This document discusses the relationship between pelvic organ prolapse, bladder outlet obstruction, and overactive bladder. It summarizes a study finding that prolapse can obstruct the bladder and cause it to become overactive. Successfully treating the prolapse through surgery often also improves overactive bladder symptoms by removing the obstruction. However, stress urinary incontinence symptoms may sometimes increase after prolapse surgery as the compressed urethra is no longer obstructed. Treating both the prolapse and any stress incontinence issues may be necessary. Overactive bladder affects both younger and older women, with or without prolapse, and can occur alongside stress incontinence as well.

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Three (Unhappy) Musketeers
Pelvic floor disorders include problems with urinary
– Prolapse, Bladder Outlet
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Urge Incontinence from Overactive
July 2010 Bladder
June 2010
While most cases of overactive bladder are idiopathic
May 2010
(medicalese for “no apparent cause”), some cases are
April 2010
caused by prolapse. When the bladder or uterus (or

2. December 2009 both) prolapse, the urethra can be kinked or compressed,
November 2009 obstructing urine outflow and making it difficult for the
bladder to empty completely. Obstructed bladders are
October 2009
cranky bladders, often becoming overactive in response to
August 2009
this interference with emptying.
A recent multicenter European study published in
Neurourology and Urodynamics showed a distinct
correlation between severe pelvic organ prolapse, bladder
outlet obstuction, and overactive bladder. Prolapse can
obstruct bladder outflow and if it does, the bladder tends to
become overactive, reminiscent of that vaudeville song,
“The head bone’s connected to the … neck bone…”. In
this timely review, they also found that successful prolapse
surgery often, but not always, calmed down bladder
overactivity by un-blocking the urethra and normalizing
bladder outflow. The connection between prolapse,
bladder outlet obstruction and overactive bladder
Women with prolapse and bladder problems often want to
know if surgery will fix both. This study helps us
understand that it indeed may help fix both the prolapse
and the obstructed/overactive bladder disorders in a large
portion of women with this unhappy combination. For
years, I’ve used pessaries (vaginal widgets that
comfortably hold prolapse in place) to help predict whether
or not prolapse surgery might also stop obstructed voiding
and overactive bladder, and most of the time it correlates
well to surgical outcome. And sometimes, the patient is so
pleased with the pessary that she cancels the operation.
For a detailed case report on women with prolapse,
obstructed voiding and overactive bladder, click on this
MedScape review:
Dr R for MedScape- prolapse, overactive bladder, stress
incontinence, obstructed bladder
http://cme.medscape.com/viewarticle/700135
One last note for women with prolapse and bladder
problems – there is another urinary incontinence
condition, called stress incontinence, that may actually
increase with pessary use or prolapse surgery, because a
stress – incontinent urethra may actually seal better with
the kinking and compression caused by prolapse, and
may therefore increase when the prolapse and kinking are
mechanically corrected. Stress incontinence is caused by
poor urethral closure that allows urine to leak out with
strenuous physical exertion, like sneezing or coughing or
opening a window or lifting heavy grocery bags. No
urgency, just “exert and squirt”.

3. Stress Urinary Incontinence = "Exert and
Squirt"
If you have prolapse and stress incontinence, your
problems require therapies for prolapse and therapies for
stress incontinence. Prolapse therapy options usually
involve pessary use or reconstructive surgery. Stress
incontinence options include Kegel exercises with pelvic
floor physical therapy, medications, or procedures such
as urethral bulking injections or minimally invasive sling
operations. You can do prolapse reconstruction and
urethral sling in one operation, for instance, taking care of
both your plumbing and your renovation problems at the
same time (on Plumbing and Renovations).
Prolapse or no prolapse, urge incontinence from
overactive bladder and stress incontinence from a weak
urethral seal can plague any woman at any age. About
13% of women with overactive bladder are under the age
of 35, and up to 30% college female athletes report
regular urinary incontinence of one sort or another during
training and competition. It comes with the territory, and it
increases in prevalence as women age.
1/3 of incontinent women suffer only stress incontinence,
1/3 only urge (overactive bladder) incontinence and 1/3
suffer a mixture of both overactive bladder / urge
incontinence AND stress incontinence.
If you have incontinence, or prolapse and bladder
problems, make sure you don’t undertake any therapeutic
measures without first understanding if you have
overactive bladder, bladder outlet obstruction, and/or
stress urinary incontinence. It is absolutely possible, and
not at all uncommon, to have all three conditions if you
suffer severe prolapse. Take the time to sort it all out,
make sure it’s clear in your mind, then work with your
doctor to set a common-sense course of action to restore
your core to normal anatomic and physiologic function.
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