Bladder prolapse

My daughter had a baby (10 lb 5 oz) seven weeks ago. A couple of weeks ago, she developed a very bad cough and, as a consequence, she now has a prolapsed bladder. The doctor has told her that she will need an operation to put it right. Are there any alternatives? She is currently having acupuncture and homeopathic Sepia, but with no effect. — J.M., via e-mail

Bladder prolapse (or a cystocoele, in medico-speak) is a surprisingly common condition that affects women exclusively and mainly after childbirth—forceps deliveries are partic-ular culprits. It arises when the muscles around the vaginal wall become weakened, thus allowing the bladder to droop into the vagina. Almost any severe muscular strain in the pelvic area can cause this to happen, even violent coughing.

So, your daughter’s problem seems to be the result of a double whammy—a pregnancy and a possibly difficult childbirth as well as severe coughing.

A cystocoele, while not life-threatening, is an unpleasant condition. It can cause urinary leakage and incomplete emptying of the bladder, creating a constant urge to urinate. Other symptoms can include a heavy sensation in the vagina, lower-back pain, pelvic pain and pain during sex. 

From the description you’ve given us and her doctor’s recommendation, your daughter may have suffered a more severe (grade 2) type of cystocoele, where the bladder has sunk in far enough to reach the vaginal opening. A relatively minor (grade 1) cystocoele would be where the bladder droops only a short way into the vagina. The most advanced (grade 3) form of cystocoele occurs when the bladder actually bulges out through the opening of the vagina. 

Few doctors would recommend surgery for a grade 1 problem—an operation would usually be considered the last resort in such cases. After all, surgery is by no means risk-free, as the result could be accidental damage to the vagina, rectum or bladder. And it may not work anyway. Even surgeons themselves admit that there are many “controversies” in this area, with “recurrence rates still unacceptably high” (Curr Opin Urol, 2006; 16: 407–12).

One treatment doctors may recommend instead of surgery is a pessary, a physical device placed in the vagina to hold the bladder in place. Pessaries come in a variety of shapes and sizes to achieve the most comfortable fit. However, there is a possible danger that they can cause infection or even ulcers, so they need to be removed regularly.

Does alternative medicine offer anything better? Your daughter has already tried two alternative treatments but, sadly, there is no evidence to support the use of either acupuncture or homeopathy for the condition.

However, there are other possible treatments that may help. One immediate step your daughter could take would be to look into her diet. To reduce straining in the pelvic area due to constipation, she should eat plenty of fibre—from fresh fruit, vegetables and bran.

Another self-help treatment her doctor might have advised before surgery is exercises to strengthen the pelvic muscles.
The best known of these are the so-called Kegel exercises, named after the American physician who popularized them. But, in fact, they were first developed by the ancient Chinese—mainly to strengthen the vaginal walls for sexual enhancement. However, carrying out these exercises requires some dedication, as they need to be performed several times a day for six to 12 weeks.

One device some women find helps strengthen the pelvic muscles is a vaginal cone. It is a weighted, cone-shaped device that is inserted into the vagina. The patient must then keep the pelvic floor muscles contracted to hold the device in place against the force of gravity.

The contraction needs to be kept up for about 15 minutes at a time, and should be done twice a day for
up to six weeks. Around 70 per cent of women are said to find this helpful.

Another possible alternative technique is biofeedback. Passive electrodes are placed on the abdomen and the peri-anal area to monitor muscle contractions. A TV monitor displays which muscles are being contracted so that the patient can see when she is working the correct ones. With this technique, 15 per cent of women are claimed to be cured, with 75 per cent of them finding an improvement in their symptoms.

In terms of electronics, two other gizmos are also available. One is called neuromuscular electrical stimulation (NMES); this delivers low-voltage electrical currents via a vaginal or anal probe to stimulate the pelvic muscles, causing the urethral sphincter muscles to contract. NMES can be carried out either in the clinic or at home; treatments usually last 20 minutes and are given at least twice a week.

The latest technique is called the NeoControl® Pelvic Floor Therapy system. Here, the patient sits in a special chair that is equipped with pulsating magnetic fields which cause the pelvic muscles to contract.