What Is Uterine and Bladder Prolapse?
Pelvic organ prolapse occurs when the connective tissues that support the female reproductive organs lose their elasticity, causing the uterus and surrounding structures to shift downward into the vaginal canal. Although commonly referred to as “uterine prolapse,” it often involves the bladder (cystocele) and the rectum (rectocele) as well.
Under normal circumstances, these organs are held securely within the pelvic cavity by the pelvic floor and surrounding ligaments. However, factors such as aging, multiple vaginal births, delivering large babies, chronic constipation, excess weight, and genetic predisposition can weaken these supportive tissues. In mild cases, women may feel a sense of heaviness or fullness. In more advanced stages, a bulge may be felt at the vaginal opening or may protrude externally. Without proper intervention, the prolapsed tissue may become irritated, injured, or infected over time.
Bladder Prolapse (Cystocele)
Cystocele refers to the bulging of the bladder into the front wall of the vagina. Women with cystocele often feel vaginal pressure during activities that increase intra-abdominal pressure such as coughing, sneezing, or lifting. The most common symptom is urinary incontinence. While leakage may initially occur only during exertion, in more severe cases it may happen even when standing, laughing, or during intercourse — due to a disrupted angle between the bladder and the urethra.
Symptoms of Uterine Prolapse
Mild uterine prolapse may present no symptoms. At moderate levels, women may experience pelvic pressure, lower abdominal heaviness, or back pain. Prolonged standing often worsens the discomfort. Pain during intercourse may also occur. In severe cases, the uterus may protrude outside the vagina and require manual repositioning, but it often slips out again. Chronic prolapse may lead to ulceration or infections in the exposed tissue.
Rectal Prolapse (Rectocele)
Rectocele is the bulging of the rectum into the back wall of the vagina. While many women may not notice major symptoms, it can contribute to constipation and a sensation of fullness or pressure in the vaginal area.
Sexual Health and Vaginal Laxity
Women with pelvic organ prolapse — particularly after difficult childbirth — may also experience vaginal laxity. This can reduce sexual satisfaction for both partners. Vaginal tightening surgery, or vaginoplasty, can restore tone and structure, addressing both functional and sexual concerns.
Risk Factors for Uterine Prolapse
Several factors increase the likelihood of uterine prolapse. Repeated and difficult vaginal births significantly weaken pelvic floor support. Delivering large babies places additional strain on these tissues. After menopause, declining estrogen levels lead to further weakening of connective tissues. Obesity increases intra-abdominal pressure and is a major contributing factor. Chronic constipation and persistent coughing also elevate pressure on the pelvic floor. Finally, long-term heavy lifting can stretch and damage the supportive structures of the uterus and nearby organs.
Treatment for Uterine Prolapse
Treatment is tailored according to the patient’s age, degree of prolapse, general health status, and desire for future pregnancy. In mild cases, pelvic floor exercises (Kegel exercises) can be beneficial. For women who have completed childbearing, surgical options often include removal of the uterus and repair of the vaginal walls.
For those who wish to preserve the uterus, supportive mesh may be inserted, or procedures to reposition the uterus can be performed. However, it is important to note that such repairs may carry a risk of recurrence within 3–5 years.
In elderly patients or those who are not suitable for surgery, pessary devices — removable rings placed inside the vagina — may provide temporary support.
Urinary Incontinence and Surgical Options
When treating cystocele, urinary incontinence is often addressed simultaneously. Mid-urethral sling procedures (TVT or TOT) are commonly used to support the bladder and restore the urethral angle during surgery.
Prevention Tips and Recommendations
Several strategies can help reduce the risk of uterine prolapse:
- Maintain a healthy weight to decrease intra-abdominal pressure on pelvic tissues.
- Consume a fiber-rich diet and avoid constipation.
- Practice regular Kegel exercises to strengthen the pelvic floor muscles.
- Avoid overly tight clothing or corsets that impair blood flow.
- Refrain from heavy lifting in daily life.
- Treat chronic cough and other conditions that increase abdominal strain.
These preventive steps can support pelvic health and reduce the risk of prolapse in the long term.
