What is POP?
Pelvic organ prolapse (POP) is a health condition where the bladder, uterus, vagina, small bowel, and/or rectum protrudes through the vaginal canal or anus due to weak pelvic floor muscles. The prevalence of uterine prolapse, in particular, is disproportionately high in Nepal. A 2015 study by UNFPA estimates that 10 percent, or 600,000 Nepali women suffer from uterine prolapse, and approximately 200,000 of them qualify for immediate surgery.
The Supreme Court of Nepal for the first time in 2008 recognized that the high incidence of uterine prolapse in Nepal may constitute a violation of human rights, including specifically women’s reproductive rights. (Prakash Mani Sharma v. Government of Nepal). Amnesty International in 2014 also urged the Government of Nepal to acknowledge the high prevalence of uterine prolapse in Nepal as a human rights issue as it is a consequence of widespread system gender discrimination.
Pelvic organ prolapse is caused by weak pelvic musculature from multiple childbirths, doing heavy lifting work shortly after childbirth, and diminished circulating estrogen. The Supreme Court of Nepal notes multiple risk factors for the unusually high rate of uterine prolapse in Nepal:
- lack of proper nutrition
- excessive smoking
- lack of access to family planning
- lack of awareness of reproductive rights
- lack of knowledge about importance of care during and immediately after pregnancy
- violence against women
UNFPA notes that early pregnancies are a significant contributing factor as well.
This is a debilitating condition for many women as it causes pain, can make it difficult to walk, sit, lift objects and participate in daily activities. It is associated with urinary incontinence and difficulty having bowel movements. It is uncomfortable, and if chronically prolapsed, can form ulcers and have increased chance of infection.
There is also considerable social stigma and shame around the condition. Sometimes women are ostracized or described as “lazy” by families and communities when they are in too much pain due to the work expected of them. In 2013 UNFPA interviewed 357 women across 11 districts who had undergone surgery for uterine prolapse about their experience of the condition. 80% said that after developing the condition they “lost hope in life.” An average of 5% of respondents said that “their mother- in-law and family members started hating them” because of their uterine prolapse and this figure was as high as 23% in some districts.
Amnesty International's research also found that often women are unable or reluctant to seek healthcare, or to even talk about their pain because of “embarrassment” or because some of them felt that it was normal to have the condition.
There are two primary treatment modalities.
- Pessaries are the first treatment option, a rubber or silicone ring is fitted to the patient and inserted into the vagina to help support the pelvic organs. These are effective for first and second-degree prolapse. However, a lower quality pessary can be uncomfortable and many women refuse to use them.
- Surgery is the other option, especially for women with 3rd and 4th degree prolapse. Surgery is conducted either to support the pelvic muscles or to remove the uterus entirely, with a common procedure called a hysterectomy.