What is Uterine Prolapse?

Uterine prolapse, is a type of pelvic organ prolapse that is characterized by the descent of the uterus. It is primarily caused by the weakening of the pelvic floor muscles that support the uterus due to various factors. 

Prevalence of Uterine Prolapse

The prevalence of uterine prolapse is estimated to be 14% among women worldwide. Mild uterine prolapse often presents no noticeable symptoms, leading many individuals to remain undiagnosed.

 Four Stages of Uterine Prolapse Severity

• Stage One: The uterus descends into the vagina, approaching within 1 cm of the vaginal opening.
• Stage Two: The uterus descends to the level just inside the vaginal opening, which can cause urinary problems.
• Stage Three: The uterus protrudes outside the vagina.
• Stage Four: The entire uterus protrudes completely outside the vagina.

Can There Be No Initial Symptoms?

In the early stages of uterine prolapse, most individuals experience no symptoms. Often, the condition is first detected during a gynecological examination.

What Noticeable Symptoms Might Occur?

As the uterus descends, the ligaments supporting it may stretch, potentially causing lower abdominal pain. As the condition progresses, a sensation of "something coming out" may be experienced when abdominal pressure increases, such as when standing for long periods, lifting heavy objects, walking, or squatting.

Additionally, during bathing, a "firm, bulging sensation" may be felt when washing the external genitalia, indicating that the cervix is protruding from the vagina. With further progression, the entire uterus, along with the vaginal wall, may descend, potentially pulling down surrounding organs like the bladder and rectum. This can lead to a feeling of "something being caught between the legs" or a sensation of "something going in when sitting and coming out when standing," increasing discomfort.

Friction with underwear may cause pain and bleeding, and vaginal discharge may increase, become reddish, or develop pus. Difficulty with bowel movements and urination, as well as urinary incontinence, may also occur, significantly impacting quality of life.

Which Medical Department Should I Consult for Initial Symptoms?

While the medical departments responsible for treating conditions involving the uterus, bladder, small intestine, and large intestine have traditionally varied, a specialized field called "urogynecology" has emerged in recent years, combining gynecology and urology. This field focuses on the diagnosis and treatment of female pelvic floor disorders, including pelvic organ prolapse and female urinary incontinence. 

If you experience any symptoms, it is advisable to consult a specialist in urogynecology or female urology before the condition progresses.

Could Those Initial Symptoms Indicate a Condition Other Than Uterine Prolapse?

Symptoms such as bleeding, increased vaginal discharge, itching, pain, dysuria (painful urination), urinary urgency, and a feeling of incomplete bladder emptying can also indicate conditions other than uterine prolapse. These symptoms may also be present in cases of uterine cancer, yeast infection, bladder infection, and other infections. Therefore, it is essential to seek medical attention promptly if you notice anything unusual.

Causes of Uterine Prolapse

The pelvis contains muscles (pelvic floor muscles) that support organs such as the uterus, bladder, and rectum, preventing them from being pushed out of the pelvis due to abdominal pressure. Uterine prolapse occurs when these pelvic floor muscles weaken, causing the uterus and vagina to descend.

Various factors can contribute to the weakening of the pelvic floor muscles, including:

• Childbirth
• Aging and menopause
• Obesity
• Habitual straining during bowel movements (constipation)
• Weak constitution
• Chronic coughing (bronchitis or asthma)
• Prolonged standing at work
• Jobs involving heavy lifting
• History of pelvic surgery 

Childbirth is a particularly common cause. Most individuals who develop uterine prolapse have a history of childbirth, with the risk increasing with the number of vaginal deliveries. However, it is rare for uterine prolapse to occur immediately after delivery, and onset typically occurs around the age of 60, after menopause.

Uterine prolapse is more common after menopause due to the decline in female hormones, which weakens supporting tissues like ligaments and pelvic floor muscles. Other factors, such as obesity, chronic constipation, coughing, and occupations involving heavy lifting, can increase abdominal pressure and contribute to uterine prolapse.

Prevention and Treatment of Uterine Prolapse

Prevention of Uterine Prolapse

The following four measures are considered effective in preventing uterine prolapse:

1. Avoid strenuous childbirth
2. Strengthen pelvic floor muscles
3. Maintain a healthy weight
4. Improve bowel habits

Avoid Strenuous Childbirth

Advanced maternal age, multiple births, and difficult labor increase the risk of uterine prolapse. Cesarean delivery is associated with a lower risk of uterine prolapse compared to vaginal delivery.

Strengthen Pelvic Floor Muscles

Since uterine prolapse is caused by the weakening or damage of pelvic floor muscles, strengthening these muscles can help prevent the condition. It is important to start early and maintain a consistent exercise routine, as strengthening the muscles after the onset of uterine prolapse may not completely reverse the condition.

Maintain a Healthy Weight

Obesity and increased visceral fat can compress organs like the uterus and bladder from within the abdominal cavity, leading to uterine prolapse. Maintaining a balanced diet and engaging in regular exercise can help prevent obesity.

Improve and Prevent Constipation

Straining during bowel movements due to constipation increases abdominal pressure and elevates the risk of uterine prolapse. Drinking plenty of fluids, consuming a high-fiber diet, and engaging in regular exercise can help improve and prevent constipation. If you experience chronic constipation that does not improve with lifestyle changes, consult a gastroenterologist.

Uterine Prolapse Treatment

Treatment for uterine prolapse varies depending on the severity of the symptoms.

Mild Cases
In mild cases, pelvic floor muscle training to strengthen weakened pelvic floor muscles, along with addressing issues like obesity and constipation, may improve the condition.

If the uterus is partially or completely prolapsed, the following treatments are typically performed:

• Pessary Therapy: A device called a pessary is inserted into the vagina to reposition the uterus within the pelvis and prevent further prolapse. Since this involves inserting a foreign object into the vagina, symptoms such as vaginitis, increased vaginal discharge, and bleeding may occur. Therefore, regular check-ups with a healthcare professional are necessary for appropriate management. To prevent complications, pessaries need to be replaced periodically.
• Surgical Treatment: Surgical intervention is used for fundamental improvement. There are several surgical options, including removing the prolapsed uterus through the vagina, suturing the loosened areas (such as the bladder and rectal walls), reinforcing the vaginal wall with mesh made of artificial material, and closing the vagina.

FemiCushion: A Medical Device for Uterine Prolapse and Pelvic Organ Prolapse

FemiCushion is a new medical device designed for the prevention and treatment of pelvic organ prolapse, including uterine prolapse, cystocele, rectocele, and enterocele.

It is suitable for those who:

• Cannot use ring pessaries
• Cannot undergo surgery due to underlying health conditions
• Have difficulty visiting the hospital regularly

FemiCushion works by supporting the prolapsed organs. With the prolapsed organs returned to their normal position within the vagina, the cushion covers the vaginal opening, while the holder and supporter lift and maintain the organs in place. It can be worn as needed by the user.

In addition to providing immediate relief from symptoms, FemiCushion helps prevent organ prolapse even under abdominal pressure. It is washable and reusable, and its design resembles underwear, making it discreet and unlikely to be recognized as a medical device by others.

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.