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Is My Bladder Dropping?

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This is a common question that is asked by many women if they have any urinary incontinence problems.

Urinary incontinence can occur simply on its own as Stress Incontinence (urine lost with excerise or any other activity), or Urge Incontinence (urine lost with uncontrollable urge, Overactive Bladder). Your bladder may be in the normal anatomic position and you may still experience incontinence. This is a totally separate issue, "the leaky faucet" problem, that itself can be treated: see blogs posted below.

"Cystocele" is the term used when the bladder drops from its normal anatomic position. It can occur with incontinence, or on its own. Essentially, the support structures under and next to the bladder become weakened and allow the bladder to push down into the vagina. This leads to a bulge a woman can feel or even see. Many women say they feel they're "sitting on ball", or see something protruding from the vagina. This is more pronounced at the end of the day. If it's uncomfortable, some women will try to push it back in.

Higher grade cystoceles that cause pain, discomfort, or bulge outward and protrude past the vaginal opening should be surgically corrected. Often, many cystoceles are mild and only occur with straining and may not warrant any treatment at all.

Sometimes cystoceles can mask stress incontinence if the urine becomes trapped in the vagina by a kinked urethra, or even have trouble evacuating the bladder leading to a constant sense of urgency and incomplete emptying. Infrequently, this can lead to UTIs.

The most often sited reasons for cystocele formation are: menopause, childbirth, chronic cough conditions (asthma, smoking), and genetic. Sometimes cystoceles occur by themsleves or inconjunction with other organs that protrude from the female pelvis: rectocele (rectum protruding), vaginal vault prolapse, procidentia (uterine prolpase).

Dr. Matthew Karlovsky is a urologist that specializes in female pelvic health in Phoenix, Ariz. For more information, visit www.urodoc.net or www.femaleurologyaz.blogspot.com/

Add a Comment3 Comments

EmpowHER Guest

My name is Tasha Mulligan and I thought I would write into your post because I provide a unique perspective as a healthcare provider who has experienced symptoms of prolapse. I am a physical therapist, athletic trainer, triathlete, and mother of 3. The topic of incontinence and prolapse isn't one that I have always been focused on, but my own journey through pregnancy and delivery pushed me into the women's health field of physical therapy 5 years ago.
A quick background - I was an avid triathlete leading up to my first pregnancy. I continued a controlled exercise program throughout my pregnancy and had great anticipation to return to running following my delivery and 6 week follow up appointment with my OB/GYN. But I soon found out that the stretching during 9 months of pregnancy and further stretching and tearing of the muscles of my pelvic floor during delivery had caused my pelvic floor to contract inefficiently and remain overall very weak. My pelvic floor just didn't bounce back, giving me the sensation that the "bottom might fall out" when I attempted to get back to my workouts.
This is simply my story, but then I began to realize, a lot of my female patients in the clinic would laugh and joke about wetting their pants as I asked them to perform specific exercises. My grandmother talked about her uterine prolapse and my pregnant friends were asking a lot of questions about why they couldn't hold their bladder. I began to realize the widespread effect of weak pelvic floor muscles. It wasn't just a few of us, but as I researched, I found there were millions of us, women of all ages, teenage gymnasts, new moms, older moms, women who have reached menopause and beyond.
So, on both a personal and professional level, the 3 components listed and described below have been the key to successful rehabilitation of both prolapse and incontinence.
1. Perform your Kegel exercises correctly. This means you need to perform the 2 actions of the pelvic floor. Most women are familiar with the Kegel description as "tightening your pelvic floor as if to stop the flow of urine or the passing of gas". This is simply the first step. The second and final step of pelvic floor strengthening is to elevate the pelvic floor, as if there is a string attached from the belly button to the pelvic floor and you are drawing it up into your pelvic outlet. If you are performing this second action correctly, you will feel your belly button draw in as you elevate your pelvic floor muscles. Let it be your goal to perform 8 Kegel contractions with elevation every day, holding them for eight seconds each. You can follow each lift and hold with a set of quick Kegel contractions to work both endurance and short burst control of your pelvic floor muscles.
2. Tighten up your entire "abdominal basket". This means that you also have to perform exercises that strengthen the surrrounding muscles. These muscles coordinate with the contraction of your pelvic floor muscles as the front, back, and sides of our abdominal basket. This includes our lower abdominals, deep hip rotators, lower back muscles, and our inner thighs that all work together to stabilize our abdominal core, including the pelvic floor.
3. Hold appropriate posture throughout your day. Remember the words your mother used to say - "Stand up straight", or "Don't slouch" - well physical therapists today are echoing those wise words. Poor posture can be the root of back pain, neck pain, shoulder pain, muscle weakness, and dysfunction including incontinence. Finding your "neutral spine" and contracting the right muscles to help hold yourself there can lead you on the path to better health. This includes improved breathing, more efficient muscle control, and better distribution of forces on our bones.
The odds of addressing pelvic floor weakness are greatly increased if all three components - the Kegel with pelvic floor elevation, the strengthening of the entire "abdominal basket", and proper posture - are addressed.

Hope some of the women reading find this information a useful starting point -- and press your doctors or other health care providers for more information on what is going on AND what your options are.

Tasha Mulligan MPT, ATC, CSCS
Creator of Hab It: Pelvic Floor dvd

May 11, 2009 - 1:44pm
(reply to Anonymous)

Thank you for your comments, Tasha.

As a marathoner, I'm in relatively good physical condition, but fighting menopause weight gain and the dreaded incontinence that you've described. Thank you for explaining "part 2" of the Kegel contractions. It's very embarrassing to have been out on a long run and return self conscious about the odor caused by the bit of leakage that I've passed off as ammonia common to distance runners who've burned through all the carbs in their bodies. Perhaps adding the additional part to the Kegels will help strengthen my pevic floor, too.

May 11, 2009 - 7:36pm
EmpowHER Guest

I am always so happy to see continuing education for women in regards to prolapse issues. There are so many problems that women face with the different types of prolapse and it is such a hush-hush scenario most of the time.
A book I have recently written about pelvic organ prolapse also addresses the many faceted issues of prolapse; I feel so strongly that all women should be aware of this condition so when they start to have symptoms, whether with bladder leakage or any of the many other symptoms like fecal incontinence, pain, or sexual dysfunction, they are aware of what may be occurring and seek help before the condition progresses to a stage needing radical treatment. The title of my book is
"Pelvic Organ Prolapse, The Silent Epidemic"
and information is available at the website below. I'd be very happy to share my views on this topic with anyone interested.

Sherrie Palm


May 9, 2009 - 6:24pm
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We value and respect our HERWriters' experiences, but everyone is different. Many of our writers are speaking from personal experience, and what's worked for them may not work for you. Their articles are not a substitute for medical advice, although we hope you can gain knowledge from their insight.

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