Are you feeling anxious about changes in your body after childbirth, such as a sense of openness in your vaginal area or discomfort in your lower abdomen? Many women experience these sensations due to the natural weakening of the pelvic floor muscles, which support the pelvic organs, during pregnancy and childbirth. This feeling of openness could be a sign of pelvic organ prolapse, specifically uterine prolapse, where the uterus descends from its normal position. In this article, we will discuss postpartum uterine prolapse, a common concern for many women, covering its symptoms, causes, and treatment options. Left untreated, prolapse can worsen, so please read on to learn how to prevent progression and seek timely medical attention.

Uterine Prolapse: A Common Postpartum Concern

Uterine prolapse occurs when the uterus descends into the vagina, sometimes even protruding outside the body. While various factors contribute to this condition, pregnancy and childbirth pose a significant risk. 

Symptoms of Uterine Prolapse

Initial symptoms often include a feeling of pressure or a sensation of something touching the inside of the vagina when sitting. As the condition progresses, it may lead to urinary incontinence, pain, and bleeding. 

Causes of Uterine Prolapse

Uterine prolapse is primarily caused by the weakening or damage of the pelvic floor muscles, which support the pelvic organs, including the uterus, bladder, and rectum. When these muscles weaken or are injured, they can no longer adequately support the organs, leading to prolapse.

Several factors can contribute to pelvic floor muscle weakening or damage, including:

• Childbirth (vaginal delivery, difficult labor, multiple births)
• Aging and menopause
• Obesity
• Chronic constipation with straining during bowel movements
• Weak constitution
• Chronic cough (bronchitis, asthma)
• Prolonged standing
• Heavy lifting
• Pelvic surgery

Childbirth is the most common cause. Women who have had multiple vaginal deliveries or have given birth at an older age are at a higher risk. While uterine prolapse rarely occurs immediately after childbirth, symptoms often manifest later in life, typically after menopause (around 50-60 years old). However, in rare cases, it can occur soon after delivery.

The increased prevalence after menopause is attributed to the decline in estrogen levels, which weakens the support structures of the pelvic floor muscles.

Obesity, constipation, chronic coughing, prolonged standing, and heavy lifting can increase abdominal pressure, contributing to uterine prolapse. Previous pelvic surgery may also damage the pelvic floor muscles, making them more susceptible to weakening with age and increasing the risk of prolapse.

Why Pregnancy and Childbirth Increase Risk

Pregnancy and childbirth are significant risk factors for uterine prolapse. During pregnancy, the growing baby increases abdominal pressure, placing continuous strain on the pelvic floor muscles.

During childbirth, the baby passes through the birth canal, potentially stretching and weakening the pelvic floor muscles. Factors such as a larger baby (over 7.7 lbs), prolonged labor, assisted deliveries (forceps or vacuum), advanced maternal age, and smoking during pregnancy further increase the risk.

When Do Symptoms Usually Appear After Childbirth?

While symptoms typically appear after menopause (around 50 years old), they can also arise soon after childbirth.

Can I Still Get Pregnant with Uterine Prolapse?

Uterine prolapse can cause discomfort during intercourse, but it does not necessarily eliminate the chances of pregnancy. If you desire to have children, non-surgical treatment options like pessaries can be considered. In younger women, pessary use can often resolve the prolapse within a few months and allow for comfortable intercourse.

Postpartum Care

While a smooth and swift delivery is ideal, it's not always within our control. After childbirth, diligently practicing pelvic floor exercises (Kegels) is crucial to strengthening the weakened muscles. If you experience any discomfort in your lower abdomen or develop uterine prolapse, seek early intervention with treatments like pessaries to prevent progression.

Treatment and Prevention of Uterine Prolapse

Prevention:

Regular pelvic floor muscle training (Kegel exercises) can effectively prevent uterine prolapse. Maintaining a healthy weight, eating a balanced diet, staying hydrated, and engaging in regular exercise can also help prevent constipation, which is another contributing factor.

Treatment:

Mild cases may improve with pelvic floor muscle training. However, if part or all of the uterus has prolapsed, the following treatments are commonly used:

• Pessary: A device inserted into the vagina to support the uterus and prevent further prolapse. Regular medical check-ups and pessary replacements are necessary to avoid complications such as inflammation and bleeding.
• FemiCushion: This external device supports the prolapsed organs by applying gentle pressure to the vaginal opening. It is comfortable to wear, reusable, and feels like underwear.
• Surgery: Surgical intervention is recommended for severe cases or when a permanent solution is desired. Options include transvaginal mesh surgery (TVM), vaginal hysterectomy with pelvic floor repair, vaginal closure surgery, laparoscopic sacrocolpopexy (LSC), and robotic-assisted sacrocolpopexy (RSC).

Why FemiCushion Is a Valuable Option

FemiCushion offers a non-invasive, body-friendly treatment option for women who cannot undergo surgery or prefer to avoid internal devices. It is widely recommended by healthcare professionals and gynecologists.

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.