Have you ever heard of a low bladder? This condition, also called cystocele, is quite literal: it refers to a change in the usual position of the bladder, which occurs due to loss of support or sagging of the local tissues.

In practical terms, this condition generates the feeling (and sometimes even the visible presence) of a "ball in the vagina". Thus, many discomforts are triggered.

"The presentation and complaints can be quite varied and are not always related to the size of the cystocele (or how far down the bladder goes), ranging from asymptomatic women who simply notice that there is something out of place in their genital region, with no other complaints, to cases in which the symptoms are very uncomfortable and detrimental to their quality of life," she explains. Augusta Morgado Ribeiro, gynecologist specialized in urogynecology and member of the medical staff of the Institute for Care, Rehabilitation and Assistance in Neuropelvetic and Gynecology (Increasing).

It is the change in the position of the bladder that can lead to a "ball in the vagina" sensation. Such a condition creates vaginal discomfort as if there is something permanently inside the vagina. In addition, it is possible to feel the pain in the lower abdomen - as if the bladder is being pulled down.

In some cases, there may be urinary dysfunction, manifested by increased daytime or nighttime urinary frequency. Other symptoms are:

• Urgency of urination;
• Sensation of incomplete emptying of the bladder;
• The perception that urine does not come out satisfactorily or that there is a need to strain;
• Feeling that it is necessary to reposition the bladder for the urine to start flowing.

Not only that, but the condition is also usually accompanied by an increased incidence of urinary tract infections. This is because of the tendency to retain urine.

Causes of a low bladder

There is not only one reason why a low bladder happens, it usually occurs due to loss of support of the organ in its original position - located in the anterior wall of the vagina and supported by ligaments and elastic tissues formed by collagen, the fascia.

"Usually the cause of cystocele is multifactorial, including conditions such as the individual fragility of each woman's collagen tissue, which depends on genetic and nutritional issues, as well as exposure to factors that accelerate the loss of strength of this tissue such as smoking or hormonal changes," explains the doctor.

The continuous increase of tension in these tissues can also facilitate the occurrence of prolapses, that is, the loss of support for the bladder and other organs, such as the uterus and intestine. Overweight and obesity, diseases that cause chronic coughing, repetitive strain or weight lifting (in physical activities or at work) can subject these tissues to an overload of stress, facilitating theirrupture.

Other mechanisms, such as pregnancies and childbirth, especially when numerous and with large babies, also cause the stretching and flaccidity of these supporting tissues. Thus, bladder collapse can occur.

Read also: Painful bladder syndrome: What it is, symptoms and treatment

Diagnosis

The diagnosis is made based on the woman's complaints and a detailed physical examination to evaluate the presence of genital prolapse.

"This exam is done in the gynecologist's office, in the usual gynecological position, so the evaluating doctor will ask the woman to do some coughing and straining maneuvers to see if there is displacement of the vaginal walls that are suggestive of prolapse," explains Dr. Augusta.

During the examination, the doctor can make some measurements with a small graduated spatula, which will help in the measurement and classification of the cystocele. It is here that the professional will also investigate and research other prolapses, for example those of the rectum or the back wall of the vagina, in addition to the uterus itself.

"If there is any urinary complaint associated with cystocele, a complementary bladder function evaluation exam, the Urodynamic Study, can be requested. Thus, it is possible to search for alterations in its filling and emptying", he adds.

Low Bladder Treatment

The appropriate treatment will happen according to each case, depending mainly on the symptoms reported by the patient and her clinical condition.

"Conservative management includes pelvic physiotherapy sessions - a specific therapy to strengthen the muscles and improve the quality of the supporting tissues, which leads to a decrease in discomfort and urinary complaints. You can also have the use of a pessary, a silicone ring placed inside the vagina. It supports the bladder and keeps it in a more favorable anatomical position forin order to control the symptoms caused by the prolapse," explains the gynecologist.

In more severe, more symptomatic cases, and when there are favorable clinical conditions, surgery may be indicated, which will include the repair of the injured tissues and their fixation in more resistant structures in the pelvis (with or without the aid of synthetic mesh), to reposition the bladder properly, providing an important improvement in quality of life.

Source: Augusta Morgado Ribeiro, gynecologist specialized in urogynecology and member of the medical staff of the Institute of Care, Rehabilitation and Assistance in Neuropelvecology and Gynecology (Increasing) .