WUNRN
Uterine Prolapse: The uterus (womb) is a muscular structure that is held in place by pelvic muscles and ligaments. If these muscles or ligaments stretch or become weak, they are no longer able to support the uterus, causing prolapse. Uterine prolapse occurs when the uterus sags or slips from its normal position and into the vagina (birth canal).
NEPAL - UTERINE PROLAPSE:
NON-SURGICAL, SIMPLE, AFFORDABLE NEW SOLUTION
An
estimated 600,000 Nepali women live with uterine prolapse - Photo: Mallika Aryal/IRIN
SIRAHA,
20 June 2014 (IRIN) - The Nepal government’s commitment to treat uterine
prolapse, a debilitating life-long gynaecological condition, sparked an uptick in
hysterectomies, but a new, less drastic low-cost intervention could spell hope
for the thousands of Nepali women in need of treatment.
But experts are not convinced that the surgery spree is solving the problem.
“The issue came to light because of the Supreme Court decision, but the
response was ‘knee-jerk’,” said Aruna Uprety, a medical doctor and reproductive
rights activist in the capital,
A 2014 report by Amnesty International criticized the
In most countries, uterine prolapse tends to affect post-menopausal women,
whereas in
UNFPA notes that 600,000 Nepali women suffer from uterine prolapse. The 2006
Nepal Demographic and Health Survey (NDHS) said 200,000 women were in immediate
need of surgery. Uprety and other health experts say women only need surgery if
they have third degree prolapse, and in rare cases second degree.
“Early marriage, unattended home deliveries, heavy work after childbirth,
improper nutrition, [and] Nepali women’s inability to make decisions regarding
their bodies, including how much they can rest after childbirth… all add stress
to a woman’s body and are the causes of uterine prolapse,” said public health
expert Tirtha Rana, of the Nepal Public Health Foundation, a Kathmandu-based organization
that advocates for health development among socially marginalized groups.
The introduction of other solutions, including the pessary ring - a supportive
device for the uterus - indicates that care for uterine prolapse in Nepal is
expanding beyond hysterectomies, other experts note.
Painful prolapse
Kala Devi Barhi, 30, was married at the age of 12 and gave birth to her first
child the following year. She had her second child at 15, and shortly after
felt her uterus was slipping - a condition that has remained untreated.
“It hurts when I walk, when I stand, sit, even when I eat, it’s uncomfortable
and I’m so ashamed,” Barhi said at her home in Bishnupurkatti village in Siraha
District, some 300km southeast of the capital,
Kala Devi Barhi was diagnosed with first-degree uterine prolapse at a screening
camp three years ago, and told that surgery was her only option.
“I couldn’t even qualify for a surgery because my situation was not bad
enough,” Barhi said. “They told me I would have to wait for my condition to get
worse so I could actually get the surgery.”
“Uterine prolapse is not an emergency situation, which means patients can take
their time to come to licensed health facilities and get treatment, said Kiran
Regmi, director of Family Health
Division at the Ministry of Health and Population.
Uterine prolapse is caused by the weakening of supportive tissues, which allows
the uterus to protrude into the vagina. Trauma sustained during childbirth
contributes, especially with large babies, difficult labour and delivery, and
multiple births at short intervals of time.
The symptoms include back pain, painful abdominal cramps, burning
urination, difficulty standing, walking, sitting or lifting, and a foul smelling
discharge.
A study of health-seeking behaviours among 66 women with uterine
prolapse in
All eyes on surgery
Activists say the government put excessive emphasis on surgery as the solution
to uterine prolapse, and officials admit it is time to implement other options.
“A uterine prolapse operation is a major surgery - you cannot perform those in
screening camps. There were reports of misuse, many women who were told their
uterus was removed found that it wasn’t, and women who had undergone surgery
started having more reproductive health problems,” Uprety said. By her
estimate, more than half the women who suffer from uterine prolapse do not need
surgery.
The UNFPA report found that 10 percent of their survey sample (of 2070)
reported uterine prolapse, and 37 percent of those suffered from first-degree
prolapse, which does not require surgery. Given
“It brings its own host of problems, such as pre-menopause and other hormonal
problems, which effect a person’s quality of life,” said the Family Health
Division’s Regmi, adding that the government has taken steps to expand services
for the condition beyond surgery.
“We have realized that surgery is not the only option and are taking steps to
treat everyone who ever suffers from a prolapsed uterus,” said Regmi.
Simple solution
Uprety said the introduction of a silicon ‘ring pessary’, inserted in the
vagina to hold the uterus in place, would make home-based treatment accessible
to women across
“In terms of affordability there is no comparison whatsoever, and it is so
simple any auxiliary nurse or midwife can be trained to insert it,” said Regmi.
Ring pessaries have been available commercially and at district health posts in
“The brand that’s available now is tough, made of rubber and extremely
uncomfortable, and we don’t have enough trained professionals to teach women
how to insert them,” Uprety said.
However, in recent months the government has procured a better quality pessary
ring made of silicon, and will distribute 10,000 to health facilities across
the country. Midwives and nurses will also be trained to insert and clean the
rings.
Kala Devi Barhi is counting the days until the silicon ring becomes available
at her local health post.
“I really thought I had to get worse before I could get treatment,” she said.
“But if the new ring can take away the pain and make me feel comfortable, I
will be first in line at the health post to receive it.”