Bladder prolapse, also known as pelvic organ prolapse or cystocele, is a condition that affects people with a vagina. It happens when the wall between your bladder and vagina weakens. If this happens, the bladder may sag or drop from your pelvis into the vagina.
Bladder prolapse is a type of vaginal prolapse. It results from the weakening of muscles and connective tissues between the organs in your pelvis from:
- pregnancy and vaginal birth
- aging
- obesity
- repeated heavy lifting
- pelvic floor (Kegel) exercises
- using a pessary, a supportive device that’s inserted into the vagina to hold your bladder in place
However, if you still have symptoms after these treatments, you may need surgery to fix the prolapse.
Keep reading to learn more about bladder prolapse surgery, including its types, about the procedure, complications, costs, and other helpful information.
There are two
Reconstructive surgery
Reconstructive surgery moves your pelvic organs back into their original position and supports them there.
During this procedure, a surgeon tightens the supportive tissues in the front (anterior) wall of your vagina to keep the bladder in its place.
Another type of reconstructive surgery is called sacrocolpopexy. It’s an abdominal surgery that can be done laparoscopically (as a minimally invasive procedure) or performed with special tools (robotic-assisted).
Obliterative surgery
Obliterative surgery narrows or closes off the vagina to support the pelvic organs. Bladder prolapse obliterative surgery is called colpocleisis.
During this procedure, a surgeon sews together the front and back walls of the vagina to shorten the vaginal canal. This provides support to your pelvic organs, including the bladder, and keeps them in place.
Obliterative surgery makes it impossible to have penetrative sex.
Before the procedure
Depending on the type of surgery, your medical team may use general anesthesia so you don’t feel any pain. Or, you may remain awake and alert, with only the affected part of your body numb to reduce pain and discomfort.
During the procedure
Anterior vaginal wall repair and colpocleisis are performed vaginally. During anterior vaginal wall repair, a surgeon will lift your bladder back into its place using stitches and then remove excess vaginal tissue. If your vaginal tissues are very thin, the surgeon might also use a tissue graft or a mesh to reinforce them.
During colpocleisis, a surgeon will make an opening in your vagina and sew the front and back walls of your vagina together. This will close off or narrow the opening and shorten the vaginal canal.
Sacrocolpopexy, on the other hand, is an abdominal surgery. During this procedure, a surgeon will attach surgical mesh from the vagina to the tailbone to suspend the top of the vagina back into its normal position. It’s usually performed laparoscopically, with a few small incisions in the abdomen.
After the procedure
The recovery time depends on the type of surgery. Laparoscopic surgeries usually have a quicker and easier recovery. You will likely be able to go home soon after it’s over.
For the first few weeks of recovery, you will need to avoid strenuous exercise and vaginal intercourse.
The success of bladder prolapse surgery depends on its type.
Obliterative surgery is considered the
Reconstructive surgery is the most popular type of bladder prolapse surgery. However, it’s less effective, meaning your symptoms may come back later, requiring more surgeries.
Sacrocolpopexy is more effective than anterior vaginal wall repair, but it may have more complications.
The risk of complications after a bladder prolapse surgery depends on the type of procedure. Obliterative surgery is often the safest approach because it’s the least invasive and takes a shorter time to complete.
Most commonly, complications are associated with the general risks of having surgery:
- adverse reactions to the anesthetic drug
- excessive bleeding
- infection
- blood clots
Other complications are:
- painful intercourse
- bladder problems
- injury to nearby structures (for example, bowels or bladder)
Rarely, laparoscopic surgeries can cause long-term complications like bowel obstruction and abdominal hernia.
Bladder pain after prolapse surgery
You may feel cramping or pressure in your bladder area after your surgery. It generally settles after a few days, but sometimes it can take up to a few weeks to dissipate.
If you have an abdominal incision, you may also experience pain around the incision as it heals. You can take over-the-counter pain medications to ease the pain.
Incontinence after bladder prolapse surgery
Urinary incontinence and other bladder problems, like difficulty emptying the bladder or urinary hesitancy, can happen after the surgery, but they usually go away on their own.
However, if it remains a problem, you might need to take medication or undergo another surgery. Make sure to consult your doctor if you have a persistent bladder issue.
Depending on the type of surgery, you might stay in the hospital for 1 to 3 nights.
It’s important to rest for a few weeks after the surgery to allow the area to heal. You will likely have a follow-up appointment with your surgeon a few weeks after the surgery to confirm that it’s healing well. You may also have additional follow-ups.
According to a 2016 article, a bladder prolapse surgery may cost at least $9,000 or more.
Robotic-assisted abdominal surgery is more expensive at around $15,000, according to a 2019 study. However, your insurance plain might cover it. Check with your insurance provider to find out the details.
There are two main alternatives to bladder prolapse surgery: pelvic floor exercises and pessary.
Pelvic floor exercises
Pelvic floor exercises are commonly known as Kegels. Kegels can help mild bladder prolapse, but they’re typically not enough for moderate or advanced cases.
Avoid using Kegel balls if you have bladder prolapse. They can put additional weight on your bladder.
Pessary
A vaginal pessary is a supportive device, usually round in shape, that’s inserted into your vagina to hold the bladder and other pelvic organs in place. It can be used for both moderate and advanced bladder prolapse.
Your doctor might suggest a bladder prolapse surgery if:
- your prolapse is severe or you have bothersome symptoms, and
- you have tried Kegel exercises and pessaries, but they didn’t work
You will not be a good candidate for bladder prolapse surgery if:
- your prolapse is mild
- you’re planning on having children
- surgery is dangerous for you because of a medical condition
Urogynecologists are the doctors that typically treat bladder prolapse and perform surgeries. They have specialized training in both gynecology and urology. Other doctors may comprise your care team as well.
Bladder prolapse occurs when your bladder drops or sags inside your vagina. Kegel exercises or a pessary can treat it, but in more severe cases bladder prolapse surgery is necessary.
There are two types of surgeries: obliterative and reconstructive. Reconstructive surgery is the most common type because it doesn’t prevent you from having vaginal sex. Surgery may have side effects, but they’re usually mild and resolve quickly.