Pelvic organ prolapse (POP) is a medical condition that affect many women around the world. This condition happens when organs in the pelvic floor like the uterus, vagina, rectum, or bladder descend into the vaginal canal due to weakened or damages pelvic floor muscles and tissues. Hysterectomy is a common surgery recommended for women with uterine prolapse where the uterus drops from its healthy position. Women who undergo this surgery expect a guaranteed solution but this is not always the case. This article will discuss the relationship between hysterectomy and POP and possibility post hysterectomy prolapse.

Understanding Pelvic Organ Prolapse

Pelvic organ prolapse is a complex condition often caused by multiple factors, including childbirth, aging, genetics, and hormonal changes. It is diagnosed when pelvic organs, such as the bladder, uterus, or rectum, sag or drop into the vaginal canal and out the vaginal opening. This leads to discomfort, pain, urinary incontinence, and other painful symptoms. Treatment is recommended to prevent the condition from worsening and to relive symptoms. Classification of the prolapse is based on the organs involved and the severity of the prolapse.

Hysterectomy and Pelvic Organ Prolapse

Hysterectomy is a surgical procedure that removes a part of or the entire uterus. This is a common treatment for women who are diagnosed with uterine prolapse. Unfortunately, this procedure is not a permanent solution for many women. Some women may experience post-hysterectomy prolapse, which happens when another pelvic organ prolapse after undergoing the surgery. The most common type of post-hysterectomy prolapse is bladder prolapse. Studies suggests that this happens because the removal of the uterus also removes structural support for other pelvic organs making it easier to slip and sag.

Management and Treatment Options

Managing and treating pelvic organ prolapse after hysterectomy has many approaches. There are non-surgical options, including pessary, external prolapse support devices (FemiCushion), lifestyle modifications, pelvic floor exercises, and pessaries to help alleviate mild symptoms. Surgical interventions, such as reconstructive pelvic surgery, may be necessary for more severe cases, although they come with their own set of risks and benefits.

Pessary

A pessary serves as a prosthetic medical device placed within the vagina to prevent further descent of prolapsed organs. Pessaries require periodic replacement and sometimes vaginal washing every 2 or 3 months at the hospital. While offering a more noninvasive alternative to surgical procedures, pessaries can pose certain risks due to it being inserted into the body. Potential side effects are infections, increased discharge, and unpleasant odor. Additionally, they might cause abrasions to the vaginal membrane, resulting in bleeding and could hinder sexual intercourse. Despite being a straightforward solution, finding a suitable pessary for every woman can be challenging especially after undergoing a hysterectomy. Fitting pessaries involves a trial-and-error method supervised by a doctor, potentially exerting a considerable toll on the body. 

Pelvic Floor Exercises

Pelvic floor exercises play a crucial role in strengthening the muscles responsible for supporting pelvic organs, such as the uterus, bladder, small intestine, and rectum. Strengthening these muscles serves to prevent the descent of pelvic organs and halt the progression of existing pelvic organ prolapse (POP). Often referred to as Kegel exercises, named after Arnold Kegel, an American gynecologist, these exercises are recommenced to slow the advancement of pelvic organ prolapse. However, pelvic floor exercises do not produce immediate effects and require time and commitment. Before starting on any exercise regimen, seek guidance from a qualified professional, such as a physiotherapist.

FemiCushion

FemiCushion is different from pessaries as it offers a non-invasive treatment specifically crafted to be used externally. It is an effective treatment for managing and relieving prolapse symptoms. This external prolapse support is made up of three primary components – cushion, holder, and supporter. These components are used together to effectively retain the prolapse within the body, alleviating associated symptoms such as pain and discomfort. A significant advantage of FemiCushion is its discreet nature; it can be worn beneath clothing without being detected by others. Users retain full control over this treatment approach, and its ease of application and removal makes it an ideal option for women of varying age groups. 

Clinical Study on FemiCushion

Research conducted by Showa University Northern Yokohama Hospital, published in The Journal of Obstetrics and Gynecology Research, focused on assessing FemiCushion's effectiveness on pelvic organ prolapse (POP) using magnetic resonance imaging (MRI). The study involved twelve participants with severe stages 3 or 4 of POP, having a median age of 72 (ranging from 56 to 84 years old).

Key findings from the study include:

• FemiCushion demonstrated its efficacy in repositioning prolapsed pelvic organs.
• It was observed that FemiCushion offered results similar to a pessary without the associated risks, such as vaginal erosion and bleeding.
• The device not only elevated the prolapsed organs but also provided support to the perineal body in an upward direction while closing the hiatuses.
• Patients with severe POP experienced a significant reduction in the degree of prolapse after using FemiCushion.
• Even with a short duration of FemiCushion use, as little as one month, it can lead to improvements in pelvic organ prolapse.

 These findings underscore the potential effectiveness of FemiCushion as a non-invasive treatment option for POP, offering benefits comparable to a pessary but without some of the associated risks. The study's outcomes indicate promising advancements in managing pelvic organ prolapse, particularly for individuals with severe stages of the condition. 

Prevention and Lifestyle Modifications

Some tips to preventing pelvic organ prolapse involves maintaining a healthy lifestyle, including proper weight management, eating a healthy diet, avoiding heavy lifting, and practicing pelvic floor exercises. It is also important to solve health issues if application that put pressure on the abdomen. This includes constipation or coughing. Patients should also be consistent with regular pelvic exams to monitor pelvic health.

Pelvic organ prolapse following hysterectomy is a complex issue that requires attention, understanding, and proactive management. By increasing awareness, promoting early detection, and exploring various treatment options, individuals affected by POP after hysterectomy can find hope in managing and improving their quality of life. The journey toward better care and outcomes for those experiencing this condition is an ongoing and evolving process, with promising advancements.

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.