What is Uterine Prolapse? A Woman's Guide to Symptoms and Treatment

Uterine Prolapse: Causes, Symptoms, and Treatment

Uterine prolapse is a condition that occurs when the uterus descends from its normal position into the vagina. In severe cases, the uterus may even protrude outside the vagina. This condition is often referred to as pelvic organ prolapse, as it involves the descent of pelvic organs.

Definition of Uterine Prolapse

Uterine prolapse is defined as the descent of the uterus into the vagina, but not outside of it. Specifically, it is diagnosed when the cervix descends below the line connecting the ischial spines, which are bony prominences on either side of the pelvis.

Prevalence of Uterine Prolapse

Studies have shown that the prevalence of uterine prolapse, including cases that have progressed to uterine prolapse, is 14% among women in general. However, many women with uterine prolapse do not experience any symptoms and therefore do not seek medical attention. This makes it difficult to accurately estimate the true prevalence of the condition. It is believed that the actual number of women with uterine prolapse is likely higher than the reported 14%.

Causes of Uterine Prolapse

The pelvic organs are supported by a group of muscles and ligaments called the pelvic floor. Uterine prolapse occurs when these muscles and ligaments become weakened or damaged, leading to the loss of support for the uterus. Several factors can contribute to the weakening of the pelvic floor, including:

* Pregnancy and childbirth: Vaginal delivery, especially multiple deliveries or deliveries of large babies, can strain and weaken the pelvic floor muscles.
* Obesity: Excess weight puts extra pressure on the pelvic floor.
* Aging: As women age, the pelvic floor muscles naturally weaken.
* Menopause: The decline in estrogen levels after menopause can contribute to the weakening of pelvic floor tissues.
* Chronic cough: Persistent coughing puts repeated strain on the pelvic floor.
* Chronic constipation: Straining during bowel movements can also weaken the pelvic floor.
* Heavy lifting: Repeatedly lifting heavy objects can put stress on the pelvic floor.

While various factors can contribute to uterine prolapse, the greatest risk factor is pregnancy and childbirth. The more vaginal deliveries a woman has, the higher her risk of developing uterine prolapse.

Symptoms of Uterine Prolapse

In its early stages, uterine prolapse often causes no noticeable symptoms. As the condition progresses, women may experience:

**Early symptoms:**

* A feeling of pressure or fullness in the pelvis
* A sensation of something "falling out" of the vagina
* Discomfort or pain during intercourse
* Low back pain

**Later symptoms:**

* Urinary incontinence or difficulty urinating
* Constipation or difficulty defecating
* Vaginal bleeding or discharge
* Protrusion of the uterus from the vagina

Diagnosis of Uterine Prolapse

A pelvic exam is usually sufficient to diagnose uterine prolapse. During the exam, the doctor will visually inspect the vagina and cervix and may ask the patient to bear down to assess the degree of prolapse.

Treatment of Uterine Prolapse

The treatment for uterine prolapse depends on the severity of the condition and the individual's symptoms.

**Conservative treatment:**

* Lifestyle changes: Losing weight, avoiding heavy lifting, and treating chronic constipation can help prevent further prolapse.
* Pelvic floor exercises: Kegel exercises can strengthen the pelvic floor muscles.
* Pessary: A pessary is a device that is inserted into the vagina to support the uterus.

**Surgical treatment:**

* Vaginal hysterectomy: This procedure involves removing the uterus through the vagina.
* Vaginal repair: This procedure involves tightening the muscles and tissues of the vagina to support the uterus.
* Sacrocolpopexy: This procedure involves attaching the top of the vagina to the sacrum (the bone at the base of the spine) using surgical mesh.

Prognosis of Uterine Prolapse

With proper treatment, most women with uterine prolapse can experience significant improvement in their symptoms and quality of life. However, it is important to be aware that uterine prolapse can recur, especially if the underlying causes are not addressed.

Uterine prolapse is a common condition that can affect women of all ages. While it can be uncomfortable and even debilitating, there are effective treatments available. If you are experiencing symptoms of uterine prolapse, it is important to see your doctor for diagnosis and treatment.

The Difference Between Uterine Prolapse and Uterine Descent

The terms "uterine prolapse" and "uterine descent" are often used to describe the same set of symptoms, such as discomfort or a feeling of heaviness in the lower abdomen. However, the two terms are often used to distinguish between different degrees of the condition.

"Uterine prolapse" typically refers to cases where the uterus has descended into the vagina, while "uterine descent" generally describes a state where the uterus has descended but has not yet protruded from the vagina. In cases of uterine descent, lifestyle changes and pelvic floor exercises may be enough to improve symptoms without the need for surgery or devices. However, if the condition has progressed to uterine prolapse, treatment with a pessary or surgery may be necessary for prevention and treatment.

Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) is a condition in which organs normally supported by the pelvic floor muscles and ligaments (such as the uterus, bladder, urethra, small intestine, and rectum) descend and protrude from the vagina. This condition is also sometimes referred to as "genital prolapse" or "vaginal prolapse."

POP can be further categorized based on the specific organ that has prolapsed, such as uterine prolapse, cystocele (bladder prolapse), and rectocele (rectal prolapse). However, it is common for multiple organs to prolapse simultaneously, which is why the term "pelvic organ prolapse" is increasingly used as a general term.

POP is not a rare condition and has been affecting women for centuries. It is more common in middle-aged and older women. Unfortunately, awareness of POP remains low, and many women suffer in silence due to embarrassment or uncertainty about which medical specialist to consult. However, it is important to seek medical attention from a gynecologist or urologist if you experience any symptoms, as POP does not resolve on its own.

Symptoms of Pelvic Organ Prolapse

Common symptoms of POP include:

* A feeling of a round object, like a ping pong ball, in the genital area (especially noticeable during bathing)
* A sensation of something descending or being pulled down in the lower abdomen or vagina
* A feeling of something being stuck between the legs
* Frequent urination
* Difficulty urinating or defecating

Symptoms often worsen throughout the day and are more pronounced in the afternoon after activity compared to the morning. In the early stages, the prolapse may only occur when straining, such as during a bowel movement. As the condition progresses, the prolapse may become more persistent and even protrude constantly, potentially causing friction against underwear and leading to bleeding. In severe cases, walking can become difficult, significantly impacting daily life.

Causes of Pelvic Organ Prolapse

The primary cause of POP is the weakening of the pelvic floor muscles and ligaments that support the pelvic organs. Chronic strain on the vagina can increase the risk of developing POP.

Factors that contribute to POP include:

* Multiple childbirths
* Aging
* Obesity
* Chronic constipation or coughing
* Occupations that involve prolonged standing or heavy lifting

Treatment for Pelvic Organ Prolapse

Treatment for POP can be broadly divided into two categories: surgical and conservative. Medications are generally ineffective in treating POP.

Surgical Treatment

Various surgical procedures are available to treat POP, and the specific approach will depend on the individual's symptoms and the extent of the prolapse. Some common surgical procedures include:

* **Vaginal hysterectomy with anterior and posterior colporrhaphy:** This involves removing the prolapsed uterus through the vagina and reinforcing the fascia between the bladder and vagina with sutures. This traditional approach has a 30-40% chance of recurrence because it involves suturing already weakened tissues.

* **Transvaginal mesh surgery:** This involves using a mesh to reinforce the weakened fascia and ligaments. The mesh is typically made of a synthetic material like polypropylene and is also used in hernia surgeries.

Conservative Treatment

A common conservative treatment for POP is pessary therapy. This is suitable for individuals with mild symptoms or those who cannot or do not wish to undergo surgery. A pessary is a device inserted into the vagina to support the uterus and/or bladder. It can be easily inserted and removed by the individual and is less invasive than surgery. Pessaries can help prevent complications like vaginitis and bleeding. However, they require regular replacement and do not address the underlying cause of the prolapse.

FemiCushion: A Less Invasive Treatment for Pelvic Organ Prolapse

FemiCushion is a product developed by Mitsui Medical Japan for the treatment of all types of pelvic organ prolapse, including uterine prolapse, cystocele, rectocele, and enterocele.

It works by supporting the pelvic organs with a cushion at the vaginal opening and a holder and supporter that lift and hold the organs in place, preventing them from protruding when abdominal pressure increases. FemiCushion provides immediate symptom relief and allows individuals to live their daily lives with confidence.

The cushion is made of a special material that is comfortable against the vaginal opening. It is not inserted into the body or left in place, minimizing the burden on the organs and vaginal mucosa while preventing the progression of the prolapse.

FemiCushion offers several advantages:

* Easy to apply and remove by the individual when needed
* Discreet design that resembles underwear
* Reusable and easy to clean

FemiCushion was developed to help women who experience discomfort and difficulties due to pelvic organ prolapse (POP) and is ideal for the following individuals:

* Those who have difficulty using or do not wish to use ring pessaries
* Those considering surgery (for pre- and post-operative management and recurrence prevention)
* Those who have concerns about sexual activity (such as those who wish to have children or do not want their partner to know about their condition)

Clinical Trial Results of FemiCushion

FemiCushion is a Class I medical device approved in Japan for its effectiveness in treating pelvic organ prolapse.

The MRI images below show (a) cystocele, (b) uterine prolapse, (c) enterocele and rectocele, and (d) complete eversion. In all cases, FemiCushion is identified as a hemisphere below the perineum (dotted line), and all prolapsed organs are supported at a significantly higher position when wearing FemiCushion, demonstrating its effectiveness in improving pelvic organ prolapse.

Source: Nomura Y, Yoshimura Y, et al: Magnetic resonance imaging evaluation of the effectiveness of FemiCushion in pelvic organ prolapse. J. Obstet. Gynaecol. Res., 48(5): 1255-1264, 2022.