Bladder Prolapse During Pregnancy: Causes, Symptoms, and How to Manage It Safely
Bladder Prolapse During Pregnancy: Causes, Symptoms, and How to Manage It Safely
Pelvic organ prolapse is the descent of one of the pelvic organs in the pelvic bowl. It can happen during pregnancy or postpartum. A bladder prolapse, known as a cystocele, is manageable and often improves postpartum. It is important for expecting mothers to know the signs of prolapse such as heaviness, pressure, or a sensation that something is in the vaginal canal. This is a very common condition that can occur after pregnancy and childbirth.
What Is Bladder Prolapse?
Bladder prolapse is when the bladder drops into the vaginal wall due to weakened pelvic floor muscles or ligaments. Prolapses can be graded as mild, moderate, and severe. A mild prolapse is a small descent, moderate is lower down and severe would be exiting the vagina. A prolapse can be diagnosed by an internal exam performed by a pelvic floor physical therapist or urogynecologist.
Why Can Bladder Prolapse Happen During Pregnancy?
Bladder prolapse can occur due to hormonal changes. The hormones progesterone and relaxin soften tissues. It can also be caused due to pressure from the growing uterus. If you have preexisting pelvic floor weakness from previous pregnancies or childbirth, this can also be a factor. Furthermore, genetic or lifestyle factors such as increased ligamentous laxity or chronic constipation can also increase the risk.
Common Symptoms to Watch For
Feeling of heaviness or pressure in the vagina.
Difficulty emptying the bladder completely.
Urine leakage (stress incontinence).
Visible or palpable bulge in the vaginal area.
Discomfort when standing for long periods or during bowel movements.
Symptoms may worsen late in pregnancy or after exertion.
How Is It Diagnosed During Pregnancy?
Prolapse during pregnancy can be diagnosed by an internal pelvic exam performed by a healthcare provider such as a gynecologist, urogynecologist or pelvic floor physical therapist.
A urogynecologist may perform an ultrasound. Pelvic floor physical therapists will perform an exam to assess the pelvic floor muscles. It is also helpful for the medical provider to perform an exam in standing for a more functional perspective in addition to lying down. A medical provider will be able to rule out other medical conditions such as urinary tract infection.
Safe Management and Treatment Options
How can we help take care of bladder prolapse through lifestyle management? We can start to incorporate pelvic floor exercises, hip strengthening and strength training. We can also pay attention to what activities make our symptoms worse. Lastly, we can make sure to reduce constipation in order to avoid straining and excess pressure on our pelvic floor. We can also make sure not to lift anything that is excessively heavy for our capabilities.
Medical Support
For those that have a prolapse, treatment options include pelvic floor physical therapy. There also exists another conservative measure known as a pessary. A pessary is a removable support device that acts as support for the pelvic organs. It is inserted into the vaginal canal where it sits and can provide support to the bladder. In some states, pelvic floor physical therapists can fit patients for pessaries, but in most areas, patients will need to find care from a urogynecologist.
Postpartum Recovery:
For some individuals, prolapse can improve after delivery. Other women may only start to experience prolapse symptoms postpartum. However, it is important to note that heaviness and pressure are common symptoms in the immediate weeks following giving birth. If you feel heaviness and pressure after being more active (standing or walking for a longer period) make sure to rest and recline. It is vital to make space for proper rest in those first immediate weeks.
If symptoms of pressure and heaviness do not improve over time it is important to reach out to your OBGYN and to see a pelvic floor physical therapist. Conservative treatment includes pelvic floor physical therapy and can include pessary support. Some may benefit from surgery if symptoms are not improving with conservative measures. That is why it is helpful to also consult with a urogynecologist.
Preventive Tips for Expecting Mothers
How can we prevent bladder prolapse during pregnancy? Expectant mothers can work with a pelvic floor physical therapist to practice proper lifting techniques and to work on core and hip strengthening. It is great to get started working on core, hip and pelvic floor strength early in the pregnancy. It is also very important to stay hydrated and to eat enough fiber and fat to prevent constipation. Lastly, it can be helpful to maintain a healthy weight.
When to Seek Medical Help
If your symptoms of heaviness or pressure start to worsen, it is important to contact your doctor and seek medical attention. Other signs and symptoms that warrant seeking medical help are difficulty urinating, signs of infection, severe pelvic pain and any other new or worrisome vaginal changes. .
Managing Prolapse During Pregnancy
Bladder prolapse during pregnancy can feel like pelvic pressure, heaviness or the sensation of something in the vaginal canal. It can be caused by hormonal changes, ligamentous laxity, increased pressure due to constipation or excessive lifting. If you think you may have bladder prolapse it is important to consult your OBGYN, a urogynecologist and a pelvic floor physical therapist. Together this team can help you manage this condition and prepare for a successful labor and delivery. With proper care, a healthy pregnancy is possible. Pelvic floor therapy can help with building core, pelvic floor and hip strength to better prepare the pelvis. It is also important to prepare for a postpartum recovery marked by rest.
