The cause of bladder prolapse often lies in the loosening and stretching of the support mechanism: In the female pelvis, various organs are located very close to each other and to the bladder: In front, immediately behind the pubic bone we find the bladder and the urethra, in the middle lie the uterus and vagina, and further back towards the sacral bone we find the rectum. All these organs, including the bladder, are connected to the pelvic bones and to each other by groups of muscles and supporting ligaments. Bladder prolapse is caused by strain throughout life on the supporting ligaments made of connective tissue, especially during pregnancy and childbirth. The size and weight of the uterus increase significantly during pregnancy, which means that its supporting ligaments come under significant strain and become stretched. This means that one or more of the ligaments may tear. And during childbirth, the groups of muscles and supporting ligaments of the bladder, vagina and uterus may loosen or become torn, leading to bladder prolapse. However, women who have connective tissue weakness may, even if they have not had children, develop a loosening and stretching of the support apparatus and consequently experience bladder prolapse as a result of everyday strain over the decades. Bladder, uterus or rectal prolapse may occur after the menopause, possibly also as a result of hormonal factors and weight gain.
Women affected by bladder prolapse describe the symptoms as a sensation of a foreign body in the vagina or noticing an unpleasant feeling during intercourse. Bladder function can also be affected by bladder prolapse, as if the bladder and urethra are not properly attached to the pelvis they can no longer completely fulfil their function. Loosening of the urethral ligaments in particular can cause urinary incontinence when coughing and during physical exertion. Whenever a person coughs, lifts up a bag of shopping or takes part in sport, the pressure in the abdominal cavity increases, and this pressure wave moves to the bladder and increases the pressure there. The urethra normally closes automatically to prevent the bladder leaking. But if the urethra is not stable enough, this closure reflex fails and involuntary urine loss occurs, with or without an accompanying urge to urinate.
Not all cases of bladder prolapse require treatment. Bladder prolapse should only be investigated and treated if the woman in question has symptoms (such as a feeling of a foreign body in the vagina, problems with intercourse) or if bladder voiding is impaired. Non-surgical treatment options are pelvic floor training, local hormone administration and the use of pessaries or special vaginal tampons. If bladder prolapse is very severe or cannot be controlled by conservative measures, a number of surgical procedures can be considered. There are various methods of raising the prolapsed bladder and reattaching it in the pelvis. The choice of surgical method requires experience on the part of the doctor, and is always adapted individually to the patient.