Prolapsed Uterus Prevention and Physiotherapy Intervention: Statistically Correlated but to be Implemented in Nepal

“I can’t sit and walking is impossible, I feel like a part of my body is falling down. Feels like dying slowly.” These are the piteous lines I have been hearing from the female clients.  Sundari Khatri (name changed) is one of the hundreds of thousands of Nepalese women suffering from uterine prolapse. A mother of 4, holds her belly as she limps behind her mud house to get her sickle and slowly disappears in the wood. 

Uterine Prolapse: A HIDDEN TRUTH OF NEPALESE WOMEN. The uterus (womb) is a muscular structure that is held in place by pelvic muscles. If these ligaments and muscles stretch or become weak it can no longer hold the uterus causing prolapse. A 2007 study by the Center for Agro-Ecology and Development reported that in Nepal, women with uterine prolapse are considered impure and isolated. About 32% did not tell anyone about their condition, of which 66% cited embarrassment as the reason for their silence, while 10% believed it was normal for a woman’s uterus to prolapse. Women try to suppress their problem just for the fear that her husband will marry another  women  if he gets a hint. So, she tolerates the pain and engages herself in house hold chores from dawn to dusk, carrying dozens of wood, cattle fodder, water pots and never fails to carry her children to feed and serves In laws and husband  without a break. This is a concealed agony of Nepalese women.  Engulfed by shame and fear she keeps on tolerating  her pain. Most of the women in village gets married before  menstruation. Probably,  this must be the phase where she doesn’t even understand what marriage and commitment actually is.  Greed for sons has been deeply rooted in our society mainly for socioeconomic and religious reasons. Therefore, women are obliged   to conceive until they give sons to the family.High prevalence of  uterine prolapse in Nepal is a human right issue as a result of early pregnancy, strenuous house hold chores during pregnancy and even during postpartum period, unsupportive husbands, gender discrimination, lack of access to healthcare and education  are some of the strong reasons for prolapsed uterus.

Social stigmas which has been deeply rooted in our society must be cast off.  Government should make sure for the budget allocation for the treatment by not focusing only on  surgical intervention but also advocate on educating society regarding preventive program approach , reproductive rights as Human/women rights , incorporating uterine prolapse with reproductive health education  and accepting the outcome measures. Once the problem is eradicated or minimized women may no longer be the victims of such dreadful agony. Women and girls have right to live free from all sorts of discrimination and violence and to control their sexuality and make choices about reproduction. NGO n INGOs in partnership with local government agencies  should  facilitate free health camps and workshop , conduct street play, organize sports competition and interaction program with youths. Introducing  safe health and population studies in school curriculum not only helps prevent the issue but also facilitates girls to fight for their right and dignity.

 Physiotherapy plays a vital role to prevent prolapse worsening and reduced prolapsed uterus symptoms. It’s sad that  Government does not recruit enough physios in their district health system where maximum number of uterine prolapse cases have been deeply rooted. Systematic channelization of physios would definitely help prevent and manage the situation which has always been the challenging part in the context of Nepal. Physiotherapy not only prevents the prolapse but also helps prevent post surgical complications like urinary incontinence and vaginal vault prolapse.

PHYSIOTHERAPY TREATMENT helps strengthen the pelvic floor muscles which supports the uterus, bladder, small intestine and rectum.

You might benefit from doing Kegal exercise if you have:

1)      Leak a few drops of urine while sneezing, laughing or coughing(stress incontinence)

2)      Have a strong, sudden urge to urinate just before losing a large amount of urine(urinary incontinence)

3)      Leak stool (fecal incontinence)

  Nepalese Women do lots of stressful household job which are simply unavoidable and this predisposes them for the pelvic organ prolapse. It’s very impractical to ask women  avoid such activities as they are linked with their bread and butter. Therefore, work pattern modification (ergonomy) , management of coexisting health condition like lung and abdominal diseases   and  awareness raising is very important. On top of that Physiotherapist who can really help to prevent as well as manage the prolapse should be the part of Nepalese health system.