Pelvic organ prolapse (POP) is a condition in which organs normally supported by the pelvic floor muscles and ligaments (such as the uterus, bladder, urethra, small intestine, and rectum) descend and protrude from the vagina. This condition is also sometimes referred to as "genital prolapse" or "vaginal prolapse."

POP can be further categorized based on the specific organ that has prolapsed, such as uterine prolapse, cystocele (bladder prolapse), and rectocele (rectal prolapse). However, it is common for multiple organs to prolapse simultaneously, which is why the term "pelvic organ prolapse" is increasingly used as a general term.

POP is not a rare condition and has been affecting women for centuries. It is more common in middle-aged and older women. Unfortunately, awareness of POP remains low, and many women suffer in silence due to embarrassment or uncertainty about which medical specialist to consult. However, it is important to seek medical attention from a gynecologist or urologist if you experience any symptoms, as POP does not resolve on its own.

Symptoms of Pelvic Organ Prolapse

Common symptoms of POP include:

• A feeling of a round object, like a ping pong ball, in the genital area (especially noticeable during bathing)
• A sensation of something descending or being pulled down in the lower abdomen or vagina
• A feeling of something being stuck between the legs
• Frequent urination
• Difficulty urinating or defecating

Symptoms often worsen throughout the day and are more pronounced in the afternoon after activity compared to the morning. In the early stages, the prolapse may only occur when straining, such as during a bowel movement. As the condition progresses, the prolapse may become more persistent and even protrude constantly, potentially causing friction against underwear and leading to bleeding. In severe cases, walking can become difficult, significantly impacting daily life.

Causes of Pelvic Organ Prolapse

The primary cause of POP is the weakening of the pelvic floor muscles and ligaments that support the pelvic organs. Chronic strain on the vagina can increase the risk of developing POP.

Factors that contribute to POP include:

• Multiple childbirths
• Aging
• Obesity
• Chronic constipation or coughing
• Occupations that involve prolonged standing or heavy lifting

Treatment for Pelvic Organ Prolapse

Treatment for POP can be broadly divided into two categories: surgical and conservative. Medications are generally ineffective in treating POP.

Surgical Treatment

Various surgical procedures are available to treat POP, and the specific approach will depend on the individual's symptoms and the extent of the prolapse. Some common surgical procedures include:

• Vaginal hysterectomy with anterior and posterior colporrhaphy: This involves removing the prolapsed uterus through the vagina and reinforcing the fascia between the bladder and vagina with sutures. This traditional approach has a 30-40% chance of recurrence because it involves suturing already weakened tissues.
• Transvaginal mesh surgery: This involves using a mesh to reinforce the weakened fascia and ligaments. The mesh is typically made of a synthetic material like polypropylene and is also used in hernia surgeries.

Conservative Treatment

A common conservative treatment for POP is pessary therapy. This is suitable for individuals with mild symptoms or those who cannot or do not wish to undergo surgery. A pessary is a device inserted into the vagina to support the uterus and/or bladder. It can be easily inserted and removed by the individual and is less invasive than surgery. Pessaries can help prevent complications like vaginitis and bleeding. However, they require regular replacement and do not address the underlying cause of the prolapse.

FemiCushion: A Less Invasive Treatment for Pelvic Organ Prolapse

FemiCushion is a product developed by Mitsui Medical Japan for the treatment of all types of pelvic organ prolapse, including uterine prolapse, cystocele, rectocele, and enterocele.

It works by supporting the pelvic organs with a cushion at the vaginal opening and a holder and supporter that lift and hold the organs in place, preventing them from protruding when abdominal pressure increases. FemiCushion provides immediate symptom relief and allows individuals to live their daily lives with confidence.

The cushion is made of a special material that is comfortable against the vaginal opening. It is not inserted into the body or left in place, minimizing the burden on the organs and vaginal mucosa while preventing the progression of the prolapse.

FemiCushion offers several advantages:

• Easy to apply and remove by the individual when needed
• Discreet design that resembles underwear
• Reusable and easy to clean

FemiCushion was developed to help women who experience discomfort and difficulties due to pelvic organ prolapse (POP) and is ideal for the following individuals:

• Those who have difficulty using or do not wish to use ring pessaries
• Those considering surgery (for pre- and post-operative management and recurrence prevention)
• Those who have concerns about sexual activity (such as those who wish to have children or do not want their partner to know about their condition)

Clinical Trial Results of FemiCushion

FemiCushion is a Class I medical device approved in Japan for its effectiveness in treating pelvic organ prolapse.

The MRI images below show (a) cystocele, (b) uterine prolapse, (c) enterocele and rectocele, and (d) complete eversion. In all cases, FemiCushion is identified as a hemisphere below the perineum (dotted line), and all prolapsed organs are supported at a significantly higher position when wearing FemiCushion, demonstrating its effectiveness in improving pelvic organ prolapse.

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.