About my prolapsed bladder

Dear Dr Mitchell,

I have been diagnosed with a prolapsed bladder since December 2011. I was having problems with frequent urination and the doctor made the diagnosis. My biggest concern is whether I will be able to have another child without further problems. I don’t want to push it further down. I already have three sons and I’m not yet married, but when I get married I would like to have a child with my husband. I would really like to know more about this condition and how to prevent it from getting worse. Is it safe for me to have sex normally and can I get it fixed? Sometimes I have a lot of pain whenever I have sex or when I hold my urine too long.

The problem that you are experiencing with a prolapsed bladder is due to weakness in the pelvic floor muscles. This is a relatively common problem in women who have had several vaginal births. The risk of prolapse increases further if the babies are very big, labour is prolonged, or seems to go rapidly. There is also a greater risk of weakness in the pelvic floor and subsequent prolapse if forceps or vacuum is used to expedite delivery of the baby.

Women tend to have decreasing oestrogen levels as they get older and this is most marked after the menopause. This low level of oestrogen leads to weakness in the pelvic floor and subsequent prolapse of the bladder, uterus and rectum in some women. Women who have long-standing diabetes mellitus have an increased risk of prolapse of the pelvic organs, including the bladder.

Prolapse of the bladder is sometimes associated with loss of urine during coughing, straining or lifting heavy objects. It is important that you be investigated for a urinary tract infection since this can also cause frequent urination. Blood in the urine and pain on passing urine are also other symptoms associated with an infection in the urinary tract.

It is safe for you to have sexual activity normally. The problem is that you may have some discomfort because of the prolapsed bladder. It is important for you to prevent worsening of the prolapse. Excessive weight, especially an increase in the size of the abdomen, will put excessive pressure on the pelvic floor and cause worsening of the prolapse. Weight loss is extremely important to enhance your ideal weight for height.

Chronic coughing, smoking and asthma are also risk factors for prolapse of the pelvic floor. These need to be managed appropriately in close collaboration with your medical doctor. Smoking is also a big risk factor and if you smoke you should stop. Lifting heavy objects put a lot of pressure on the pelvic floor and cause worsening of pelvic floor prolapse and this should be avoided by all means.

Prolapse of the bladder can be corrected by doing surgery to replace the bladder base in its correct position. However, doing pelvic floor exercises (Kegel exercises) will help to strengthen the pelvic floor and correct the problems if you are motivated to do these regularly. A ring pessary can also be put in as a temporary measure to help correct the problem but can cause vaginal discharge, infection and pain during sexual intercourse in some women. Prolapse can recur even after surgical correction so measures should always be taken to prevent recurrence even after surgical correction.

If surgery is done to correct pelvic floor prolapse, your next baby should be delivered by Caesarean section to avoid further damage to the pelvic floor. If the damage is significant at this time, then a Caesarean section should be done in any event even if surgery is not done before your next pregnancy. This will prevent further damage to the pelvic floor during vaginal birth.

Consult your family doctor or gynaecologist who will do a urine culture to rule out a bladder infection and assess the degree of prolapse and make the appropriate recommendations.

Best wishes.

Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.

DISCLAIMER:

The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.