I had a complete hysterectomy 14 years ago and now my bladder is “fallen” and I want to know what my options are. Someone told me the only thing I could do is bladder suspension – is this true?
A fallen bladder, also known as cystocele or prolapsed bladder, is common after hysterectomies. It involves the bladder falling into the vaginal canal. Prolapsed bladder symptoms include tissue in/protruding from the vagina, problems with urination, increased bladder infections, pelvic discomfort, pain in the lower back, and pain during intercourse. If any of these symptoms are present, it is important to see your doctor so they can conduct a pelvic exam to diagnose you.
There are four stages of prolapse that help gauge the degree of severity. Stage I is when the bladder begins to droop into the vaginal vault; Stage II involves the bladder dropping into the lower section of the vaginal region; Stage III is when the bladder is visible at the vaginal opening; Stage IV is when the bladder is outside of the body. The stages can help determine the best type of care for your situation.
If you are diagnosed with a prolapsed bladder, there are a variety of treatment options. A pessary is a device that can be inserted into the vagina to support the bladder. Internal measurements of the vagina are taken to determine the size of pessary needed. When a pessary is used correctly, it is comfortable and stays in place. Pessaries are a good alternative to surgery and can decrease prolapse symptoms. Pelvic floor exercises, also known as Kegels, can be done to strengthen the muscles of the pelvic floor. If you are not responding to pelvic floor muscle exercises, another way to strengthen pelvic muscles is with physical therapy, including electrical stimulation and biofeedback. Electrical stimulation involves applying a probe to muscles in the pelvic floor or vagina to deliver electrical currents causing muscle contractions. Biofeedback uses a sensor to monitor muscle activity of the vagina, which helps a doctor make exercise recommendations to strengthen muscles. A prolapsed bladder can also be treated with medication. The muscles surrounding the vagina can be strengthened with estrogen replacement therapy, orally or topically. After menopause, women experience a decrease in estrogen production, which can result in weakening of vaginal muscles.
In severe cases, surgery is used to correct prolapsed bladders; however, non-surgical methods should be attempted first. Depending on the type of reconstructive surgery, procedures may be performed through the vagina or through the abdomen. A “suspension operation” is a surgical procedure typically done through the vagina that can be performed to lift a fallen bladder. Procedures that are done through the vagina typically result in less recovery time compared to abdominal procedures. The abdominal procedures may be a better option if you’re looking to experience less pain during sex. Recovery varies; however, it is best to avoid strenuous lifting, exercise and sexual intercourse for several weeks after surgery. Be sure to consult with your healthcare provider before starting any treatment method.
For more information on prolapsed bladders and various treatment options, see these sources:
- Background information on prolapsed bladder and treatment options: http://www.emedicinehealth.com/prolapsed_bladder/article_em.htm
- Description of various treatment options: http://www.ucurology.org/areas-of-specialization/female-pelvic-organ-prolapse#kegel
- Helpful guide for prolapse after hysterectomy: http://www.lifeafterhysterectomy.com/prolapse-after-hysterectomy/
- Information on pessaries: https://www.pelvicexercises.com.au/pessaries/
- Description of surgery methods for pelvic organ prolapse: http://www.acog.org/Patients/FAQs/Surgery-for-Pelvic-Organ-Prolapse#pelvic
- Hysterectomy information: https://www.nwhn.org/hysterectomy/
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