Pelvic organ prolapse (POP) occurs when the muscles and connective tissues of the pelvic floor weaken, causing one or more organs, such as the bladder, uterus, or rectum, to descend from their normal positions. This downward shift presses into the vaginal canal, creating a noticeable bulge and disruptive symptoms. The concern regarding a prolapsed bladder and its connection to bowel function is common due to the close proximity of these organs. While a bladder prolapse primarily affects urinary health, the shared supportive structures mean that weakness in one area often coexists with weakness in others.
Understanding Pelvic Organ Prolapse
A prolapsed bladder, medically termed a cystocele, occurs when the bladder wall bulges into the front wall of the vagina. This condition develops when the fascia, the fibrous tissue separating the bladder from the vagina, becomes stretched or damaged. The compromised pelvic floor integrity allows the bladder to sag from its proper anatomical position.
The primary factors contributing to this loss of support involve events that place chronic strain on the pelvic floor muscles. Vaginal childbirth is a significant risk factor, especially with difficult or multiple births, as tissues are stretched and potentially torn. Other causes of increased intra-abdominal pressure also contribute to tissue weakening. These include chronic constipation with repeated straining, chronic coughing, or a history of heavy lifting.
A decline in estrogen levels, associated with aging and menopause, further exacerbates the condition because this hormone helps maintain the strength and elasticity of the pelvic tissues. Healthcare providers use a grading system to classify the severity of a cystocele, which guides treatment decisions.
Cystocele Grading
In a Grade 1 prolapse, the bladder drops only a short distance into the vagina, often causing minimal symptoms. The condition progresses to Grade 2 when the bladder descends far enough to approach the vaginal opening, causing a sensation of pressure or a bulge. A Grade 3 prolapse is characterized by the bladder protruding outside the vaginal opening. A Grade 4, or complete, prolapse means the bladder is fully exposed outside the body.
How Different Prolapses Affect Bowel Function
A pure cystocele, involving only the bladder’s descent, typically causes urinary symptoms such as stress incontinence, urinary frequency, or incomplete bladder emptying. Since the pelvic floor is a single unit of interconnected muscles and ligaments, it is uncommon to experience only one type of prolapse. The weakness allowing the bladder to drop often permits the simultaneous descent of organs closer to the rectum, which leads to bowel problems.
Rectocele and Bowel Obstruction
The condition most directly responsible for bowel symptoms is a rectocele, or posterior prolapse, where the rectum bulges into the back wall of the vagina. When stool moves down the colon, it can enter this newly formed pouch instead of traveling straight toward the anal canal. This anatomical diversion creates a mechanical obstruction, resulting in difficulty passing a bowel movement, known as obstructive defecation.
Individuals with a rectocele frequently experience chronic constipation and a persistent feeling of incomplete evacuation. This mechanical issue is sometimes relieved only by manual splinting, which involves pressing on the posterior vaginal wall to push the prolapsed tissue back into alignment.
Another related condition is an enterocele, where the small intestine descends and pushes against the upper vaginal wall. An enterocele can contribute to difficulty with bowel movements and cause a feeling of pelvic pressure, particularly after standing. While a prolapsed bladder itself does not cause bowel issues, the underlying pelvic floor dysfunction is frequently accompanied by a rectocele or enterocele, which are the true sources of the bowel symptoms.
Treatment and Management Strategies
The initial approach to managing pelvic organ prolapse begins with conservative, non-surgical methods, regardless of the primary symptoms. Pelvic floor muscle training, often called Kegel exercises, strengthens the muscles that support the pelvic organs. This therapy is often enhanced by biofeedback, which uses sensors to confirm the patient is engaging the correct muscle groups effectively.
Lifestyle adjustments reduce unnecessary strain on the pelvic floor, preventing symptom progression. Maintaining a healthy body weight is recommended, as excess weight increases intra-abdominal pressure. Managing chronic conditions also reduces repetitive straining. This includes controlling a chronic cough and managing constipation through a high-fiber diet and adequate hydration.
A supportive device known as a pessary provides a non-surgical option by physically holding the prolapsed organ in place. These silicone devices come in various shapes and sizes and are inserted into the vagina for internal structural support. A healthcare provider fits the pessary, which the patient can often manage or requires periodic cleaning and replacement by a clinician.
When conservative treatments fail or the prolapse is severe, surgical correction may be considered. The goal of surgery is to restore the native anatomy by lifting the descended organs and repairing the weakened supportive tissues. Procedures may be performed vaginally, such as a colporrhaphy or a native tissue repair like sacrospinous ligament fixation. Abdominal approaches, such as sacrocolpopexy, use surgical mesh to attach the vaginal vault to a strong ligament near the tailbone, providing long-term support.