Bladder Prolapse - how much will it improve?

[DarkDarkNight]

I’ve had a bladder prolapse since I had my child 12 years ago. I’m only just seeking treatment now, I know I should have done something sooner but what kind of improvement can I expect?

I had an appointment with a pelvic floor physio including lots of questions and an internal exam. She said pretty much what I know - the bladder is pressing in to the vaginal wall, lying down it isn’t too bad but when she asked me to bear down and then cough it was more visible and close to the entrance of the vagina (the exam was lying down but I can feel it quite far down when standing).

She assessed my pelvic floor exercises and said I had good technique with minimal stomach tightening. But what improvements can I expect with these alone?

I just feel a bit despondent like I’m stuck with this problem and without surgery (which doesn’t have great success rates) it’s not really going to alter much.

Look at hypopressives, sometimes called low pressure fitness. It’s a technique for exercising the pelvic floor that also stimulates the core, so it’s more effective. It has been shown to have better results than simple pelvic floor exercises for prolapse.

Do a pelvic lift every time you cough. Avoid constipation and heavy lifting.

Did you get a gynaecologist referral? Ideally you would get an internal scan. A pessary is also an option and really helps with symptoms. I
have a ring pessary and it’s brilliant - I leave it in taking it out every few months to clean. You can have sex with it in without any issue.

For a bladder prolapse, I would ask for a referral to urology not gyne. Gyne know a little but urology are experts and I'd go to them more. Uro-gyne is a mix of both, but I think your issues are more severe and as you've only now sought treatment will need more expertise.

Go and see your GP and get an exam from them, let them know what the physio has said as well, and ask for a cystoscopy - a tube into the bladder etc and also a transvaginal ultrasound.

Thank you both for the replies.

I will have a look at the hypopressives and definitely do a pelvic lift when coughing @Nightmanagerfan (the physio said about that for lifting too). Unfortunately there’s a good bit of lifting in my job. Is the pessary noticeable?

@TheLivelyViper More severe in terms of the grade of prolapse? I’ve left it too long I know but in terms of symptoms it’s actually better now than it used to be, or at least I’ve learned to manage it more.

What would a referral to Gynae or Uro do? Confirm it’s definitely a bladder prolapse or offer treatment such as surgery?

I mean it's more severe because you've left it for so long, so it can be harder, even with treatment to get it back to the way it was before and may take longer and need a few different types of interventions to work together. You've likely unintentionally bladder trained slightly, so somewhat alleviated your symptoms there, but symptom severity doesn’t always match the anatomical stage. Some people with a Stage 2 prolapse feel a lot of heaviness. Others with a Stage 3 may not.

From what you've said, I'd say you have Stage 2. Your prolapse descends to the level of the vaginal opening but does not protrude beyond it, and is noticeable when standing, straining, or coughing. Prolapse progression is mainly in the first few years after childbirth, and after that, it often stabilises, so that is also why you feel your symptoms haven't deteriorated.

Urology can yes diagnose officaly the prolapse and stage, but they can also:
1.Bladder function testing (e.g urodynamics, cystometry, post-void residual measurement, urine flow testing, electromyography). They would use a range of these tests to identify if you have urinary symptoms like leakage, urgency, or incomplete emptying to help decide treatment options

They are more likely to use these over an internal scan, but I'd ask your GP to book you for a transvaginal ultrasound and perhaps a urinary tract ultrasound as well - these can be sent to urology along with your referral.
I'd ask GP to refer you directly to urology now, gyne have their place but it's better for what you have to go straight with urology or you'll have to wait longer as gyne will send you to them for the majority of treatment options, but you'll have to wait to see gyne and then wait all over again) as further evidence and it's good for them to have a picture of the problem.

1. Ultrasound measurements to confirm the exact type and grade of prolapse (bladder vs. uterus vs. rectocele)
2. Targeted pelvic floor exercises, sometimes with further electrical stimulation, I know you have seen a pelvic physio, but it can be good to have a second opinion and using electrical stimulation can reduce the degree of descent
3. They can use the urodynamic testing to determine if there stress incontinence, urgency incontinence, or any voiding dysfunction
4. They can figure out if you also have additional bladder issues alongside your prolapse like underactivity etc

For treatment there's a few options:

Antimuscarinic Medication such as Tolterodine, solifenacin or mirabegron - these can reduce the urgency to pee by reducing bladder contractions.
For mixed incontinence they can also use beta-3 agonists as well
Continence rings or continence pessaries, which they can insert. Pessaries should not be noticeable
Botulinum toxin injections into the bladder
Surgery: Anterior vaginal wall repair (colporrhaphy) or newer mesh-free techniques - they will be up-to-date on some of the newer methods, and so once they explained the differences between some of them you could choose, but you'd have access to different methods now.
Success rates are pretty good now and have increased, it is around 70–90% for 3/4 years.

Thank you for that information @TheLivelyViper i have actually been looking at the Kegel8 electrical stimulation devices. I have no reason why I’ve left it so long - a mixture of embarrassment and learning to live with the symptoms. You’re right I have definitely learned to manage and bladder train - I used to finish washing my hands and almost need to turn around and go right back to the toilet, I’ve learned to fully empty my bladder now, although I think I still need to go more regularly than a ‘normal’ person.

I both want surgery and am scared of it as well, I’m not sure what I want. To be honest I am looking to start dating and this problem has held me back as I’m worried about sexual function as much if not more than bladder function. I should have dealt with it years ago.

Hey I was just wondering how you are doing? Have you seen your GP? Gotten any progress, referral to urology etc?