Increasing age, bodily stresses like pregnancy and vaginal childbirth, obesity, menopause etc. can stretch and weaken the pelvic floor muscles and ligaments. As the connective tissues lose their strength, they fail to provide the required support to the pelvic organs like the womb or uterus. As a result, the uterus may drop down from its position and slip into the vaginal canal. In severe cases, the uterus can even protrude out of the vagina.

Various treatment options are available for uterine prolapse depending upon the complexity of the condition. While minor cases can be managed by self-care measures, pessaries, and prolapse support belts. Advanced cases of uterine prolapse however, might require surgery.

What is Uterine prolapse surgery?

Any surgical procedure that helps treat uterine prolapse is characterized as uterine prolapse surgery. Uterine prolapse is typically corrected by hysterectomy, i.e. surgically removing the uterus either by making an incision in the vagina (vaginal hysterectomy) or through the abdomen (abdominal hysterectomy). Hysterectomy is a major surgery and is only considered as the last recourse as pregnancy would not be possible for the patient after the surgery.

Uterine prolapse surgeries are pretty common. Over 10% of women undergo surgery for uterine prolapse. In the United States, about 20,000 hysterectomies are performed annually for the treatment of uterine prolapse.

The cost of uterine prolapse surgeries depends upon the type of the procedure, the surgeons’ experience, and the hospital or facility the surgery is to be performed, and any additional costs associated with anesthesia, medical equipment, and follow-up care. On average, the cost of vaginal hysterectomy can range from $10,000 to $20,000, whereas uterine suspension surgery can cost between $5000 to $ 15,000. Insurance coverage may also play a role in determining the cost, with some health plans covering all or a portion of the surgery expenses. Patients should discuss the costs with their healthcare provider and insurance company beforehand to ensure they have a clear understanding of the potential financial obligations. Additionally, some hospitals and medical facilities may offer financial assistance or payment plans to help alleviate the financial burden for patients.

How is Uterine prolapse diagnosed?

• Medical history and physical examination: Early stages of uterine prolapse are often asymptomatic and only diagnosed after a pelvic exam by an OB/GYN or a primary care physician. The pelvic exam involves visual inspection of the vaginal walls and cervix, as well as manual palpation of the pelvic organs to feel for any abnormalities. For uterine prolapse your doctor would examine your uterus for any signs of descent or protrusion into the vaginal canal. For women who are experiencing prolapse symptoms, your doctor will also ask you about your symptoms, medical history, and the medications you are taking. This information will help your doctor understand the cause of uterine prolapse as well as ruling out other health conditions. It's important for women to be aware of the symptoms of uterine prolapse and seek medical help as soon as possible.

• Imaging tests: Your doctor may also ask you to get some imaging tests such as an ultrasound, MRI or CT scan done. These will help your doctor get a detailed picture of the pelvic organs and allow him to identify the extent and severity of the prolapse.

• Pelvic organ prolapse quantification (POP-Q) exam: In some cases, your doctor may ask you to get a pelvic organ prolapse quantification (POP-Q) exam to measure and observe the pelvic organs. During the exam, the patient is asked to bear down or strain to visualize the prolapse. The doctor will then use a speculum to examine the vagina and cervix and assess the degree of prolapse. They will also measure several key points on the pelvic organs, including the location of the cervix, the depth of the vaginal wall, and the position of the bladder and rectum. Based on these measurements, a numeric value to the degree of prolapse is assigned to help make treatment recommendations. The POP-Q exam is considered a reliable and effective tool for diagnosing and evaluating pelvic organ prolapse and is often used in conjunction with other diagnostic tests.

Non-Surgical Treatment Options for Uterine prolapse

• Kegel exercises: These are the most common non-surgical uterine prolapse treatment that involves contracting and relaxing the pelvic floor muscle. They help strengthen the pelvic floor muscles. Kegel exercises can be helpful for women who experience urinary incontinence, fecal incontinence, or pelvic organ prolapse. To perform Kegel exercises, the try to contract the pelvic muscles, hold it for a few seconds then relax. This process should be repeated several times a day, gradually increasing the duration and frequency of the contractions as the muscles get stronger.

• Pessaries: These are small prosthetics devices usually made from silicone that are inserted into the vagina to support the uterus and other prolapsed pelvic organs. They come in different shapes and sizes and require to be fitted by a healthcare professional. Pessaries would need to be removed and replaced every 3-6 months and vaginal washing may be recommended to reduce the risk of infections.

• FemiCushion: FemiCushion is prolapse support device that features a small silicone cushion designed to conforms to the shape of the body. It is not inserted into the body unlike a pessary and provide natural and non-invasive support to the pelvic floor muscles and prevent pelvic organ prolapse. This treatment option is suitable for women who cannot undergo vaginal prolapse surgery or those who are incompatible with pessary use.

• Hormone replacement therapy: Hormone therapy is not commonly used as a primary treatment for uterine prolapse, as it is not effective in correcting the underlying anatomical changes that caused the condition. Instead, it is considered a complementary treatment option for uterine prolapse and is often used in conjunction with other treatment methods like pelvic floor exercises, pessary, or surgery. However, hormone replacement therapy is suggested for women who experience vaginal dryness, itching, or discomfort because of menopause or hormonal changes. This treatment option can help improve the strength and elasticity of the pelvic muscles and tissues.

• Lifestyle modifications: Making certain lifestyle changes, such as maintaining a healthy weight, regular exercising, avoiding heavy lifting, and managing chronic cough or constipation, stop smoking, eating a healthy diet etc. can help prevent prolapse.

Different Types of surgical procedures for Uterine prolapse

• Vaginal hysterectomy: This procedure involves surgically removing the uterus through the vaginal canal. It is a minimally invasive procedure as no incisions need to be made in the abdomen.

• Laparoscopic hysterectomy: This surgery also involves removing the uterus but it is done through small incisions in the abdomen, using a laparoscope.

• Colpocleisis: This procedure is used to treat pelvic organ prolapse for women who do not wish to have any more children and does not have sexual intercourse. It involves closing the vaginal canal partially or completely to provide support to the pelvic organs and alleviate symptoms of prolapse caused by protruding organs.

• Sacrocolpopexy: Sacrohysteropexy is a surgical procedure that uses graft tissues or surgical mesh to connect the cervix and sacrum (a bony structure located at the base of the backbone and is connected to the pelvis). After the procedure, the mesh will provide long-term support to the uterus and preventing the prolapse from recurring.

Recovery and Complications from surgery

Uterine prolapse recovery surgery depends upon the type of surgery required and the patient’s age, medical history, and overall health. Your doctor may prescribe pain medication to mitigate pain and discomfort. You will also be advised to get plenty of rest and avoid strenuous activity for a few weeks after surgery. You will also be asked to schedule follow-up appointments with your doctor.

Every surgical procedure comes with its own complications. Pelvic organ prolapse surgery complications includes:

• Infection
• Bleeding
• Pain and discomfort
• Urinary incontinence or retention
• Bowel issues like constipation or fecal incontinence
• Recurrence of vaginal prolapse
• Mesh related complications like infection, erosion, or perforation of nearby organs.

Uterine prolapse is a common condition that can significantly impact a woman's quality of life. If you are experiencing prolapse symptoms and suspect that you may have pelvic organ prolapse, consult your doctor as soon as possible. Even though pelvic organ prolapse is not a fatal condition, it can cause a lot of burden to daily life. Additionally, leaving the condition alone without treatment will most likely cause the prolapse to worsen over time. While non-surgical uterine prolapse treatment such as Kegels and pessaries may be effective for mild cases, more severe cases may require surgery to correct the prolapse. Different surgical options like vaginal and laparoscopic hysterectomy, colpocleisis, and sacrocolpopexy are available. Consulting your treatment options with your doctor and surgeon can help you weigh the risks and benefits before making a decision. In general, surgery for uterine prolapse is considered a safe and effective option for women who are experiencing significant symptoms, and it can significantly improve quality of life.

FemiCushion and Clinical Study Outcomes

FemiCushion presents a non-surgical solution for uterine, bladder, rectocele, and enterocele prolapse, featuring a soft silicone cushion for direct support, a holder to secure the cushion and manage leakage, and a supporter with adjustable belts for optimal positioning. Simple to wear and remove, FemiCushion effectively prevents organ prolapse while providing comfortable support. This external support device is particularly suitable for patients who may find pessary use or surgery challenging or uncomfortable.

A study published in The Journal of Obstetrics and Gynecology Research, conducted by Showa University Northern Yokohama Hospital, utilized magnetic resonance imaging (MRI) to assess pelvic organ anatomical changes with FemiCushion use. Involving twelve participants aged 56 to 84 with severe stages 3 or 4 pelvic organ prolapse (POP), the study demonstrated FemiCushion's capacity to reposition affected organs. Key findings suggested comparable results to a pessary without associated risks such as vaginal erosion and bleeding. FemiCushion not only lifts prolapsed organs but also provides upward support to the perineal body. Notably, severe POP patients showed a significant reduction in prolapse, with potential improvement observed after just one month of using FemiCushion.

An independent study by the Urology Department at the University of Campinas in São Paulo, Brazil, published in the Pelviperineology journal, focused on women aged 60 to 79 using FemiCushion consistently for three months. The study reported effective results with lower complication risks compared to pessaries. FemiCushion's external placement and daily removal for hygiene purposes contributed to reduced infection risks. The research highlighted improvements in symptoms associated with pelvic organ prolapse, concluding that FemiCushion is a viable and effective option for enhancing the quality of life.

During the 18th Annual Fall Scientific Meeting in October 2017, the Sexual Medicine Society of North America presented findings from an independent study exploring dermal tissue transplantation for treating pelvic organ prolapse. FemiCushion was employed post-surgery to aid recovery and improve patients' overall quality of life. The study documented a case where a patient, discharged on the fifth day after surgery, utilized an external pessary (FemiCushion) for two months postoperatively. This external pessary supported pelvic floor muscles, potentially serving as a preoperative option after removing a vaginal pessary. The study suggested that incorporating FemiCushion could enhance patient quality of life before and after surgery, particularly in cases involving sexual dysfunction associated with vaginal pessary use.

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.

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