- How to know if your bladder is low
- Tests for low bladder
- Treatments for low bladder
- 1. Exercises for low bladder
- 2. Physiotherapy for low bladder
- 3. Remedies for low bladder
- 4. Lower bladder surgery
The low bladder occurs when the muscles and ligaments of the pelvic floor are unable to hold the bladder exactly in place, which is why it 'slips' from its normal position and can be easily touched through the vagina.
This situation can be called cystocele, bladder prolapse, low bladder or fallen bladder, being more frequent in women over 40 years of age, who have already become pregnant. The woman may have only a fallen bladder, but the uterus, urethra and rectum may also fall at the same time.
Treatment for low bladder can be done with lifestyle changes, with weight loss, stop smoking, fight constipation, in addition to physical therapy, pelvic exercises, indicated by the physiotherapist, or through surgery, in the most severe cases, when the bladder reaches the entrance to the vagina or passes through the vagina.
How to know if your bladder is low
Signs and symptoms that indicate that the bladder is drooping include:
- Lump in the vagina, which can be seen with the naked eye or felt with the fingers during vaginal touch; Feeling of heaviness in the bladder, Ball sensation in the vagina, Pain or discomfort in the pelvic region; Weakness or flaccidity of the muscles and ligaments of the perineum; Involuntary loss of urine may occur; Difficulty in passing urine during the first seconds of urination; Urgency and increased urinary frequency; Pain and irritation in the vagina during sexual contact; In case of prolapse also of the rectum, there may be the formation of a 'pouch' close to the anus causing pain, discomfort and difficulty in eliminating the stool.
The doctor most indicated to make the diagnosis and indicate the treatment for cases of low bladder is the gynecologist specialized in urogynecology. Physiotherapy is also useful in treatment.
Tests for low bladder
The exams that can be requested by the gynecologist to evaluate the fallen bladder are:
- Assessment of pelvic muscle strength; Transvaginal ultrasound: to assess the muscles of the perianal region and to assess whether there is any change in the uterus, emptying the bladder or urethra; Urodynamic studies: to assess the ability of the bladder to retain and eliminate urine; Magnetic resonance imaging: to have a better view of all structures in the pelvic region. Cystourethroscopy: to see the urethra and bladder, in women with urgency, urinary frequency, pain in the bladder or blood in the urine.
Bladder fall is more common during or after menopause, after pregnancy, in cases of constipation, after surgery to remove the uterus, in case of overweight or obesity, after 50 years of age, and in women who smoke.
Another situation that favors the fall of the bladder are jobs that require physical effort, such as housework or where it is necessary to hold or carry heavy objects. So, to prevent the bladder from falling again, it is necessary to avoid all these factors.
Treatments for low bladder
Treatment varies according to the degree of cystocele a woman has:
| Type | Feature | Treatment |
| Grade 1- light | Small bladder drop in the vagina, without symptoms | Pelvic Exercises + Life Changes |
| Grade 2 - moderate | When the bladder reaches the opening of the vagina | Physiotherapy + Pelvic exercises + Surgery |
| Grade 3 - severe | When the bladder exits through the vagina | Surgery + Physiotherapy + Pelvic exercises |
| Grade 4 - very serious | Complete exit of the bladder through the vagina | Immediate surgery |
1. Exercises for low bladder
Kegel exercises are indicated for less severe cases, where the woman has a bladder fall or weak pelvic muscles, with few symptoms, and therefore surgery is not indicated. These exercises must be performed daily so that they have the expected effect and are very effective when performed correctly.
How to do kegel exercises:
- Empty the bladder; Identify the pubococcygeal muscle: for this, try to stop the pee stream while urinating; Contract the pubococcygeal muscle again after urinating to make sure you know how to contract the muscle correctly; Perform 10 consecutive muscle contractions; Relax for a few resume exercise, doing at least 10 sets of 10 contractions every day.
Kegel exercises can be performed in any position, whether sitting, lying or standing, and can even be performed with the aid of gymnastic balls. However, it is easier to start by lying down with your legs bent. Watch more details in this video:
How to do hypopressive gymnastics:
Hypopressive gymnastics is also indicated to combat the low bladder because it also helps to strengthen the pelvic floor muscles. To do:
- Inhale normally and after letting out the air completely, until the abdomen starts to contract on its own and then 'shrink the belly', sucking the abdominal muscles inwards, as if it wanted to touch the navel to the back. This contraction should be maintained for 10 to 20 seconds initially and over time, gradually increase the time, remaining as long as possible without breathing. After the pause, fill your lungs with air and relax completely, returning to normal breathing.
See the step by step of hypopressive exercises in this video:
2. Physiotherapy for low bladder
In physiotherapy, in addition to the exercises indicated above, there are still other possibilities, such as the use of a pessary, which is a small device that serves to place inside the vagina to help hold the bladder. They are small lead balls with varying weights that can be inserted into the vagina during the exercise.
Other resources that can also be used are intravaginal electrical stimulation or biofeedback, which are devices that help women to be more aware of their pelvic muscles, in order to facilitate the performance of exercises correctly.
Physiotherapy in women's health consists of individual sessions, lasting from 30 minutes to 1 hour, which must be performed at least once a week, although the exercises must be performed, at home, every day. Learn more details of physiotherapy for urinary incontinence.
3. Remedies for low bladder
Some estrogen-based remedies can be used during menopause to help control cystocele symptoms, so hormone replacement during menopause is also indicated to complement treatment in some women. Learn more details about hormone replacement.
4. Lower bladder surgery
Cystocele surgery consists of strengthening the structures of the pelvic region to restore the correct position of the bladder, uterus and all structures that are 'fallen'. Usually the doctor places a 'net' to serve as a support for the pelvic organs which is very effective, being especially indicated for the most serious cases.
This type of surgery can be done through laparotomy or abdominal cut, with regional or general anesthesia, but like all others it has its risks, such as organ perforation, bleeding, infection, pain during sexual contact and return of urinary incontinence, in some cases.
The surgery is quick and the woman is hospitalized only 2 or 3 days, but it is necessary to rest at home and avoid efforts in the first week after the surgery. Find out more details of recovery from this type of surgery at: Surgery for urinary incontinence.
