Uterine prolapse is a condition that affects many women, especially as they age. It occurs when the pelvic floor muscles weaken, causing the uterus to descend into or outside of the vaginal canal. This condition can significantly impact quality of life, leading to symptoms like discomfort, urinary issues, and reduced physical activity. While surgery is one treatment option, it’s not the only route. In fact, there are numerous non-surgical options that can help manage and even alleviate symptoms of uterine prolapse. These alternatives are crucial for women who wish to avoid surgery due to its risks, costs, or long recovery periods.

What is Uterine Prolapse?

Uterine prolapse is when the uterus sags or slips from its normal position and drops into the vaginal canal. This happens due to weakened pelvic floor muscles, which can be caused by childbirth, menopause, aging, obesity, or chronic coughing. Uterine prolapse can be mild, moderate, or severe, depending on how much the uterus has descended. It can also coexist with other pelvic organ prolapses, such as bladder or rectal prolapse, which may worsen the symptoms.

Symptoms of Uterine Prolapse

Symptoms of uterine prolapse vary depending on the severity. Common signs include:

• Pressure or a “dragging” sensation in the pelvic area
• Lower back pain
• Difficulty with urination or bowel movements
• Vaginal bulging or a sensation of something “falling out”
• Discomfort during intercourse
• Increased urinary frequency or incontinence

While mild prolapse may have few or no symptoms, moderate to severe cases can be distressing, limiting daily activities, and reducing overall quality of life.

Causes and Risk Factors for Uterine Prolapse

Uterine prolapse can be distressing, impacting daily comfort and quality of life. Understanding the causes and risk factors associated with this condition is essential for both prevention and management.

Common Causes of Uterine Prolapse

Uterine prolapse occurs when the pelvic floor muscles and ligaments weaken, failing to adequately support the uterus, which then descends into or outside of the vaginal canal. Several factors can contribute to the weakening of the pelvic floor muscles:

• Childbirth

• Childbirth, particularly multiple births or difficult deliveries, is one of the most common causes of uterine prolapse. The strain on the pelvic floor muscles and connective tissues during labor can weaken or stretch these structures, increasing the likelihood of prolapse.

• Aging and Menopause

• As women age, especially after menopause, they experience a natural decline in estrogen levels. Estrogen plays a crucial role in maintaining the strength and elasticity of pelvic floor tissues. With lower estrogen levels, tissues become more prone to weakening and sagging, contributing to prolapse.

• Genetics

• Some women may have a genetic predisposition to weaker connective tissues. If a family member has experienced uterine prolapse or other types of pelvic organ prolapse, a woman may have a higher chance of developing the condition.

• Previous Pelvic Surgery

• Pelvic surgeries, including hysterectomy or other procedures, can sometimes weaken the pelvic floor, altering the support structure and increasing the risk of prolapse.

Identifying Risk Factors

While the causes of uterine prolapse provide some insight, it’s equally important to understand the risk factors that can increase the chances of developing this condition. Recognizing these risk factors allows for proactive management and preventive measures.

• Obesity

• Carrying excess weight places additional pressure on the pelvic organs and the muscles that support them. Over time, this added strain can lead to weakening of the pelvic floor, increasing the risk of uterine prolapse. Weight management and maintaining a healthy BMI can significantly reduce this risk.

• Chronic Coughing

• Conditions that cause frequent coughing, such as chronic bronchitis, asthma, or smoking, can lead to repeated strain on the pelvic floor. Each cough exerts a downward force on the pelvic organs, causing the muscles to stretch and weaken over time. Managing respiratory conditions and quitting smoking can help lower this risk.

• High-Impact Physical Activities

• High-impact activities, including running, heavy lifting, or certain types of athletic training, can put intense pressure on the pelvic floor. This is especially true if these activities are performed without proper technique or support. While physical activity is generally beneficial, it’s important to balance it with pelvic floor-strengthening exercises and, if necessary, modify high-impact routines to reduce strain on the pelvic area.

• Hormonal Changes and Menopause

• Hormonal changes, especially during menopause, can reduce collagen and elastin in the connective tissues of the pelvic floor, making them more susceptible to prolapse. Hormone therapy can sometimes mitigate this risk, though it should be discussed thoroughly with a healthcare provider to weigh potential benefits and risks.

• Heavy Lifting in Daily Life

• Regularly lifting heavy objects, whether as part of a job or daily activities, can stress the pelvic floor. Proper lifting techniques and avoiding prolonged lifting without rest breaks can help protect pelvic health.

Why Consider Non-Surgical Options?

Surgery, including hysterectomy and pelvic reconstructive procedures, can be effective but comes with risks such as infection, anesthesia complications, and long recovery times. For some women, surgery may not be an option due to health conditions, or they may simply prefer to avoid an invasive procedure. Non-surgical treatments offer alternative solutions that can be effective in managing symptoms and supporting pelvic health. They’re typically less risky, have shorter recovery times, and can be adapted to fit individual needs and lifestyles.

Non-Surgical Management Benefits

Non-surgical options provide a variety of benefits, particularly for women looking for low-risk, less invasive methods to manage uterine prolapse. These options empower women to take an active role in their health, offering flexibility and control over their treatment. They can also be adjusted as needed, allowing women to find the right balance of therapies that suit their lifestyle and personal health goals.

Non-Surgical Treatment Options for Uterine Prolapse

Pelvic Floor Exercises

Strengthening the pelvic floor muscles is one of the most effective non-surgical ways to support the uterus and reduce prolapse symptoms. These exercises not only help improve muscle tone but can also prevent further weakening.

• Kegel Exercises

• How to Perform Kegels Effectively: Kegel exercises focus on contracting and relaxing the pelvic floor muscles, which support the bladder, uterus, and rectum. To perform a Kegel:
• Begin by identifying your pelvic floor muscles, which are the same muscles you would use to stop the flow of urine.
• Contract these muscles for 5 seconds, then relax for 5 seconds. Aim for sets of 10–15 repetitions, three times a day.
• Gradually increase the duration of each contraction as you gain strength, working up to holding for 10 seconds.
• Be sure to breathe normally and avoid contracting surrounding muscles like the abdomen or glutes.
• Benefits: Regular Kegel exercises can improve muscle tone, alleviate symptoms of prolapse, and support bladder control.

• Additional Exercises for Pelvic Health

• Bridge Pose: Lie on your back with knees bent and feet flat on the floor. Lift your hips while keeping your feet grounded, engaging the glutes and pelvic floor. Hold for a few seconds before lowering. This exercise helps strengthen core and pelvic muscles.
• Squats: Properly performed squats engage the pelvic floor and glutes. Stand with feet shoulder-width apart, lower yourself as if sitting in a chair, and return to standing. Keeping the core engaged helps to activate pelvic muscles.
• Bird Dog Exercise: On all fours, extend one arm and the opposite leg simultaneously, balancing your core and engaging pelvic muscles. Repeat on each side for additional stability and pelvic strength.

Lifestyle Modifications

Daily habits can have a significant impact on managing uterine prolapse. Simple changes in lifestyle can help reduce strain on the pelvic area and improve overall pelvic health.

• Weight Management

• Importance of Healthy Weight: Excess weight places additional pressure on the pelvic organs, exacerbating prolapse symptoms. By maintaining a healthy weight through balanced nutrition and regular exercise, women can relieve some of the stress on their pelvic floor, reducing the risk and severity of prolapse.

• Dietary Changes

• Fiber-Rich Diet: A fiber-rich diet can prevent constipation, which is critical in managing prolapse. Straining during bowel movements can place unnecessary stress on the pelvic floor muscles. Adding foods like fruits, vegetables, whole grains, and legumes can promote regularity and reduce this risk. Staying hydrated is equally important, as it aids in digestion and eases bowel movements.

Supportive Devices

For women who need additional support, devices like pessaries offer an effective non-surgical solution. Pessaries are designed to provide structural support to the uterus and pelvic organs, relieving prolapse symptoms.

1. Pessaries

• Types of Pessaries: Pessaries come in various shapes and sizes to suit individual needs. Some common types include:
• Ring Pessaries: Often used for mild to moderate prolapse, ring pessaries are simple, flexible rings inserted into the vagina to provide internal support for the uterus.
• Gellhorn Pessaries: These have a knob-like structure and are suitable for more advanced cases of prolapse. They offer a more secure fit and are often used in cases where the prolapse is more severe.
• Cube Pessaries: A cube-shaped device that creates suction within the vagina, providing a stronger hold for women who experience prolapse symptoms during physical activity or standing for long periods.
• Usage and Fitting: A healthcare provider can help determine the best type of pessary and fit it properly. Many pessaries can be managed at home, though some types require periodic visits to a doctor for cleaning and maintenance.

2. Advantages and Limitations of Pessaries

• Advantages: Pessaries are non-surgical, customizable, and can be removed as needed. They provide immediate relief from prolapse symptoms and allow women to maintain their daily activities with minimal disruption.
• Potential Challenges: Some women may experience initial discomfort or irritation. Regular cleaning is essential to prevent infections, and some types of pessaries may require professional assistance for insertion and removal. Additionally, not all types of pessaries are suitable for all levels of prolapse.

Alternative Therapies for Managing Uterine Prolapse

Non-surgical therapies, including physical therapy, biofeedback, and self-care strategies, provide a holistic approach to managing uterine prolapse (POP) and promoting pelvic health. These alternative options empower women to make lifestyle adjustments, strengthen their bodies, and recognize when to seek medical advice.

Physical Therapy

Physical therapy, particularly pelvic floor physical therapy, is a cornerstone of non-surgical management for POP. Working with a trained physical therapist allows women to target the pelvic floor muscles specifically, improving strength, coordination, and control.

• Pelvic Floor Physical Therapy:
  A pelvic floor therapist can teach specialized exercises to strengthen and stabilize the muscles supporting the uterus and bladder. The therapy usually begins with an assessment to understand each patient's unique needs, followed by a personalized exercise plan.
• Benefits:
  Physical therapy helps reduce prolapse symptoms, minimizes discomfort, and may prevent further prolapse. Many women report improvements in bladder control and physical activity levels.

Biofeedback Training

Biofeedback is a tool often used in conjunction with physical therapy to assist women in identifying and activating their pelvic floor muscles correctly.

• What is Biofeedback Training?
  Biofeedback uses sensors to monitor and display muscle activity. With a biofeedback device, women receive real-time visual or auditory feedback on how well they are engaging their pelvic muscles during exercises like Kegels. This technology helps women learn the correct way to contract and relax their muscles, enhancing the effectiveness of exercises.
• Benefits of Biofeedback:
  Biofeedback training can be highly beneficial, especially for women who have difficulty isolating pelvic muscles. The immediate feedback promotes proper technique, improves muscle engagement, and can speed up progress. 

Lifestyle and Behavioral Strategies

In addition to physical therapy, lifestyle changes can play a significant role in managing uterine prolapse. Adopting habits that support pelvic health can reduce symptoms and improve overall well-being.

1. Self-Care Strategies for POP
• Posture and Core Engagement:
  Practicing good posture and strengthening the core muscles that support the pelvic area are essential. Core exercises that avoid straining the pelvic floor, like planks and controlled leg lifts, can complement pelvic floor therapy.
• Managing Strain:
  Avoiding heavy lifting, practicing safe lifting techniques, and minimizing high-impact activities can reduce stress on the pelvic floor. When lifting, always engage the core and lift with the legs rather than the back.
2. Daily Habits to Support Pelvic Health
• Stay Active, But Gentle:
  Low-impact activities like walking, swimming, and gentle stretching are excellent for maintaining overall fitness without overloading the pelvic muscles. Regular activity promotes circulation, helping pelvic muscles stay strong and flexible.
• Prioritize Bowel Health:
  Constipation is a common contributor to pelvic organ prolapse symptoms. Eating a high-fiber diet, drinking plenty of water, and staying active help prevent constipation, reducing strain on the pelvic floor.

Recognizing Symptoms and Consultation with Healthcare Providers

Knowing when to consult a healthcare provider is vital in managing uterine prolapse effectively. Women should be aware of changes in symptoms or any discomfort that interferes with daily life.

1. Importance of Professional Guidance

• A healthcare provider can offer guidance on treatment options, monitor the progress of prolapse, and recommend therapies based on each woman’s unique circumstances. Providers can also educate patients on managing symptoms and reducing strain, preventing further progression of prolapse.

2. When to Consider Surgical Options

• While non-surgical options are effective for many, there are cases where surgery may be necessary, especially if prolapse symptoms are severe and impact daily functioning despite lifestyle changes and therapies. Surgery is typically considered when prolapse interferes with bladder or bowel function, causes persistent pain, or severely affects quality of life.
• Discussing Surgery with a Provider:
  Women experiencing moderate to severe prolapse symptoms should discuss surgical options with their healthcare provider. Surgical procedures for prolapse, such as hysterectomy or reconstructive surgery, are tailored to individual needs and come with benefits and risks that should be considered carefully.

 Success Stories and Testimonials of FemiCushion

Women around the world use FemiCushion to relive painful symptoms cause by pelvic organ prolapse. FemiCushion allows women who are not suitable or pessary use or unable to undergo surgery an alternative treatment option. This support device is non-invasive and the user has complete control over their treatment. Many women share with us their positive experiences with FemiCushion. Here are some listed below.

“I have been recommending FemiCushion to several of my patients, and the results have been nothing short of impressive. This revolutionary product has proven to be a game-changer for many individuals struggling with pelvic organ prolapse who don't want surgery. The true testament to FemiCushion’s efficacy comes from the feedback of my patients. Many have reported significant improvements in their symptoms. It's heartening to see how this product has positively impacted their lives.” 

“Thank you for developing this. I am waiting for surgery, and this is providing relief and the ability to walk around and be productive again. Pessaries didn’t work for me and I was ready to give up, but then found this product online. I use the medium cushion and easy open support panties. They are wonderful. Thank you so much.”

“What I am most happy about is the fact that the FemiCushion itself has worked to hold up my prolapse and I have not had one single UTI episode since starting to where the FemiCushion this past February of 2024.”

FemiCushion Clinical Trial

A study from Showa University Northern Yokohama Hospital, published in The Journal of Obstetrics and Gynecology Research, examined the effectiveness of FemiCushion for treating pelvic organ prolapse (POP) using MRI scans. The study included twelve women aged 56 to 84, all with severe stage 3 or 4 POP.

Key Findings

• Effective Repositioning: FemiCushion was highly effective in repositioning prolapsed pelvic organs, showing results similar to a pessary.
• Reduced Risks: Unlike pessaries, FemiCushion presented fewer risks, such as vaginal erosion and bleeding.
• Supportive Benefits: It not only lifted the prolapsed organs but also supported the perineal body and helped close hiatuses.
• Significant Improvement: Users with severe POP saw a marked reduction in prolapse severity.
• Quick Results: Positive changes were noted after just one month of use.

These results highlight FemiCushion as a promising, non-invasive alternative for managing severe POP, providing similar benefits to pessaries with fewer side effects.

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.