Age increases risk of bladder prolapse

DEAR DOCTOR: I am a woman in my early 70s who has been diagnosed with a bladder prolapse. I have no symptoms and was told I don’t need surgery until symptoms appear. Should I seek surgery, which could lead to serious complications, even though my case is mild?

DEAR READER: Bladder prolapse, or a cystocele, is one type of pelvic organ prolapse, which is a protrusion of pelvic organs into the vaginal region. In a cystocele, the front portion of the vaginal wall becomes weak, allowing the bladder to bulge down into the vaginal region.

One major risk factor for a cystocele is having had children. The more children a woman has, the greater the risk of a cystocele. Compared to the risk of women without children, the risk of pelvic organ prolapse is four-fold greater with the first child, eight-fold greater with the second, nine-fold greater with the third and 10-fold greater with the fourth. The theory is that pregnancy and delivery injure the muscles and nerves in the pelvic region, allowing for herniations in the vaginal area. The risk of pelvic organ prolapse also increases with prolonged labor, having a high-birthweight infant

and having a first pregnancy before age 25.

Another risk factor for cystocele is increasing age. The majority of patients who seek treatment for symptomatic pelvic organ prolapse are in their 60s and 70s. Obesity also increases the risk of cystocele.

Many patients with cystoceles feel the bulge of the bladder into the vaginal region, as if something has dropped into the vaginal area. In addition, women can have increased frequency, urgency and urinary incontinence with cystoceles.

Women with urinary symptoms or pelvic discomfort can consider a pessary, a device inserted into the vagina to support the bladder, or surgery to lift the bladder and tighten the pelvic floor ligaments and muscles.

For now, try pelvic floor muscle training exercises to prevent the cystocele from getting worse. Vaginal estrogen or the osteoporosis medication raloxifene might help as well.