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.

FemiCushion: A Non-Invasive Solution for Pelvic Organ Prolapse

FemiCushion, developed by Mitsui Medical Japan, is designed to treat various forms of pelvic organ prolapse (POP), including uterine prolapse, cystocele, rectocele, and enterocele.

This innovative product provides support to the pelvic organs with a cushion placed at the vaginal opening, along with a holder and supporter that lift and secure the organs, preventing them from protruding during abdominal pressure. FemiCushion offers immediate relief from symptoms, empowering individuals to maintain their daily activities with ease and confidence.

Crafted from a specialized material that ensures comfort against the vaginal opening, FemiCushion is non-intrusive—it does not require internal placement or continuous use. This reduces strain on the organs and vaginal mucosa while effectively halting the progression of prolapse.

Key Benefits of FemiCushion:

• Easy to use: Can be applied and removed by the individual as needed.
• Discreet design: Resembles underwear for subtle wear.
• Reusable and low-maintenance: Easy to clean and maintain.

FemiCushion was created to address the challenges faced by women dealing with POP. It is particularly suitable for:

• Those who struggle with or prefer not to use ring pessaries.
• Individuals planning for surgery, as it aids pre- and post-operative care and prevents recurrence.
• Those with concerns about sexual activity, including those planning to conceive or wishing to maintain privacy regarding their condition.

Clinical Evidence Supporting FemiCushion

FemiCushion is a Class I medical device, approved in Japan, proven effective in managing pelvic organ prolapse.

Magnetic resonance imaging (MRI) studies, as highlighted by Nomura Y, Yoshimura Y, et al., demonstrate FemiCushion's ability to significantly elevate prolapsed organs to their proper positions. Images show effective support across various cases of prolapse, including cystocele, uterine prolapse, enterocele, and rectocele.

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.

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.