Question Title: Bladder

I am in my fifties and have had a problem for several years, but have never talked to a doctor or anyone else about it. My bladder dropped after giving birth and I have had problems since that time (many years ago). Lately, the problem has gotten worse as the bladder can be seen quite easily. Is this something that needs attending to? If so, would a procedure stop the linkage? I have no discomfort. Thank you for your time in answering my questions.

The “dropping of the bladder” that you describe is called a cystocele. It is essentially a bulging forward of the bladder into the vagina caused by weakness of the supporting structures which frequently occurs after vaginal delivery. The bulging may appear somewhat exacerbated by increased abdominal pressure (i.e. as occurs with coughing, etc.) and is associated with urinary incontinence. Other structures could also protrude from different portions of the vagina. For example, a rectocele is bulging of the rectum through the back wall of the vagina where the supporting tissues have become weak, an enterocele is bulging of the intestines through the deeper portions of the vagina where the supporting tissues have become weak. Sometimes the uterus can prolapse (“fall down” or protrude due to weakening of the support structures).

It is very possible that the structure that you see protruding is your bladder, but it is also possible that it may be one of the other conditions described above, or a combination. In any case the most important first step is to be evaluated by your gynecologist, primary care physician, or a urologist. Although you may not be experiencing any pain or discomfort, it is important to first be evaluated. You can then make a decision whether you want to follow their recommendation or not. Repair of a cystocele may help the incontinence but again, you need to have some tests to help predict the likelihood of resolution of your incontinence. There are many different types of procedures that can be performed, depending on the specific problem, with their associated success and complication rates, the discussion of which is beyond the scope of this forum. These can best be discussed your physician. Wish you the best.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).

Sincerely,
HFHS M.D.-JJ
*Keyword: cystocele, incontinence

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