exercises.
Topical herbs have often been used to help shrink some fibroids but occasionally, as mentioned earlier, some stubborn ones do resist. Prevention and good maintenance can help keep a strong healthy bladder.
Sydney-based Lyn Craven is a practitioner of naturopathy, nutrition, medical herbalism, Bowen therapy, Reiki energy healing and meditation, and is a corporate health presenter/consultant with 17 years' experience in natural therapies.