Help! My Bladder is Falling Out!

Have you ever been in the shower and noticed a bulge in your vaginal area? If so, you may be one of the many women with something called pelvic organ prolapse (POP).  Nearly half of women over the age of 50 have POP, but rarely are they prepared for it or even know what it is when they discover it.  It can be a frightening thing, not knowing what is going on.  If your doctor has ever told you that your ‘bladder has dropped’, then you have prolapse.  While it can be very disconcerting, frightening, or just annoying, it is not something to fear. It won’t just do any good to shout out, ‘Help, my bladder is falling out!’ Continue reading to learn what it is and what to do about it.

Types of Pelvic Organ Prolapse

The three most common types are cystocele, rectocele, and uterine prolapse.  A cystocele is what it is called when your bladder drops towards or out of the vaginal opening. If this occurs, you may have no symptoms at all, but you may find that you struggle to empty your bladder or that your urine ‘sprays’ in different directions.  Sometimes you can lift your bladder up and it will help you void.

A rectocele is when the bulge is the rectum protruding into the vagina.  Like all types of prolapse, the most common symptom is simply feeling a bulge. However, this can cause problems with constipation and sometimes leakage of stool.  Women with a rectocele often find that if they press up on the back part of their vagina, it is easier to have a bowel movement.

Uterine prolapse is pretty self-explanatory. It is when your uterus drops down.  Again, the most common symptom is just feeling a bulge.  Sometimes you will have either bladder or bowel symptoms too, depending on how far down it is.  You may also feel more of a pressure sensation with this type, or feel like a tampon is stuck in your vagina even though there isn’t one there.

What to do about it

First, get someone who is familiar with prolapse to do an exam so you know exactly what is going on.  Having a bulge is not an emergency, but having the knowledge of what is going on with your body will put your mind at ease that nothing more serious has happened.  Second, you will usually have several choices

  1. Do nothing. Again, it’s not an emergency. You aren’t going to damage anything by leaving it as it is. Intercourse may be uncomfortable but it is not harmful. If it’s mild or if it doesn’t bother you, then observing it for a while is perfectly fine.  Depending on how severe it is, it may or may not get worse with time.
  2. Physical therapy. Many women have pretty weak pelvic floor muscles.  There are specialists who can teach you how to train these muscles and that can help some of your symptoms.  If you have mild prolapse, it can help reduce it, or it can help keep it from getting worse.
  3. This is a flexible vaginal insert that is usually made from silicone. They come in many different shapes and sizes, but the goal is to give you relief of symptoms (pressure, difficulty emptying your bladder or bowels) without surgery.  Getting one is as simple as a visit to your doctor.  They do need to be removed for intercourse, so make sure you learn how to manage it on your own before you leave your doctor’s office.
  4. There are loads of different surgeries that can be done for prolapse.  Only someone with adequate training in prolapse surgery should be advising you on what to do here.  What surgery you are offered should depend on your own personal goals with surgery, what type of prolapse you have, and how severe it is.  As long as you are healthy enough for surgery, it is extremely uncommon to not have any option at all for fixing it.

In short, prolapse is common, uncomfortable, but there are options available to manage or treat it. Don’t be embarrassed to ask your doctor about it.

Bladder infections

Frequent urinary tract infection is one of the most common reasons women come to see me in my clinic.  Why? Because they are awful.  Anyone who has ever had an infection in their urine, called a UTI, knows this.  They can cause severe pain, urinary frequency, a terrible odor in the urine, and be disruptive to even normal daily activities.  Having just one is something a woman is likely to remember for a lifetime.  Unfortunately, many women get them several times a year.

If you have had 2 or more UTIs in the last 6 months, or 3 or more in the last year, then you have recurrent UTIs.  Now, here’s the catch – these need to be ‘proven’ based on urine culture.  Overactive bladder, chronic pelvic pain, vaginal infection, and painful bladder syndrome can all mimic the symptoms of UTI and need to be ruled out before you spend your time and money trying to prevent a bladder infection.  A word of caution – much of the time, when a patient comes to my office, they have never actually had a urine culture.  They think they have, but what was actually done was a screening test called a urinalysis that was suspicious, so they were given antibiotics. If your symptoms get better on antibiotics, then great.  But if not, don’t assume it’s because the medicine didn’t work.  It may just be that you didn’t have a UTI to begin with.

For those women who do  have frequent UTIs, here are some things you can do…

Keep a diary.  Track your symptoms so you can talk to your doctor about how often you have them, what your symptoms are, if anything makes them better or worse, what antibiotics you were given, etc.  Look for patterns – are they always after intercourse? Do you see blood? Have you changed your diet, your birth control, any medications? All of these things are important for planning your next step.

If your infections always occur after intercourse – the easiest way to manage this is to take one dose of an antibiotic after sex. Most of the time this does the trick.  Good sexual hygiene is also very important. If you use spermicides for birth control, consider a different option. If your partner is not circumcised, make sure they clean themselves well.

If you have gone through menopause – you probably need estrogen. After menopause, women will develop what’s called atrophy. This is a thinning of the lining of the vagina and bladder, which leads your body’s natural defenses to be impaired.  Simply using a tiny amount of estrogen cream a few times a week can go a long way to resolving your infections.

Probiotics. Many infections are caused by bacteria that originally come from the gut.  Any imbalance in good vs bad gut bacteria can make you prone to infections.  Any imbalance in the good bugs in the vagina can create a place for the bad bacteria to grow, which later cause urinary tract infections.  Probiotics can help balance this out.  And if you’re willing to put the probiotics in the vagina, it can help even more.

Cranberry.  This is a controversial treatment.  Honestly, the studies are all over the place on this one.  Some say it works great, some say it doesn’t work at all.  In my opinion, it shouldn’t hurt to try cranberry supplements.  But stick with the capsules – the juice has way too much sugar, and even if it’s sugar free, it can really irritate your stomach and bowel.

D-mannose.  This is a supplement you can buy at most stores. Again, the studies here are limited, but it may be able to help prevent bacteria from taking hold in your bladder and causing problems.

pH adjusters.  A neutral pH in your urine may help prevent infections.  There’s very limited data on what the best pH adjusters are, but if nothing else is working for you, this is something to consider.

Corn silk.  This is a ‘natural remedy’ that might be an option.  Like most herbal supplements, information is scarce on whether it works or not.  The theory is that it helps decrease inflammation and soothes the bladder, so it may be best used to get some relief if you have an active infection.  Always talk to your doctor before taking corn silk extract – it can cause your blood sugar to go down, potassium to decrease, and interfere with medicines like coumadin.

Antibiotics.  Some women get so many infections that they really just need to be on a small dose of antibiotics every night for a while.  This should not be the first thing to try, but is something that can be considered if other things don’t help.