Pelvic organ prolapse (POP) is a widespread medical condition that affects millions of women globally, causing discomfort, pain, and disruption to daily life. This article provides an overview of pelvic organ prolapse, including its causes, symptoms, diagnosis, and available treatment options.

What is Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when the pelvic floor muscles and connective tissues weaken or become damaged, leading to the descent of pelvic organs from their normal position. Commonly affected pelvic organs include the bladder, uterus, and rectum, which may protrude into the vaginal canal or beyond the vaginal opening. Factors contributing to pelvic organ prolapse include childbirth, aging, chronic coughing, obesity, and pelvic surgery.

The Risk of Pelvic Organ Prolapse

This can vary among individuals and is influenced by several factors. Understanding these risk factors is crucial for identifying individuals who may be more susceptible to developing POP and implementing preventive measures where possible. Below are some common risk factors associated with pelvic organ prolapse:

1. Childbirth: Vaginal childbirth, especially multiple deliveries or traumatic births involving prolonged pushing, large babies, or the use of forceps or vacuum extraction, increases the risk of pelvic floor muscle damage and POP. Cesarean section deliveries also carry a lower but still present risk.
2. Aging: As women age, hormonal changes, decreased collagen production, and weakening of pelvic floor muscles and connective tissues occur, contributing to the development of POP. Postmenopausal women are particularly vulnerable due to hormonal fluctuations and decreased estrogen levels.
3. Genetics: There may be a genetic predisposition to pelvic organ prolapse, with a family history of POP increasing an individual's risk. Genetic factors can influence connective tissue strength and pelvic floor muscle integrity.
4. Obesity: Excess body weight places added stress on the pelvic floor muscles and tissues, increasing the risk of weakening and prolapse. Obesity is associated with higher rates of POP and may exacerbate symptoms.
5. Chronic Constipation or Straining: Regularly straining during bowel movements due to chronic constipation or other gastrointestinal issues can weaken pelvic floor muscles over time, leading to POP.
6. Chronic Coughing: Conditions such as chronic obstructive pulmonary disease (COPD), asthma, or habitual smoking can cause chronic coughing, which increases intra-abdominal pressure and strains the pelvic floor muscles, contributing to POP.
7. Pelvic Surgery: Previous pelvic surgeries, such as hysterectomy or surgeries to treat pelvic organ prolapse itself, can weaken pelvic floor support structures and increase the risk of recurrent or new prolapse.
8. Heavy Lifting or High-Impact Activities: Regularly engaging in activities that involve heavy lifting, repetitive straining, or high-impact movements can strain the pelvic floor muscles and increase the risk of prolapse, especially if proper techniques are not used.
9. Hormonal Changes: Fluctuations in hormone levels, such as those experienced during pregnancy, childbirth, menopause, or hormone replacement therapy, can weaken pelvic floor muscles and contribute to POP.

Symptoms of Pelvic Organ Prolapse

The symptoms of pelvic organ prolapse can vary in severity and may include:

• A sensation of pressure or fullness in the pelvic area.
• Discomfort or pain in the pelvis, lower back, or during sexual intercourse.
• Urinary symptoms such as incontinence, urinary urgency, or difficulty emptying the bladder completely.
• Bowel symptoms including constipation, straining during bowel movements, or difficulty controlling bowel movements.
• Visible bulging or protrusion in the vaginal area, especially during activities such as standing, coughing, or lifting heavy objects. 

Diagnosis of Pelvic Organ Prolapse

Diagnosing pelvic organ prolapse typically involves a thorough medical history review, physical examination, and possibly additional tests such as pelvic floor assessment, ultrasound, or magnetic resonance imaging (MRI). Healthcare providers may use standardized grading systems to classify the severity of prolapse and guide treatment decisions. 

Treatment Options for Pelvic Organ Prolapse

The treatment of pelvic organ prolapse aims to alleviate symptoms, improve quality of life, and prevent complications.

Treatment options may include:

• Pelvic floor exercises, such as Kegel exercises, to strengthen the muscles supporting the pelvic organs.
• Lifestyle modifications, including weight management and avoiding activities that strain the pelvic floor muscles.
• Pessaries, which are supportive devices inserted into the vagina to help hold pelvic organs in place.
• Surgical intervention, such as pelvic reconstructive surgery or hysterectomy, may be recommended for severe cases of pelvic organ prolapse that do not respond to conservative treatments.
• Prolapse support underwear, like FemiCushion which features a silicone cushion that is placed at the vaginal opening to prevent organs from prolapsing out of the body.

What is FemiCushion?

FemiCushion is a product designed to provide support and comfort for individuals experiencing pelvic organ prolapse (POP) or related pelvic floor issues. It consists of a set of specially designed cushions, holders, and a prolapse support underwear that are worn externally to help alleviate the symptoms and discomfort associated with POP.

The FemiCushion system includes different sizes of silicone cushions, fabric holders, and a prolapse underwear that is worn strategically over the pelvic area to provide gentle but firm support to the prolapsed organs and relieve pressure on the pelvic floor muscles. The prolapse undergarment is designed to be discreet and comfortable, allowing individuals to wear them throughout the day without discomfort or interference with daily activities.

The main objectives of FemiCushion are:

1. Support: The cushions and support underwear is engineered to provide targeted support to the pelvic organs affected by prolapse, helping to alleviate symptoms such as pressure, discomfort, and bulging.
2. Comfort: FemiCushion aims to enhance comfort for individuals with POP, allowing them to engage in daily activities with greater ease and reduced discomfort.
3. Improved Quality of Life: By providing support and comfort, FemiCushion seeks to improve the overall quality of life for individuals living with pelvic organ prolapse, enabling them to maintain an active lifestyle and manage their condition effectively.

FemiCushion: Medical Study

A study conducted by Showa University Northern Yokohama Hospital and published in The Journal of Obstetrics and Gynecology Research investigated the effectiveness of FemiCushion in managing pelvic organ prolapse (POP) using magnetic resonance imaging (MRI). The research focused on twelve participants, aged between 56 and 84 years old, all of whom had severe stages 3 or 4 of POP.

Key findings from the study include:

• FemiCushion effectively repositioned prolapsed pelvic organs.
• The device yielded outcomes comparable to those of a pessary but without associated risks like vaginal erosion and bleeding.
• FemiCushion not only lifted the prolapsed organs but also supported the perineal body upward while closing the hiatuses.
• Patients with severe POP experienced a significant reduction in prolapse severity after using FemiCushion.
• Even with a short usage duration, as little as one month, FemiCushion demonstrated improvements in POP.

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

FemiCushion is typically recommended as a non-invasive, conservative treatment option for pelvic organ prolapse, particularly for individuals with mild to moderate symptoms or those who may not be suitable candidates for surgery. It can be used in conjunction with other treatment modalities such as pelvic floor exercises, lifestyle modifications, and pelvic floor physical therapy to optimize symptom management and pelvic floor health. 

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.