Bladder Prolapse (Cystocele) among African, Asian, and Middle Eastern Women: A Clinical and Socio-Cultural Perspective

Gayathri Delanerolle^1,2Vindya Pathiraja^3*Tharanga Mudalige³Nirmala Rathnayake³Abirame Sivakumar⁴Wijamunige Nimesha Prashadini⁵Nihal Mohamed Al Riyami⁶Lamiya Al-kharusi⁶Mohammad Haddadi⁷Fred Tweneboah-Koduah⁸Om Kurmi⁹George Uchenna Eleje¹⁰Peter Phiri^1,11Lauri Romanzi¹²Sohier Elneil^13*

• ¹Hampshire and Isle of Wight Healthcare NHS Foundation Trust, Southampton, United Kingdom
• ²University of Birmingham, Birmingham, United Kingdom
• ³University of Ruhuna, Matara, Sri Lanka
• ⁴University of Jaffna, Jaffna, Sri Lanka
• ⁵General Sir John Kotelawala Defence University, Rathmalana, Sri Lanka
• ⁶Sultan Qaboos University College of Medicine and Health Sciences, Seeb, Oman
• ⁷Tehran University of Medical Sciences, Tehran, Iran
• ⁸Narh-Bita Hospital, Tema, Ghana
• ⁹Coventry University, Coventry, United Kingdom
• ¹⁰Nnamdi Azikiwe University, Awka, Nigeria
• ¹¹University of Southampton, Southampton, United Kingdom
• ¹²Thomas Jefferson University, Philadelphia, United States
• ¹³University College London, London, United Kingdom

ABSTRACT Bladder prolapse, also known as cystocoele, is the most common form of pelvic organ prolapse (POP), significantly affecting women's physical, sexual, and psychosocial health, particularly in low-and middle-income countries (LMICs). Despite its widespread prevalence and disabling consequences, bladder prolapse remains under-recognised and inadequately addressed in global health strategies. Prevalence estimates vary widely across regions, from 3% to 64.6%, influenced by diagnostic methods and cultural reporting biases. Common risk factors include high parity, early childbirth, prolonged labour, poor postpartum care, malnutrition, obesity, and ageing. Clinical diagnosis often relies on simplified grading systems in resource-limited settings. Conservative treatments like pelvic floor muscle training and pessary use are underutilised due to lack of staff training, and cultural barriers. Surgical management, primarily native tissue anterior repair, is often inaccessible or inconsistently performed. Key challenges include sociocultural stigma, lack of epidemiological data, inadequate provider training, and limited access to specialised care. Bladder prolapse remains a hidden burden in LMICs due to structural, sociocultural, and health system gaps. Addressing it requires integrating prolapse screening into routine maternal care, expanding conservative management, training healthcare providers, reducing stigma, and investing in locally relevant research and national guidelines. Here, we argue for evidence-based practices in LMICs to improve our understanding through epidemiology, risk factors, clinical presentation, diagnostic practices, treatment approaches, and sociocultural barriers. Elevating bladder prolapse as a public health and gender equity issue can improve health outcomes and quality of life for millions of women in Africa, Asia, and the Middle East.