“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.
