Uterine prolapse and its implication on family health

1. Uterine Prolapse and its implication on
family health
Prepared and Presented by:
Surakshya Poudel
BPH 2nd batch (3rd yr)
UCMS

2. Introduction
• Uterine prolapse is a debilitating form of pelvic organ
prolapse(POP) that occurs when the muscles and ligaments that
support a woman’s uterus are weakened, resulting in the descent
of the uterus from its original position within the body.
• UNFPA defines pelvic organ prolapse as “the descent or
herniation of the pelvic organ, uterus, rectum or bladder into the
vagina”.

4. Stages of Uterine Prolapse
Uterine prolapse (UP) is recognized as a form of maternal morbidity,
and can be classified into three stages terms of severity.
Stage-I: The uterus leaves its place but is still inside the vagina.
Stage-II: The uterus leaves its place and comes upto the opening of
the vagina.
Stage-III:The uterus comes out of the vagina.

6. Depending on the severity of the prolapse, different treatments may
be effective:
• first and second stage prolapse may be treated with specific exercises
which strengthen the pelvic floor or by the insertion a small low cost
medical device called a ring pessary.
• severe prolapse requires surgical intervention in the form of a vaginal
hysterectomy or pelvic floor repair surgery.

7. Status of Uterine Prolapse in Nepal
• Uterine prolapse is one of the major public health problem among
postmenopausal and women of reproductive age group in Nepal.
• In Nepal, according to a study carried out by the UNFPA in 2013, the
median age at which Nepali Women first experience uterine prolapse is
26.
• The 2006 study conducted by Institute of Medicine (IOM) and United
Nation Population Fund (UNFPA) estimates that there may be around
600,000 women with UP in Nepal and 200,000 are in need of immediate
care (UNFPA, 2006).

8. • In the 2006 NDHS survey women aged 15-49 who have had a
pregnancy were asked whether they had ever experienced symptoms
of UP (patheghar khasne/ang khasne).
• In 2006, 7 %of women said they had experienced symptoms of UP
while by 2011 the prevalence declined to 6 %.(NDHS,2011)

9. Fact sheet about Uterine Prolapse
A 2004 study of field-based health camps in 10 districts of Nepal conducted by
the Safe Motherhood Network revealed the following statistics about women
affected by uterine prolapse:
Among the 415 patients who came for health check-ups,
• 70 % represented women from the hilly region and 30 % represented
women from the plains
• 58 % were Brahmin/Chettris, while the rest were from indigenous groups
and Dalits
• Although the disease is usually detected among Nepali women aged 25 to 50
years, the study found that a 16 year-old girl and 80 year old woman were
also among the patients

10. • 86 % of the women were already married by the age of nineteen and
among these women, 31 % were women between the ages of 20 and 24
and 19 % were women between the ages of 15 and 19 yrs
• 95 % of the women had carried large and heavy loads within 45 days of
child birth
• 61% of the women had between three and five children
• Among the women who visited the health camps, 40 % had one child
while 22 % had two children;
• Among the 2900 women who went through a health check-up, 10 % were
affected by the disease; (Medical Study Institution, 2006)

11. • Uterine Prolapse was more prevalent among women who were
deprived of general health services.
• Generally Uterine Prolapse occurred because of a lack of nutritious
food, appropriate rest, and health services and care.
• Lack of health education was also one factor for the high prevalence
of the disease.

12. Causes of Uterine Prolapse in Nepal
The causes of the high prevalence of uterine prolapse in Nepal are complex and
manifold:
• Within Nepal, there are various sociocultural norms that expose women to
multiple risk factors that decrease the age at which prolapse occurs, and
increase the prevalence of the condition within the country.
• Nepal is a patriarchal society, within which gender has immediate
implications for health and wellbeing throughout one’s life course.
• UP in Nepal is also exasperated by poverty and limited access to adequate
health care services.

13. • A lack of access to skilled health workers that many Nepali women
are exposed to harmful birthing practices that heighten their chances
of experiencing UP later in life.

14. Risk Factors of Uterine Prolapse in Nepal
• This condition is more common in women who have had one or more
vaginal births.
• Carrying heavy loads or strenuously working six weeks after child birth.
• Giving birth at a tender age and lack of nutritious food during
pregnancy and after child birth
• Unsafe abortions
• Continuously coughing after child birth
• Applying more pressure than required before the time of child birth
• Malnutrition, dysentery for a long period, anemia
• Lack of rest after child birth.

15. Consequences of Uterine Prolapse in Nepal
• The development of UP, if left untreated, leads to severe pain and
discomfort.
• In many instances these symptoms may manifest as painful
intercourse, an inability to sit, walk, and/or stand, difficulties
urinating and defecating, odorous discharge and an inability perform
daily tasks.
• Women in Nepal who suffer from UP often experience emotional and
physical abuse from their family and or community because of the
stigmatization surrounding the condition.

16. • In a 2013 UNFPA study which interview 357 women who underwent
surgery in Nepal to treat UP, 80% of women said that after having
developed the condition they lost hope in life.
• Depending on the district, between 5% and 23% of women said that
“their mother-in-law and family members started hating them”
(UNFPA, 2013).
• Owing to the ostracization and stigmatization that women with UP in
Nepal experience, many choose to conceal the condition, living in
severe pain and discomfort, sometimes for decades.

17. Addressing the problem
UNFPA and the government of Nepal are working together to develop a
three-fold national strategy to tackle prolapse:
1.Improving access to appropriate health care for low-income women, low
caste women and women living in conflict areas.
2.Improving the volume and quality of reproductive health care services,
including mobile reproductive health camps.
3.Promoting awareness of the issue at community level.

18. National Response to POP
• Government of Nepal has recognized POP as a high priority
condition and has shown its commitment by creating a fund for
provision of free POP surgery services to women in need.
• UNFPA and other key stakeholders have been supporting GoN efforts
by supporting POP treatment through designated reproductive health
(RH) camps and POP surgeries.
• From 2008/9 to 2011/12, around 34,000 women have been
benefited from POP surgery through GoN supported RH camps
• . UNFPA has supported for POP surgery of about 6,700 women and
ring pessaries for additional 8,100.

19. Prevention
The following suggestions are offered in the prevention of Uterine
Prolapse:
• Eating nutritious food: Women must eat nutritious food such as
spinach, beans, milk, yoghurt, fruits, eggs, fish and meat, etc.
Nutritious food is very important for pregnant women and for women
after child birth which is widely available in the villages.
• Large liquid intake: The intake of liquid is very important because this
can clear the stomach and ease pressure on the muscles.

20. • Not carrying heavy loads: If there is a need to lift a heavy load, the
knee should be used to lift the weight instead of the whole body.
Alternatively, it is best to ask someone nearby to help lift the weight
unto woman’s back.
• Receiving proper rest: There is a need to receive appropriate rest
during pregnancy and after child birth. Only light work should be
done and heavy loads avoided.

21. • Short-delivery period: If the delivery period exceeds more than 12
hours, a health worker must be consulted. Longer delivery periods
will put pressure on vaginal and stomach muscles which will weaken
them and possibly result in the dropping of the uterus;
• Special exercise: In order to prevent the uterus from dropping,
special exercise called 'Kagel' can be practiced.