I am sure that many of you are wondering what uterine prolapse is (like I was when I saw it in The Advocacy Project fellowship application). Here you will get a glimpse into what uterine prolapse is and how it impacts the lives of Nepali women.

Definition

The descent or herniation of the pelvic organ, uterus, rectum or bladder into the vagina (Amnesty International ,2014); when the muscles (levator ani muscles/ pelvic floor) around the uterus weaken the and the uterus moves into the vagina.

Normal position of uterus.

Uterine: relating to the uterus (the female organ that develops eggs) or womb (Merriam-Webster)

Prolapse: out of place (Merriam-Webster)

Is Uterine Prolapse Treatable?

Yes. There are 4 stages of uterine prolapse and different ways to treat each stage.

• Stage 1: uterus is in the upper half of the vagina; muscle strengthening exercise can prevent continued muscle weakness
• Stage 2: uterus is at the opening of the vagina; a ring pessary is placed into the vagina to keep the uterus in place and support pelvic organs
• Stage 3 & 4: uterus protrudes or is completely out of the vagina; pelvic floor repair surgery is done to tighten vagina walls or a hysterectomy is completed to remove the uterus.
  

  Severe uterine prolapse.

Do women die from this?

NO! But it still affects women’s DALYs (Disability-Adjusted Life Year) and in Nepal many women are abused due to their condition. More on this can be read: Vulvodynia: Is a ‘Depressed’ Vagina The Reason You Find Sex Painful?

Common Causes

• Old age
• Young child bearing age
• Strain on pelvic muscles from obesity, heavy object lifting, constipation, or persistent coughing
• High number of births and low periods between
• Prolonged difficult labor
• Malnutrition
• Pushing down on abdomen during labor

*The causes in italics are common among Nepali Women*

Symptoms

• Uterus protruding from vagina (severe cases); sometimes ulcers on prolapsed uterus
• Backache
• Difficulty carrying out daily tasks, walking, sitting, lifting objects
• Difficulty urinating or defecating
• Urine leaking
• Sexual intercourse discomfort or difficulty
• Discharge and strong odder from vagina

Barriers

• Social Stigma/ Shame: Women avoid treatment because of fear that family and/or community members will hate and isolate them. Women have also experienced physical and emotional abuse.
• Cultural Practices: Men have the authority to decide if a woman can seek health care in certain caste groups and communities. Women are in charge of heavy manual labor to sustain household income. Women are deemed useless if they are not able to bare children and work.
• Lack of Health Care Access: Healthcare clinics are not available in every region of Nepal. For some the trip to a health clinic or hospital is too expensive. The trip and treatment would also require the women to take off work which reduces the household income.

(Amnesty International ,2014)

What is being done in Nepal?

The Nepali government mainly focuses on treatment of uterine prolapse. One way they ensure treatment is provided is through prolapse screening camps where surgery is given to women diagnosed with uterine prolapse. Monitoring and prevention of uterine prolapse is lacking however. Only focusing on treatment for uterine prolapse will not stop women from developing uterine prolapse. Also ignoring the issues surrounding uterine prolapse such as gender discrimination is a violation of international law.

During my fellowship I will explore how Care Women Nepal (CWN) is effectively addressing the issue of uterine prolapse through helping facilitate the Women’s Health Camp.