A bulging bladder is a prolapse of the base of the bladder along with the anterior part of the vagina towards the vagina. In severe bladder bulge, the bladder may reach below the level of the urethra and cause difficulty in urination. The most common cause is a birth injury that causes damage to the fascia and muscles of the pelvic floor that keep the bladder in its normal position and is not repaired in time. In severe cases, the urethra also bulges. In mild cases, it is asymptomatic, but in severe cases, it is often associated with lower back pain and a sensation that something is coming out of the vagina. It is often accompanied by difficulty in urination and a feeling of incomplete urination. It is often accompanied by tension incontinence, which means that urine can be spilled when the abdominal pressure increases, such as when coughing or straining, and the symptoms worsen after menopause. A metal catheter inserted into the urethra can identify the bulging part as the bladder. Mild cases do not require treatment, but in severe cases, anterior vaginal wall repair is feasible, as well as correction of long-term chronic disorders that increase abdominal pressure, such as chronic coughing and wheezing. Etiology The pubic bladder cervical fascia and the bladder support tissues on both sides of the anterior vaginal wall are overstretched or torn. If the supporting tissues at the base of the bladder are weakened or torn during childbirth, heavy lifting and repetitive exertion, and premature participation in physical labor during the puerperium, the vaginal supporting tissues cannot be restored to normal are the causes of bladder bulge. Clinical manifestations Mild cases can be asymptomatic or have a mild sensation of falling, lumbago, aggravated after prolonged standing, and shrink after bed rest. In severe cases, in addition to the sensation of falling, there is often difficulty in urination, and often more residual urine, more complicated urinary tract infection, such as the urethral sphincter is also relaxed, can increase abdominal pressure in the case of laughing, coughing, force, etc., there is urine overflow, called tension urinary incontinence. In addition to the above-mentioned obvious conscious symptoms, during vaginal examination, the vaginal opening is often exposed to a large extent and the anterior vaginal wall is spherically bulging to varying degrees, soft to touch and enlarging or shifting downward when breath is held. The patient is asked to cough and observe whether there is urine overflow. If there is, then compress both sides of the urethra with the middle and index fingers, and if there is no urine overflow, it indicates the presence of tension incontinence. According to the different degrees of bladder bulge can be clinically divided into three degrees. The mild degree is that the bulging bladder has reached the hymenal edge and has not yet bulged out of the vaginal opening. Moderate degree is when the bulging bladder has partially bulged out of the vaginal opening. In severe cases, the bulging bladder is completely bulging out of the vaginal opening. Mild cases may be asymptomatic. In severe cases, there can be a feeling of falling, the vagina has a swelling out, exertion or after standing for a long time, the swelling increases when the bladder accumulates urine, the swelling shrinks or disappears after bed rest or urination. In severe bladder bulge, the urethra is at an acute angle, so urinary difficulty and urinary retention can occur, and the patient can urinate freely if the prolapsed anterior vaginal wall is returned by hand. Because there is often residual urine in the bladder, it is easy to cause bladder infection and symptoms such as urinary frequency, urinary urgency and painful urination. Prevention Pay attention to labor and delivery. If perineal tear occurs, it should be repaired immediately; avoid participating in physical labor too early after delivery, and postpartum health exercises help to recover the pelvic floor muscles and fascial tension. Treatment In mild cases, attention should be paid to proper nutrition, herbal medicine and anal retraction exercises. In severe cases, pelvic floor wall repair should be performed. In severe and symptomatic cases, an anterior vaginal wall repair should be performed to restore the bulging bladder to its normal anatomical position. The key to the procedure is to hold the bulging tissues and organs back in place and to fix the bladder in a higher area to strengthen it to support the bladder. Those who have conscious symptoms but are not suitable for surgery due to other chronic diseases. Nutrition should be strengthened and prolonged standing and heavy physical labor should be avoided to avoid overfilling of the bladder. Do frequent anal lift exercises. The uterine support can temporarily reduce the patient’s discomfort and make urination smooth and inflammation disappear, but it must be put in in the morning and taken out at night before going to bed. In order to avoid secondary infection or long-term pressure caused by foreign body urinary fistula, fecal fistula.