What is Pelvic Organ Prolapse?

Pelvic Organ Prolapse (POP) is a condition in which one or more of the pelvic organs (such as the bladder, uterus, or rectum) descend or shift from their normal position. This occurs when the muscles and connective tissues supporting these organs become weakened or stretched, often resulting in a variety of symptoms. While this condition can affect both men and women, it is most commonly seen in women, particularly after childbirth or during the aging process.

Organs Involved in Pelvic Organ Prolapse

There are several key organs in the pelvic region that can be affected by pelvic organ prolapse:

1. Bladder: When the bladder drops into the vaginal space, this is referred to as a cystocele. It can cause urinary issues, such as incontinence or frequent urges to urinate.
2. Uterus: In women who have not had a hysterectomy, the uterus can descend into the vaginal canal. This is called a uterine prolapse. Uterine prolapse can lead to discomfort and, in severe cases, the uterus can protrude outside of the body.
3. Rectum: A rectocele occurs when the rectum drops into the vaginal space, which can lead to bowel problems, such as constipation or difficulty emptying the bowels.

Common Symptoms of Pelvic Organ Prolapse

The symptoms of pelvic organ prolapse can vary depending on the severity of the condition and which organs are involved. Some of the most common symptoms include:

• Pressure or a heavy feeling in the pelvic area: This sensation can range from mild to severe and may feel like something is “falling out.”
• Bulging sensation: Some people feel or notice a bulge in the vaginal area, especially when standing or straining.
• Discomfort or pain: This can occur in the lower back or pelvis, and it may worsen during physical activity, coughing, or heavy lifting.
• Urinary issues: These include urinary incontinence (leaking urine), urgency, or difficulty fully emptying the bladder. A prolapsed bladder (cystocele) often causes these symptoms.
• Bowel problems: A rectocele can result in constipation, difficulty with bowel movements, or a feeling that the bowels have not completely emptied after a movement.
• Sexual dysfunction: Prolapse may cause discomfort during intercourse, and in some cases, the sensation of a vaginal bulge can interfere with sexual activity.

Causes and Risk Factors of Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic floor muscles and ligaments that support the pelvic organs become weakened or damaged. Several factors contribute to the development of this condition, including:

1. Childbirth: One of the most significant risk factors for pelvic organ prolapse is vaginal childbirth. The strain and stretching of the pelvic floor muscles during labor can weaken the supportive tissues, especially after multiple deliveries. Large babies or instrumental deliveries (e.g., forceps or vacuum-assisted birth) also increase the risk.
2. Aging: As women age, particularly after menopause, the natural decline in estrogen can lead to weakening of the pelvic floor muscles and connective tissue. This is why POP is more common in postmenopausal women.
3. Obesity: Excess weight places added pressure on the pelvic floor, which can contribute to the development of prolapse. Being overweight or obese increases the risk of both pelvic floor dysfunction and prolapse.
4. Genetics: Some people may have a genetic predisposition to weaker connective tissues. If a person has a family history of prolapse or other connective tissue disorders, they may be at higher risk of developing POP themselves.
5. Chronic Coughing: Conditions that lead to chronic coughing, such as chronic obstructive pulmonary disease (COPD) or asthma, can increase intra-abdominal pressure. This repeated pressure can strain the pelvic floor, leading to prolapse.

The Impact of Untreated Pelvic Organ Prolapse

Pelvic Organ Prolapse (POP) may start as a mild condition, but if left untreated, it can progressively worsen, leading to a variety of physical, emotional, and social consequences. As the prolapsed organs continue to shift out of place, the symptoms often become more severe, significantly affecting a person’s quality of life. The impact of untreated prolapse extends beyond just physical discomfort—there can be significant emotional distress, social isolation, and even strain on personal relationships.

Physical Consequences of Untreated Pelvic Organ Prolapse

The physical symptoms of pelvic organ prolapse can worsen over time if the condition is not managed. As the pelvic organs (bladder, uterus, rectum) descend further, the individual may experience:

1. Increased Pressure and Discomfort: The sensation of heaviness or pressure in the pelvic area can become more pronounced. This discomfort may interfere with normal activities such as walking, exercising, or standing for extended periods.
2. Urinary and Bowel Dysfunction: If untreated, prolapse can lead to worsening urinary problems, such as frequent incontinence or a constant urge to urinate, which can be both physically uncomfortable and socially embarrassing. In some cases, the inability to fully empty the bladder may lead to urinary tract infections (UTIs). Similarly, rectal prolapse can cause severe constipation, incomplete bowel movements, or painful straining, potentially leading to further gastrointestinal issues or rectal prolapse.
3. Protrusion of Organs: In severe cases, untreated prolapse can cause one or more organs (such as the uterus or bladder) to protrude from the vaginal opening. This is not only physically uncomfortable but can also be distressing and affect a person's body image and self-esteem.
4. Increased Risk of Injury: With prolapsed organs becoming more displaced, the risk of tissue damage or injury can increase, particularly during physical activity or sexual intercourse.

Emotional and Psychological Impact of Untreated Prolapse

The emotional toll of pelvic organ prolapse is often underestimated. The physical symptoms, combined with the frustration of an untreated condition, can lead to significant emotional distress, including:

1. Anxiety and Stress: The constant worry about the potential for urinary leakage, bowel accidents, or the possibility of prolapse worsening can lead to chronic anxiety. Many individuals with untreated POP may also experience embarrassment, which can lead them to avoid social situations or public settings.
2. Depression: Chronic discomfort and the inability to engage in normal daily activities can lead to feelings of isolation and sadness. The emotional burden of coping with prolapse, especially when it disrupts one's sense of identity or sexuality, may contribute to depression.
3. Body Image Issues: The physical changes associated with prolapse, such as a bulging or protruding vagina, can lead to negative body image. This may affect a person’s self-esteem and cause them to feel self-conscious or ashamed, particularly during intimacy.
4. Relationship Strain: Pelvic organ prolapse can place a strain on intimate relationships. Physical discomfort during sexual intercourse, coupled with emotional issues like anxiety and body image concerns, can lead to reduced sexual activity or avoidance of intimacy. Couples may experience tension due to misunderstandings or frustrations stemming from the impact of prolapse.

Impact on Daily Life, Work, and Social Activities

Untreated prolapse can interfere with almost every aspect of daily life, causing significant limitations:

1. Physical Activity and Exercise: Activities that involve lifting, bending, or intense movement, such as running or aerobic exercises, may become uncomfortable or even impossible. The physical pressure of prolapse can limit the ability to engage in exercise, which may, in turn, contribute to weight gain, poor physical fitness, and overall health deterioration.
2. Work and Productivity: The discomfort and fatigue associated with untreated pelvic organ prolapse can negatively impact work performance, especially for jobs that require standing, sitting for long periods, or physical labor. Frequent bathroom trips or the inability to concentrate due to pain and discomfort can affect productivity and may lead to increased absenteeism.
3. Social Isolation: Many people with untreated prolapse avoid social situations due to embarrassment or the fear of experiencing symptoms like leaking urine or experiencing pelvic pressure in public. This can lead to withdrawal from social engagements, hobbies, and even family events, contributing to feelings of loneliness and isolation.
4. Impact on Family Life: The physical and emotional toll of untreated prolapse can also affect family dynamics. Caregiving duties or household responsibilities may become more difficult, and the person with prolapse may feel overwhelmed. Additionally, the stress of dealing with prolapse symptoms may cause frustration in relationships, leading to increased tension or conflict.

Why Seeking Medical Advice is Crucial

While the physical and emotional consequences of untreated pelvic organ prolapse can be severe, it’s important to remember that help is available. Seeking medical advice early on can significantly improve outcomes and prevent further complications. Here are a few reasons why early treatment is essential:

1. Effective Treatment Options: Treatments for prolapse can vary depending on the severity and the organs involved. Non-surgical options, such as pelvic floor exercises (like Kegel exercises), pessary devices, or lifestyle changes (e.g., weight management and diet modifications), can provide relief for many people. In more advanced cases, surgical interventions may be necessary, but the earlier the problem is addressed, the more successful the outcome is likely to be.
2. Prevention of Further Damage: Early intervention can help prevent the condition from worsening, which reduces the risk of prolapse progressing to the point where surgery is required. Treating underlying conditions (like chronic coughing or obesity) can also prevent additional strain on the pelvic floor.
3. Improved Quality of Life: Seeking medical treatment helps improve not only physical health but also emotional well-being. Addressing the condition can reduce symptoms, such as pain and discomfort, and alleviate anxiety or depression related to prolapse. It can also help individuals regain their self-esteem and body image, improving their relationships and overall happiness.
4. Personal Empowerment: By seeking help, individuals can take control of their health, learn about their condition, and explore available treatment options. This can be empowering, helping them make informed decisions about their care and improving their confidence in managing the condition.

Pelvic Floor Exercises for Prolapse

Pelvic floor exercises, commonly known as Kegel exercises, are often recommended as a first-line treatment for mild pelvic organ prolapse (POP). These exercises focus on strengthening the pelvic floor muscles—the muscles and tissues that support the bladder, uterus, rectum, and small intestine. By performing Kegels regularly, you can help reduce the symptoms of prolapse, such as pelvic pressure, urinary incontinence, and discomfort. Strengthening these muscles not only provides immediate relief but also helps prevent the condition from worsening over time.

What Are Kegel Exercises?

Kegel exercises involve repeatedly contracting and relaxing the muscles that make up the pelvic floor. These muscles act like a hammock, supporting your pelvic organs and controlling functions like bladder control. When the pelvic floor muscles are weak or stretched, they may allow the pelvic organs to drop, leading to prolapse. By strengthening these muscles through targeted exercises, you can help lift and support the organs, alleviating many symptoms associated with prolapse.

Step-by-Step Instructions on How to Perform Kegel Exercises

Performing Kegels correctly is key to ensuring you’re engaging the right muscles and getting the most benefit from the exercise. Follow these steps to do Kegels effectively:

1. Identify the Correct Muscles

Before you begin, it's important to locate the pelvic floor muscles. The easiest way to identify them is by attempting to stop the flow of urine midstream while you're in the bathroom. The muscles you use to do this are your pelvic floor muscles. Important note: Never make Kegels a regular part of urination, as this can lead to incomplete emptying of the bladder and other issues.

2. Get Into a Comfortable Position

You can perform Kegel exercises lying down, sitting, or standing. It’s often easiest to start lying on your back with your knees bent and feet flat on the floor. Once you get the hang of the exercises, you can practice them in different positions, including sitting or standing.

3. Contract the Pelvic Floor Muscles

Tighten your pelvic floor muscles by gently lifting the muscles up and in, as if you’re trying to stop urine flow or hold back gas. Avoid tightening your abdomen, buttocks, or thighs while doing the exercise. Focus on isolating the pelvic floor muscles.

4. Hold the Contraction

Once you’ve contracted the pelvic floor muscles, hold the contraction for 3-5 seconds. If you can’t hold it for that long initially, start with shorter intervals and gradually build up to longer holds.

5. Relax the Muscles

After holding the contraction, slowly release and relax the pelvic floor muscles for 3-5 seconds. Ensure you completely relax between each repetition.

6. Repeat the Exercise

Repeat the contraction-relaxation cycle for 10-15 repetitions per session. Aim to perform 3 sets per day.

Example Routine:

• Set 1: 10 Kegels (hold for 3-5 seconds, relax for 3-5 seconds)
• Set 2: 10 Kegels
• Set 3: 10 Kegels

7. Progress Gradually

Over time, you can work up to holding the contraction for 10 seconds and repeating 10-15 times in a set. However, avoid straining or overexerting yourself. Focus on controlled movements and proper technique.

Benefits of Regular Pelvic Floor Exercises for Prolapse

1. Improved Muscle Strength: Regularly doing Kegel exercises strengthens the pelvic floor muscles, helping to support the pelvic organs and reduce the symptoms of prolapse.
2. Reduced Symptoms: Strengthening the pelvic muscles can reduce the feeling of pelvic pressure or heaviness, as well as help with urinary incontinence and bowel issues like constipation.
3. Prevention of Prolapse Worsening: For those with mild prolapse, consistent pelvic floor exercises can prevent the condition from worsening over time, reducing the need for more invasive treatments.
4. Better Bladder Control: Kegels improve bladder control by strengthening the muscles responsible for stopping urine flow, which can be especially beneficial for people with bladder prolapse (cystocele) or urinary incontinence.
5. Enhanced Sexual Health: Strengthening the pelvic floor muscles can lead to improved sexual function and pleasure, as the muscles involved in sexual activity are also targeted during Kegel exercises.

Tips for Incorporating Kegels into Your Daily Routine

To reap the benefits of Kegel exercises, consistency is key. Here are some tips to help you incorporate them into your daily life:

1. Set a Reminder: Schedule a specific time each day to do your Kegel exercises. You could incorporate them into your daily routine, such as after brushing your teeth in the morning or while watching TV in the evening.
2. Do Kegels During Routine Activities: You don’t need to set aside special time for Kegels. Try doing them while sitting at your desk, standing in line, or even while driving. These exercises are discreet and can be done virtually anywhere.
3. Track Your Progress: Keep track of how many Kegels you do each day. Gradually increase the number of repetitions or the length of time you hold the contraction. Monitoring progress can help you stay motivated.
4. Start Slow: If you’re new to Kegel exercises, start with a small number of repetitions (5-10 per set) and work your way up. Doing too many too soon can cause muscle fatigue and discomfort.
5. Practice Deep Breathing: Relaxing your body and breathing deeply while doing Kegels can help reduce tension and improve the effectiveness of the exercise. Try to inhale deeply as you relax and exhale as you contract the muscles.
6. Combine with Other Pelvic Floor Health Practices: In addition to Kegels, other practices such as maintaining a healthy weight, avoiding constipation, and practicing good posture can support pelvic floor health.

Staying Motivated

It can be easy to forget or neglect pelvic floor exercises, especially if you don't notice immediate results. Here are some tips to stay motivated:

1. Create a Habit: Turn your Kegel exercises into a daily habit by linking them with an already established routine (e.g., after meals, before bed, or during your morning coffee).
2. Join a Support Group: Whether online or in person, connecting with others who are doing Kegel exercises for pelvic health can provide motivation and encouragement.
3. Celebrate Small Wins: Recognize your progress, whether that’s being able to hold the contraction longer or feeling less pelvic pressure. Every improvement counts!
4. Consult a Specialist: If you’re struggling with doing Kegels correctly, consider consulting a pelvic floor physical therapist who can guide you and ensure you're using the right technique.

Prolapse Support Devices: Finding the Right Solution

Pelvic organ prolapse (POP) can be an incredibly challenging condition to manage, affecting both physical comfort and emotional well-being. While pelvic floor exercises (such as Kegel exercises) are often the first line of treatment, prolapse support devices can be a highly effective solution for managing the symptoms of prolapse, especially when the condition is more advanced or causing significant discomfort. These devices are designed to provide physical support to the pelvic organs, helping them stay in place and reducing symptoms like pelvic pressure, urinary incontinence, and vaginal bulging.

Types of Prolapse Support Devices

There are several types of prolapse support devices available, and the right choice will depend on factors like the severity of the prolapse, the type of prolapse (e.g., bladder, uterine, or rectal), and personal comfort. Below are the main types of support devices used to manage prolapse symptoms:

1. Pessaries

A pessary is a device that is inserted into the vagina to support the prolapsed organs. Pessaries come in various shapes and sizes, and they work by physically holding the organs in place to prevent further descent. They are often used for managing prolapse of the bladder (cystocele), uterus (uterine prolapse), or rectum (rectocele).

• How they work: Pessaries provide mechanical support to the pelvic organs, alleviating the pressure and discomfort caused by prolapse. They can help relieve urinary incontinence, reduce vaginal bulging, and improve bladder and bowel function.
• Types of Pessaries:

• Ring Pessary: The most common type, shaped like a ring, and used primarily for cystocele (bladder prolapse) and uterine prolapse.
• Gellhorn Pessary: A more rigid, T-shaped device often used for more severe prolapse cases.
• Cube Pessary: A small, cube-shaped pessary designed for those with more advanced prolapse or vaginal scarring.
• Donut Pessary: Similar to the ring pessary but with an added donut-shaped middle that provides more support.

• Benefits:

• Non-surgical option for prolapse management.
• Helps improve symptoms of incontinence and pelvic pressure.
• Allows for continued sexual activity if removed during intercourse.
• Easy to use once fitted properly by a healthcare provider.

• Considerations:

• Pessaries must be fitted and sized by a healthcare professional for maximum effectiveness and comfort.
• They require regular cleaning and periodic replacement.
• Some women may experience irritation or discomfort, especially if the device is not fitted correctly.
• Not all women are suitable for pessary use.

2. Supporters and Pelvic Support Garments

Pelvic supporters or pelvic support garments are external devices that provide gentle compression and support to the pelvic region. These devices are typically worn as undergarments or as part of a specially designed garment and are less invasive than pessaries.

• How they work: Supporters are designed to offer external pressure to support the pelvic floor and reduce the strain on the pelvic organs. They help prevent the organs from prolapsing further by stabilizing the area around the pelvis.
• Types:

• Pelvic Support Shorts: Specially designed shorts that fit around the hips and pelvis, providing gentle compression to support the pelvic floor muscles.
• Pelvic Belts: Adjustable belts that wrap around the waist and hips to provide targeted support to the pelvic area.

• Benefits:

• Non-invasive and easy to wear.
• Can be worn throughout the day for continuous support.
• Less maintenance than internal devices like pessaries.
• Ideal for managing mild prolapse symptoms and preventing further descent of pelvic organs.

• Considerations:

• May not provide as much support for more advanced prolapse as pessaries.
• Not a substitute for pelvic floor exercises but can complement other treatments.

How Support Devices Relieve Symptoms and Improve Quality of Life

Prolapse support devices work by reducing the symptoms associated with pelvic organ prolapse. Support devices help improve the quality of life in the following ways:

1. Reducing Pressure and Discomfort: By supporting the pelvic organs and preventing them from descending further, support devices help reduce the constant feeling of pelvic pressure or heaviness that many women experience with prolapse.
2. Improving Bladder and Bowel Function: Prolapse can interfere with bladder and bowel function, leading to issues like urinary incontinence, urgency, and constipation. Support devices can alleviate these symptoms by maintaining the correct position of the pelvic organs, allowing for more normal function.
3. Increasing Comfort During Physical Activities: Women with prolapse may find it difficult to engage in everyday activities such as walking, standing for long periods, or exercising. Wearing a support device can help reduce discomfort and make daily tasks more manageable.
4. Enhancing Sexual Health: In cases of uterine prolapse or vaginal bulging, support devices can improve comfort during sexual activity. Some pessaries are designed to be easily removed for intercourse, allowing couples to maintain an active sex life.
5. Avoiding Surgery: Support devices can be a useful non-surgical option for managing prolapse. In many cases, they provide enough relief from symptoms to delay or even eliminate the need for surgical intervention.

Choosing the Right Prolapse Support Device

Selecting the right prolapse support device depends on several factors, including the severity of your prolapse, your specific symptoms, and your lifestyle preferences. Here’s a guide to help you make the right choice:

• Consult a Healthcare Professional: Before using a prolapse support device, it’s essential to consult with a healthcare provider, such as a gynecologist or pelvic floor specialist. They can help you determine the type of prolapse you have (bladder, uterus, rectum), the severity of the condition, and the most appropriate device for your needs.
• Consider Your Lifestyle: If you lead an active lifestyle or are frequently on your feet, a pelvic support garment or supporter may be more comfortable and discreet. If you’re experiencing more severe symptoms, a pessary may provide better support.
• Comfort and Fit: Whatever device you choose, comfort and fit are paramount. If a pessary or supporter feels uncomfortable, it may not provide the relief you need. Be sure to work with a healthcare provider to find the correct size and fit, and try different devices to see which one works best for you.
• Maintenance: Some support devices, like pessaries, require regular cleaning and periodic replacement, so consider how much maintenance you’re willing to commit to when choosing a device.

FemiCushion: A Comfortable and Effective Option for Prolapse Support

For women looking for a comfortable, non-invasive way to manage mild prolapse symptoms, FemiCushion is an innovative and effective option. This pelvic support device is designed to provide gentle but firm support to the pelvic region, helping to relieve pressure and discomfort associated with prolapse.

• How FemiCushion Works: The FemiCushion is an external support device that can be worn discreetly under clothing. It offers relief by using a soft cushion to lift and support any prolapsed organs. It is ideal for women with mild to moderate prolapse who are seeking a comfortable, non-invasive solution.
• Benefits:

• Soft, cushioned material for enhanced comfort.
• Easy to put on and take off.
• Non-intrusive and discreet under clothing.
• Provides targeted relief for pelvic pressure, making daily activities more comfortable.

• Why Choose FemiCushion:

• It is particularly beneficial for those who want a comfortable, wear-and-forget option without the need for frequent adjustments.
• FemiCushion is also great for women looking for a lightweight alternative to more rigid pessaries and support garments.
• For women who are not suitable for surgery or pessaries, this is a great treatment option.

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.