Risk Factors for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is a common condition where one or more pelvic organs, such as the bladder, uterus, or rectum, drop from their normal position, often causing discomfort or other symptoms. POP occurs when the muscles and tissues supporting the pelvic organs weaken, causing these organs to press against or descend into the vaginal canal. While prolapse is more common than many realize, understanding the risk factors can be key to prevention and early intervention. Here, we’ll explore some of the primary risk factors, including aging, childbirth, and lifestyle factors like weight and chronic health conditions, and how each affects the pelvic area.

Impact of Aging: How Aging Leads to Muscle Weakness in the Pelvic Area

As we age, our body naturally undergoes changes that affect muscle strength, flexibility, and tissue resilience. This process is particularly relevant in the pelvic area, where muscles and ligaments are required to support a variety of organs. With age, collagen levels in the body decrease, reducing the elasticity of supportive tissues, which can make pelvic organs more prone to shifting from their natural positions.

Menopause, which commonly occurs in midlife, also plays a significant role in weakening pelvic support. Estrogen, a hormone that helps maintain muscle tone and tissue strength, declines during menopause, contributing further to tissue laxity and reduced muscle function in the pelvic area. The combined effects of age-related muscle weakening and hormonal changes create a significant risk factor for pelvic organ prolapse.

Preventive Measures:

Strengthening the pelvic floor muscles through targeted exercises, like Kegels, can help mitigate age-related muscle weakness. Additionally, hormone replacement therapy (HRT) may be an option for some women to counteract the effects of reduced estrogen levels, although this should be discussed with a healthcare provider.

Childbirth and Women’s Health: The Effects of Childbirth on Pelvic Support and How to Mitigate Them

Childbirth is one of the leading factors associated with pelvic organ prolapse, especially in women who have had multiple vaginal deliveries. During pregnancy, the weight of the growing baby places increased pressure on the pelvic floor, and the process of childbirth can further strain or damage the muscles, tissues, and nerves involved in pelvic support. This can lead to a weakened pelvic structure, increasing the risk of prolapse later in life.

Although not all women who give birth will experience prolapse, the likelihood is higher for those who have had long or difficult labors, multiple pregnancies, or delivered larger-than-average babies. Prolapse may also occur in women who have had cesarean deliveries, although the risk is generally lower compared to vaginal births.

Preventive Measures:

To support recovery after childbirth, new mothers can benefit from pelvic floor physical therapy, which can help restore muscle strength and address any trauma caused by childbirth. Practicing gentle pelvic floor exercises postpartum is encouraged, but women should always consult their healthcare provider to determine when it’s safe to begin exercising after delivery. Additionally, wearing supportive garments or using pelvic floor support devices, such as pessaries, can also help reduce the risk of prolapse.

Obesity and Chronic Coughing: The Importance of Weight Management and Health Maintenance

Excess weight is another major risk factor for pelvic organ prolapse. Carrying extra weight, particularly in the abdominal area, increases intra-abdominal pressure, which places a continuous strain on the pelvic floor muscles. Over time, this can lead to muscle fatigue and weakness, making it more difficult for these muscles to support the pelvic organs. Studies show that women who are overweight or obese are at a higher risk of prolapse, and weight management can be a crucial preventive measure.

Chronic health issues, like persistent coughing associated with asthma, bronchitis, or smoking, can also contribute to prolapse. Frequent, forceful coughing exerts repeated pressure on the pelvic floor, weakening the support system over time.

Preventive Measures:

Maintaining a healthy weight through balanced diet and regular exercise can greatly reduce the strain on the pelvic floor. For individuals with chronic respiratory conditions, working with healthcare providers to manage symptoms and reduce coughing frequency can be beneficial. Quitting smoking is highly recommended, as it not only lessens the risk of respiratory issues but also contributes to overall health and reduces strain on the pelvic floor.

Lifestyle Improvements for Reducing the Risk of Pelvic Organ Prolapse

Lifestyle changes can play a critical role in reducing the risk of pelvic organ prolapse (POP) by strengthening the body’s natural support system. Adopting healthy habits can alleviate strain on the pelvic area, enhance muscle strength, and support overall well-being. Here are some essential lifestyle improvements to consider, including weight management, diet, regular exercise, and managing chronic conditions.

Maintaining a Healthy Weight

One of the most impactful steps in preventing pelvic organ prolapse is maintaining a healthy weight. Excess weight, particularly in the abdomen, places constant pressure on the pelvic floor muscles, increasing the risk of prolapse over time. Losing even a small amount of weight can help reduce this strain and improve pelvic health.

Diet: Importance of a Balanced Diet and Increased Fiber Intake

A balanced diet that’s rich in fruits, vegetables, lean proteins, and whole grains provides essential nutrients to keep muscles and tissues strong, including those in the pelvic area. Including plenty of fiber in the diet is particularly important, as it helps prevent constipation—a common issue that leads to frequent straining and pressure on the pelvic floor.

A high-fiber diet includes foods like whole grains, legumes, leafy greens, and fruits such as apples and berries. Fiber not only aids digestion but also promotes a healthy gut, which can relieve the pelvic floor from additional strain.

Exercise: The Role of Regular Physical Activity in Prevention

Regular exercise strengthens muscles, boosts energy, and supports overall health. For pelvic health, engaging in low-impact exercises, such as walking, swimming, or cycling, can help reduce weight and build core strength without putting too much strain on the pelvic area. Additionally, exercises that specifically target the pelvic floor, such as Kegels, can help maintain and improve muscle tone.

It’s important to avoid high-impact activities, such as heavy lifting or intense jumping exercises, especially if you are at higher risk for prolapse, as these can increase pressure on the pelvic floor. Working with a physical therapist specializing in pelvic health can help you create a safe, tailored exercise plan.

Managing Chronic Coughing and Constipation

Chronic coughing and constipation both create repeated, forceful strain on the pelvic area. Persistent coughing, often associated with respiratory conditions or smoking, places ongoing pressure on the pelvic muscles, weakening them over time. Similarly, constipation can lead to frequent straining, which puts stress on the pelvic floor.

Tips for Managing Coughing and Constipation:

• Manage Respiratory Conditions: If you experience chronic coughing, work with a healthcare provider to manage underlying conditions and consider quitting smoking if applicable.
• Stay Hydrated: Drinking enough water aids in digestion and helps prevent constipation.
• Increase Fiber Intake: A high-fiber diet can help prevent constipation, reducing the need for straining during bowel movements.
• Use Proper Posture: When lifting objects or coughing, engage your core and exhale to minimize strain on the pelvic floor.

Medical Consultation

While lifestyle changes are essential, medical consultation is equally important, especially if you’re experiencing symptoms or have concerns about pelvic health. A healthcare provider can offer personalized guidance, perform a physical examination, and suggest treatments or preventive measures based on your needs. Early intervention is key, as it can prevent or slow the progression of prolapse.

Simple Daily Strategies

In addition to weight management, diet, and exercise, there are other small adjustments that can make a big difference in supporting pelvic health. These include:

• Practice Good Posture: Sitting and standing with good posture can help evenly distribute weight and reduce strain on the pelvic floor.
• Avoid Heavy Lifting: When lifting is unavoidable, use proper form—bend at the knees, engage your core, and lift with your legs to minimize pressure on the pelvic area.
• Limit Prolonged Sitting or Standing: Alternating between sitting and standing can reduce strain and improve circulation, which helps support the pelvic area.
• Stay Active: Light, frequent movement throughout the day can help prevent stiffness and strengthen the pelvic floor.

Exercises and Techniques to Strengthen Pelvic Floor Muscles

A strong pelvic floor is essential for pelvic health, as it supports organs such as the bladder, uterus, and rectum and helps prevent pelvic organ prolapse. Incorporating pelvic floor exercises into a daily routine can enhance muscle tone, improve bladder control, and alleviate discomfort. Here’s a closer look at exercises, posture tips, and proper lifting techniques to help protect and strengthen the pelvic area.

Exercises to Strengthen Pelvic Floor Muscles

Kegel Exercises

Kegel exercises are one of the most effective ways to strengthen the pelvic floor muscles. They involve contracting and relaxing the muscles that control urination. Kegels can be done anywhere and are particularly beneficial for those experiencing pelvic floor weakness, such as postpartum women or those with early symptoms of prolapse.

How to Do Kegels:

1. Identify your pelvic floor muscles by stopping the flow of urine midstream (only to locate the muscles; don’t make a habit of this).
2. Once you’ve identified the muscles, sit or lie down in a comfortable position.
3. Squeeze the pelvic floor muscles, as if you’re holding in urine or preventing gas.
4. Hold the contraction for 3-5 seconds, then relax for another 3-5 seconds. This is one rep.
5. Aim for 10-15 reps per session and try to do this three times daily.

As strength improves, gradually increase the hold time up to 10 seconds per contraction. Remember to breathe normally and avoid contracting nearby muscles like those in the abdomen, thighs, or buttocks.

Other Strengthening Techniques

In addition to Kegels, other exercises can help build core stability and support the pelvic floor. These include:

1. Bridge Pose (Glute Bridge):
• Lie on your back with your knees bent and feet flat on the floor, hip-width apart.
• Engage your pelvic floor muscles as you lift your hips off the ground, forming a straight line from your shoulders to your knees.
• Hold for a few seconds, then lower back down. Repeat 10-15 times.
2. Squats:
• Stand with your feet hip-width apart.
• Lower into a squat by bending at the knees and pushing your hips back, keeping your back straight and chest lifted.
• Engage your pelvic floor as you return to a standing position. Repeat 10-12 times.
3. Bird-Dog:
• Begin on your hands and knees in a tabletop position.
• Extend your right arm forward and your left leg back, keeping your spine neutral and engaging your core and pelvic floor.
• Hold for a few seconds, then switch to the opposite side. Repeat 10 times per side.

These exercises engage the pelvic floor muscles indirectly while building core strength and stability.

Proper Posture and Lifting Techniques

Good posture and correct lifting techniques are essential for protecting the pelvic floor from strain. These habits are particularly beneficial for individuals with pelvic floor weakness or those who are at risk of prolapse.

How to Lift Correctly

When lifting objects, even if they’re not heavy, using proper form can help prevent pressure on the pelvic area:

1. Prepare: Stand close to the object with your feet shoulder-width apart.
2. Bend at the Knees: Avoid bending at the waist, as this increases pressure on the lower back and pelvic area. Instead, squat down by bending your knees.
3. Engage Core and Pelvic Floor: Before lifting, tighten your core and gently engage your pelvic floor muscles.
4. Lift with Your Legs: Use the strength in your legs to lift the object, keeping it close to your body as you stand up. Avoid twisting your torso while lifting.
5. Exhale on the Effort: Exhaling during the lift reduces intra-abdominal pressure, helping to protect the pelvic floor.

Sitting and Standing Posture

Maintaining proper posture while sitting and standing helps distribute weight evenly across the body, reducing pelvic strain.

Sitting Posture:

• Sit with your feet flat on the ground and your knees at a 90-degree angle.
• Keep your back straight, shoulders relaxed, and avoid slouching, which can strain the lower back and pelvic area.
• If sitting for long periods, take breaks every 30-60 minutes to stand and stretch.

Standing Posture:

• Stand with feet shoulder-width apart and weight evenly distributed.
• Engage your core muscles and keep your back straight, shoulders down, and chest open.
• Avoid locking your knees, which can throw off your balance and put additional strain on the lower body.

Supportive Products for Managing Pelvic Organ Prolapse Symptoms

For many women dealing with pelvic organ prolapse (POP), supportive devices can be life-changing, providing relief and confidence in daily activities. Supportive products are designed to alleviate the discomfort associated with prolapse by helping support the pelvic organs, which can be particularly beneficial for those experiencing prolapse in the bladder, uterus, or rectum.

Supportive devices for prolapse vary in design and function, each tailored to different needs. These can range from pessaries, which provide internal support to the vaginal walls, to cushions and braces that support the pelvic floor externally. Some women use these aids daily, while others use them situationally, depending on their comfort level and specific prolapse symptoms. Choosing the right supportive product can be a helpful step toward managing POP symptoms effectively.

Introduction to FemiCushion

One innovative product that offers external support for those with prolapse, is the FemiCushion. FemiCushion features a comfortable, discreet cushion that can be used while sitting or engaging in light physical activities. This product has been developed with ergonomic features that gently lift and support the affected area, reducing strain and discomfort for users managing any type of pelvic organ prolapse.

FemiCushion is crafted from high-quality, supportive materials that maintain their shape while providing relief. It’s a convenient option for women who spend long hours sitting at a desk, driving, or participating in activities that require a stable and gentle support for the pelvic area. FemiCushion allows women to manage their symptoms more comfortably, and in many cases, it helps delay or prevent the need for more invasive treatments.

Benefits of Using FemiCushion in Daily Life (with Trial Test Results)

In user trials, many women reported significant improvements in comfort and a reduction in prolapse symptoms while using FemiCushion. Test results indicated that:

• The FemiCushion proved highly effective in repositioning prolapsed pelvic organs.
• The device showed results comparable to those of a pessary but with fewer risks, such as vaginal erosion and bleeding.
• FemiCushion not only lifted the prolapsed organs but also provided support to the perineal body and helped close the hiatuses.
• Users with severe POP experienced a significant reduction in the severity of their prolapse after using the FemiCushion.
• Improvements in POP were observed even after just one month of use.

These results highlight FemiCushion’s potential to enhance the quality of life for those with prolapse. Regular use can help make day-to-day tasks more manageable and comfortable, whether working at a desk, traveling, or relaxing at home.

Tips for Proper Usage of FemiCushion

To get the most benefit from FemiCushion, follow these tips:

• Make sure all prolapsed organs are returned inside the body before putting on the device.
• Choose the appropriate cushion and supporter size for your own body.
• Adjust the horizontal and vertical belts of the supporter to adjust the level of prolapse support.
• FemiCushion is only worn during the day and taken off at night when sleeping.

Regular Medical Checkups

Routine medical checkups are essential for monitoring the progression of prolapse. Regular assessments with a healthcare provider can help track any changes in prolapse severity and allow for timely adjustments to your management plan. These checkups may include physical exams, imaging, or discussions about any symptoms you’ve been experiencing.

Benefits of Early Detection

Early detection of pelvic organ prolapse is key to effective management and prevention of symptom progression. When prolapse is identified early, conservative treatments, such as pelvic floor exercises, lifestyle modifications, and supportive products like FemiCushion, can be more effective. Healthcare providers can also help customize a management plan to delay or prevent more invasive treatment options.

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.