A prolapsed bladder, medically known as a cystocele, is a common condition where the bladder descends and bulges into the front wall of the vagina. This occurs when the supportive tissues and muscles of the pelvic floor weaken, allowing the organ to shift from its normal position. Symptoms vary greatly, ranging from a feeling of mild pressure to physical discomfort and urinary changes. While many women experience no symptoms, others find the condition impacts their daily life and warrants medical consultation.
Understanding a Prolapsed Bladder
A cystocele develops when the fascia separating the bladder from the vagina deteriorates or tears. This loss of structural integrity allows the bladder to push against the vaginal wall, creating a bulge. This weakening results from events that strain the pelvic floor, such as vaginal childbirth, chronic coughing, heavy lifting, or reduced estrogen after menopause.
Healthcare providers classify the severity of a cystocele using a grading system based on how far the bladder has dropped. A Grade 1 prolapse is mild, dropping only a short distance down the vaginal canal. A Grade 2 prolapse means the bladder has descended far enough to reach the opening of the vagina.
The most severe cases are Grade 3 or Grade 4, where the bladder visibly protrudes outside the vaginal opening. The severity of the prolapse often correlates with the intensity of symptoms.
The Source of Bleeding
A prolapsed bladder itself does not typically bleed because the bladder’s internal lining (urothelium) is not exposed. Bleeding noticed by women is almost always vaginal and originates from the descended prolapsed tissue. When the vaginal wall bulges significantly, the exposed tissue is irritated by constant friction.
This friction occurs from movements like walking, wearing tight underwear, or physical activity. The rubbing causes the vaginal lining on the prolapsed area to become dry, inflamed, or develop small sores called ulcerations. These surface ulcerations and abrasions are the source of the bleeding.
The bleeding is usually light and intermittent, often appearing as spotting or a pink discharge, especially after straining or intercourse. Any unexplained vaginal bleeding requires medical evaluation to rule out other causes. A healthcare provider must exclude conditions such as cervical polyps, uterine fibroids, or other gynecological issues.
Other Common Symptoms of Prolapse
Common symptoms of prolapse relate to mechanical discomfort and changes in urinary function. Many individuals report a sensation of pelvic pressure or heaviness in the lower abdomen that worsens throughout the day or after long periods of standing. This pressure is caused by the bladder physically bulging into the vaginal space.
A frequent complaint is the feeling that something is “falling out” or a noticeable bulge at the vaginal opening. This sensation may be accompanied by lower back discomfort. For some women, this bulge becomes noticeable only during activities like coughing or straining.
Urinary symptoms are also common, including difficulty fully emptying the bladder (incomplete voiding). The change in bladder position can cause the urethra to kink, making urination difficult or resulting in a slow stream. Many women also experience stress incontinence, which is the involuntary leakage of urine when coughing, sneezing, laughing, or exercising.
Diagnosis and When to Seek Urgent Care
Diagnosis typically begins with a thorough pelvic examination. During the exam, the doctor often asks the patient to strain or cough to visualize the extent of the prolapse. The severity of the descent is measured, and the doctor assesses for co-occurring conditions, such as a rectocele or uterine prolapse.
To understand bladder function, the physician may recommend specialized tests. Urodynamic testing measures the bladder’s ability to store and release urine, helping to diagnose associated incontinence. A cystoscopy, which involves inserting a thin, lighted tube into the urethra, may also be performed to inspect the inside of the bladder and rule out other urinary tract issues.
While light spotting from surface irritation may relate to the prolapse, certain signs warrant immediate medical attention. Seek urgent care if you experience heavy or continuous bright red bleeding, especially if it soaks through pads or is accompanied by severe pelvic pain. Signs of infection, such as fever, chills, or bloody urine with a foul odor, also require prompt evaluation.