Pelvic organ prolapse (POP) refers to the descent or dropping of one or more pelvic organs from their normal position, typically due to weakened pelvic floor muscles and ligaments. The pelvic organs that can be affected by prolapse include the bladder, uterus, rectum, or the top of the vagina (vault). Pelvic organ prolapse can vary in severity, ranging from mild to severe, and may lead to various symptoms depending on the organs involved.

The Impact of Pelvic Organ Prolapse on Daily Life

Pelvic organ prolapse can have a profound impact on various aspects of daily life. Some examples are included below.

• Physical Discomfort: Individuals with pelvic organ prolapse may experience sensations of pressure, heaviness, or fullness in the pelvic area. This discomfort can be particularly pronounced during activities such as standing, walking, or lifting heavy objects.
• Urinary Symptoms: Prolapse of the bladder (cystocele) can lead to urinary symptoms such as increased frequency of urination, urgency, difficulty emptying the bladder completely, or urinary incontinence. These symptoms can be bothersome and may affect daily activities and social interactions.
• Bowel Symptoms: Prolapse of the rectum (rectocele) can cause symptoms such as difficulty with bowel movements, constipation, or the sensation of incomplete evacuation. These bowel symptoms can interfere with daily routines and may lead to discomfort or embarrassment.
• Sexual Dysfunction: Pelvic organ prolapse can impact sexual function and intimacy, leading to discomfort or pain during intercourse. Additionally, concerns about prolapse may affect body image and self-esteem, contributing to reduced sexual desire or avoidance of sexual activity.
• Activity Limitations: Severe pelvic organ prolapse may limit an individual's ability to engage in physical activities or exercise, particularly those that involve straining, lifting heavy objects, or high-impact movements. This limitation can impact overall fitness and well-being.
• Emotional Impact: Coping with the physical symptoms and lifestyle changes associated with pelvic organ prolapse can take a toll on emotional well-being. Feelings of embarrassment, frustration, or anxiety about managing symptoms or discussing the condition with others may arise.
• Impact on Daily Activities: Pelvic organ prolapse can interfere with daily activities such as work, household chores, or caring for children or family members. Individuals may need to modify their routines or seek assistance to manage symptoms effectively.

Types of POP and their Causes/Risk Factors

Pelvic organ prolapse (POP) can involve various pelvic organs, and the specific type of prolapse depends on which organ or organs are affected. It is important to understand the specific type of prolapse and its underlying causes for effective management and treatment.

Cystocele (Bladder Prolapse):

Cause: Cystocele occurs when the supportive tissues between the bladder and the vaginal wall weaken, allowing the bladder to protrude into the vagina. The primary cause of cystocele is typically weakening of the pelvic floor muscles and connective tissues due to factors such as childbirth, aging, hormonal changes, chronic coughing, obesity, or previous pelvic surgery.

Rectocele (Rectal Prolapse):

Cause: Rectocele occurs when the thin wall of tissue (septum) separating the rectum from the vagina weakens, causing the rectum to bulge into the vaginal space. Risk factors for rectocele include childbirth (especially with prolonged pushing during delivery), aging, chronic constipation or straining during bowel movements, obesity, and connective tissue disorders.

Uterine Prolapse:

Cause: Uterine prolapse involves the descent or sagging of the uterus into the vaginal canal. It typically occurs due to weakening of the pelvic floor muscles and ligaments that support the uterus. Risk factors for uterine prolapse include multiple childbirths, vaginal delivery of large babies, aging, hormonal changes (such as menopause), obesity, chronic coughing, and previous pelvic surgeries. 

Vaginal Vault Prolapse:

Cause: Vaginal vault prolapse occurs when the top of the vagina (vault) descends or drops down into the vaginal canal after hysterectomy (surgical removal of the uterus). This type of prolapse is caused by weakening of the supportive structures of the pelvic floor and can be exacerbated by factors such as aging, obesity, chronic coughing, or previous pelvic surgeries.

Enterocele:

Cause: Enterocele is a less common type of pelvic organ prolapse that involves the small intestine protruding into the vaginal space. It typically occurs due to weakening of the pelvic floor muscles and connective tissues, often in combination with other pelvic organ prolapse. Risk factors for enterocele include multiple childbirths, aging, chronic constipation or straining during bowel movements, and previous pelvic surgeries.

What are Some Symptoms of Vaginal Prolapse?  

Pelvic organ prolapse (POP) manifests with a range of symptoms, reflecting the displacement or descent of pelvic organs from their normal position. Common indicators of POP encompass sensations of pressure or heaviness in the pelvic area, often exacerbated by standing or physical exertion. Some individuals may observe a visible bulge or protrusion at the vaginal opening, particularly during activities that increase intra-abdominal pressure, like coughing or sneezing. Urinary symptoms frequently accompany POP, including urinary incontinence—characterized by urine leakage during activities such as laughing or lifting—increased urinary frequency, urgency, and difficulty emptying the bladder completely. Bowel symptoms such as constipation, straining during bowel movements, and a sense of incomplete evacuation are also prevalent. Pelvic discomfort or pain, including discomfort during sexual intercourse, may be reported by individuals with POP. Lower back pain can occur due to altered pelvic organ positioning and increased pressure on surrounding structures. Additionally, individuals may experience a "dragging" sensation in the pelvic region, particularly after prolonged standing or walking.

Pelvic Organ Prolapse Diagnosis. What to Expect at the Doctor.

Diagnosing pelvic organ prolapse typically involves a combination of medical history, physical examination, and sometimes additional tests.

Medical History: The healthcare provider will begin by taking a detailed medical history, including specific questions about symptoms related to pelvic organ prolapse. They may inquire about sensations of pressure or bulging in the pelvic area, urinary or bowel symptoms, any discomfort during sexual intercourse, and factors that may contribute to pelvic floor dysfunction, such as childbirth, chronic constipation, or previous pelvic surgeries.

Physical Examination: A pelvic examination is a crucial component of diagnosing pelvic organ prolapse. During the pelvic exam, the healthcare provider will visually inspect the external genitalia and may use a speculum to visualize the vaginal walls and cervix. They will manually assess the position of the pelvic organs, including the bladder, uterus (if present), and rectum, to determine if there is any descent or bulging into the vaginal canal. The provider may also assess the strength and integrity of the pelvic floor muscles.

Additional Tests: Depending on the individual's symptoms and medical history, additional tests may be ordered to further evaluate pelvic organ prolapse and assess bladder function. These tests may include:

• Urinalysis: A urine sample may be collected and analyzed to check for signs of urinary tract infections or other urinary abnormalities.

• Urodynamic Studies: These tests assess bladder function and may include measurements of bladder pressure, urine flow rate, and bladder capacity to evaluate urinary symptoms and bladder dysfunction. 

• Imaging Studies: In some cases, imaging studies such as ultrasound, magnetic resonance imaging (MRI), or computed tomography (CT) scans may be ordered to visualize the pelvic organs and assess the extent of pelvic organ prolapse.

By combining the information obtained from the medical history, physical examination, and any additional tests, healthcare providers can accurately diagnose pelvic organ prolapse and develop an appropriate treatment plan tailored to the individual's needs. Regular follow-up with a healthcare provider is essential for monitoring symptoms, assessing treatment effectiveness, and addressing any changes or new concerns that may arise.

What is FemiCushion for Pelvic Organ Prolapse? 

FemiCushion is a solution designed to provide comfort and aid for individuals experiencing pelvic organ prolapse (POP) or similar pelvic floor issues. Comprised of cushions, holders, and supportive undergarments, this system is specifically designed for external application to alleviate the discomfort and symptoms associated with POP.

Each kit includes all the necessary components for prolapse relief. These components are strategically placed over the pelvic area to provide gentle yet effective support to the prolapsed organs, while also reducing pressure on the pelvic floor muscles. Engineered with both discretion and comfort in mind, the prolapse undergarment allows individuals to wear it throughout the day without hindering their daily activities.

A research investigation conducted at Showa University Northern Yokohama Hospital and documented in The Journal of Obstetrics and Gynecology Research examined the effectiveness of FemiCushion in managing pelvic organ prolapse (POP) through magnetic resonance imaging (MRI). The study involved twelve participants aged 56 to 84, all diagnosed with severe stages 3 or 4 of POP.

Key findings of the study include: 

1. FemiCushion significantly repositioned prolapsed pelvic organs.
2. The device produced results comparable to a pessary but without associated risks such as vaginal erosion and bleeding.
3. FemiCushion not only lifted prolapsed organs but also provided upward support to the perineal body while closing the hiatuses.
4. Individuals with severe POP experienced a noticeable reduction in prolapse severity after using FemiCushion.
5. Even within a short usage period, as little as one month, FemiCushion exhibited improvements in POP.

These results highlight FemiCushion's potential as a non-invasive treatment option for POP, offering similar benefits to a pessary while mitigating certain risks. The findings signify promising progress in managing pelvic organ prolapse, particularly for individuals with severe stages of the condition.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.