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1 Department of Midwifery, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia. bezabihterefe898@gmail.com.

2 Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.

3 Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan, Ethiopia.

4 Department of Midwifery, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia.

Bezabih Terefe Dora et al.

BMC Womens Health .

2022 .

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Abstract

PubMed

PMID

Affiliations

1 Department of Midwifery, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia. bezabihterefe898@gmail.com.

2 Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.

3 Department of Midwifery, College of Medicine and Health Sciences, Mizan Tepi University, Mizan, Ethiopia.

4 Department of Midwifery, College of Medicine and Health Sciences, Arbaminch University, Arbaminch, Ethiopia.

Respondent’s post-partum rest before returning to usual work at Public Hospitals in Hawassa City, Southern Ethiopia,
Modern contraceptive use of the respondents at Public Hospitals in Hawassa City, Southern Ethiopia, 2020
types of pelvic organ prolapse among cases at Public Hospitals in Hawassa City, Southern Ethiopia,

Asresie A, Admassu E, Setegn T.
Asresie A, et al.
Int J Womens Health. 2016 Dec 12;8:713-719. doi: 10.2147/IJWH.S122459. eCollection 2016.
Int J Womens Health. 2016.

PMID: 28003773
Free PMC article.

Borsamo A, Oumer M, Asmare Y, Worku A.
Borsamo A, et al.
BMC Womens Health. 2021 Mar 1;21(1):86. doi: 10.1186/s12905-021-01245-0.
BMC Womens Health. 2021.

PMID: 33648495
Free PMC article.

Woday A, Muluneh MD, Sherif S.
Woday A, et al.
PLoS One. 2019 Nov 11;14(11):e0225060. doi: 10.1371/journal.pone.0225060. eCollection 2019.
PLoS One. 2019.

PMID: 31710645
Free PMC article.

Abebe D, Kure MA, Demssie EA, Mesfin S, Demena M, Dheresa M.
Abebe D, et al.
BMC Womens Health. 2022 Jun 11;22(1):223. doi: 10.1186/s12905-022-01817-8.
BMC Womens Health. 2022.

PMID: 35690856
Free PMC article.

Deprest JA, Cartwright R, Dietz HP, Brito LGO, Koch M, Allen-Brady K, Manonai J, Weintraub AY, Chua JWF, Cuffolo R, Sorrentino F, Cattani L, Decoene J, Page AS, Weeg N, Varella Pereira GM, Mori da Cunha de Carvalho MGMC, Mackova K, Hympanova LH, Moalli P, Shynlova O, Alperin M, Bortolini MAT.
Deprest JA, et al.
Int Urogynecol J. 2022 Jul;33(7):1699-1710. doi: 10.1007/s00192-022-05081-0. Epub 2022 Mar 10.
Int Urogynecol J. 2022.

PMID: 35267063

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Introduction:

Even though the Pelvic organ prolapse (POP) is outstanding gynecologic problem, most private and asymptomatic nature of the illness makes it the "hidden epidemic." The aim of this study was to identify the determinants of POP.

Methods:

Facility based unmatched case control study was conducted from June 15 to September 10, 2020. All cases diagnosed with POP were enrolled in the study by using consecutive random sampling method by assuming that patient flow by itself is random until the required sample size was obtained. Then 1:2 cases to control ratio was applied. A structured interviewer-administered questionnaire and chart review for type and degree of prolapse was used. Epi-data was used for data entry and SPSS were used for analysis. Chi square test and binary and multivariable logistic regression analysis was employed. Multicollinearity was checked.

Result:

On multivariate logistic regression, heavy usual work load(AOR = 2.3, CI(1.066-4.951), number of pregnancy ≥ 5(AOR = 3.911, CI(1.108-13.802), birth space of < 2 years(AOR = 2.88, CI(1.146-7.232), history of fundal pressure (AOR = 5.312, CI(2.366-11.927) and history of induced labor (AOR = 4.436, CI(2.07-9.505) were significantly associated with POP with P value < 0.05 and 95% CI after adjusting for potential confounders.

Conclusion:

Heavy usual work load, having pregnancy greater than five, short birth space, history of induced labor, and history of fundal pressure are independent predictors of pelvic organ prolapse. Hence the responsible body and obstetric care providers should counsel the women about child spacing, minimizing heavy usual work load and effect of multigravidity on POP. Incorporation of health education on those risk factors related to POP on antenatal and postnatal care should be considered. The obstetric care providers also avoid fundal pressure and labor induction without clear indication and favorability, and the hospital officials set a law to ban fundal pressure during labor.

Keywords:

Determinants; Hawassa city; Hospitals; Pelvic organ prolapses.

Authors declare that there is no competing interests to disclose this work.
Respondent’s post-partum rest before returning…
Respondent’s post-partum rest before returning to usual work at Public Hospitals in Hawassa…
Modern contraceptive use of the respondents at Public Hospitals in Hawassa City, Southern…
types of pelvic organ prolapse among cases at Public Hospitals in Hawassa City,…

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This condition refers to the bulging or herniation of one or more pelvic organs into or out of the vagina. The pelvic organs consist of the uterus, vagina, bowel, and bladder. Pelvic organ prolapse occurs when the muscles, ligaments and fascia (a network of supporting tissue) that hold these organs in their correct positions become weakened.
The main cause is damage to the nerves, ligaments and muscles which support the pelvic organs and may result from the following:
A prolapse may arise in the front wall of the vagina (anterior compartment), back wall of the vagina (posterior compartment), the uterus and/or top of the vagina (apical compartment). Many women have a prolapse in more than one compartment at the same time.
Prolapse of the Anterior Compartment
This is the most common type of prolapse and involves the bladder and/or urethra bulging into the vagina. Your doctor may refer to it as cystocele or cysto-urethrocele.
Prolapse of the Posterior Compartment
This is when the lower part of the large bowel (rectum) bulges into the back wall of the vagina (which your doctor may refer to as rectocele) and/or part of the small intestine bulges into the upper part of the back wall of the vagina (which your doctor may refer to as enterocele).
Many women (up to 40%) have a minor degree of prolapse with minimal or no symptoms. Your physician will take a complete medical history and perform a vaginal examination to determine prolapse severity and grade. Different physicians utilize different grading systems and your doctor will explain this to you.
Treatment options can be categorized into non-surgical and surgical options.
For women with symptomatic prolapse, a surgical repair may be offered. Your surgeon will recommend the most appropriate surgical treatment for you based on a number of factors including your age, previous surgical history, severity of prolapse, and your general health. There are two main options: reconstructive surgery and vaginal closure surgery.
There is no single best approach for all patients. The approach for your particular surgery will depend on many factors, including your history, your surgeon’s training and experience with different approaches, and your preference. Your surgeon will discuss the various options with you and will recommend the type of surgery best suited to your condition and needs. Each repair is individualized; even two different women with the same prolapse may have different needs.
It is important to note that the use of vaginal meshes for repair have been withdrawn or restricted in a number of countries including the UK, USA, Australia and New Zealand. Most repairs do not routinely require a graft. Grafts were used in repeat surgeries and where significant risk factors for failure existed with the aim of trying to increase the durability of the repair, but the risk of complications have led to their withdrawal. You should discuss with your surgeon.
Approximately 75% of women having vaginal surgery, and 90-95% having an abdominal approach, will have a long-term cure of their prolapse symptoms. Recurrent prolapse may be due to continued factors which have caused the initial prolapse e.g. constipation and weak tissues.
It is generally advised to withhold the definitive prolapse repair surgery until completion of your family. In the meantime, conservative management such as pelvic floor exercises or the use of a vaginal pessary may be employed.
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Pelvic organ prolapse can feel like a devastating diagnosis for many women. Interestingly, some women have it and never know, while other women can tell if the slightest thing feels wrong in their vagina and seek help immediately. Mild to moderate prolapse is rarely ever painful, but pelvic floor issues such as tightness or a hypertonic muscle state can mimic prolapse, so these symptoms are actually the pain or discomfort from tight muscles and not the prolapse itself. The sensation of prolapse can feel like something is there, like wearing a tampon that hangs a little low.
Bladder or urethral prolapse (bulge on the front vaginal wall/cystocele/urethrocele) can be associated with stress incontinence (leaking with jump/sneeze) but is usually not associated with pain or increased UTI feelings. Pain and UTI type feelings are generally caused by muscular tightness in the front of the pelvic floor and not the prolapse itself. Once the tightness decreases the symptoms usually go away, even if the prolapse is unchanged. Front prolapse can also cause some irritation during sex if the tissue has thinned out. This is more commonly seen in grades 3 to 4.
Uterine prolapse can cause some low back pain. You may also feel a “heavy” sensation.
Rectoceles (bulge on the back vaginal wall) usually don't cause any pain, but they can make having a bowel movement really annoying (lack of professional term for this!) Splinting is often recommended to ease these symptoms. This is when you place your fingers in or at the opening of the vagina and apply support to the posterior (back) vaginal wall.
All types of prolapse can cause a sensation of something being “there,” and mentally that feeling is very bothersome.
Pain most often comes from pelvic floor muscle tightness, and surgery will not help with that -- so make sure if you’re going in for surgery, it’s for reducing the bulge and not for treating pain.
I’ve seen post-surgical patients who thought the prolapse was causing the pain, but they still had the exact same pain (or worse pain) after the prolapse repair surgery and now it was accompanied by urinary frequency they hadn’t known was an added risk.
I am very pro-surgery when it’s needed, but we just want to make sure that the surgery outcome and patient expectations match before diving into that level of treatment. I’m so glad there are surgical options and great surgeons! Healthcare has moved forward so much in this area.
A great foundation makes for a great surgery recovery! And we want to make sure someone doesn’t rush into surgery to resolve an issue that’s not being caused by the prolapse. Mild to moderate prolapses produce very few symptoms and are almost never painful.
If pelvic floor-safe strategies are not adopted, the prolapse could come back even after surgery. So, as a PT, I like getting someone to the point where their strategies are so automatic that they hardly have to think about their pelvic floor, and they know they are keeping it safe before having surgery! That’s a win that can only be gained through learning about pressure management and building strength and body awareness.
For the purpose of this article, though, I’d like to focus on prolapse treatment without surgery. So let’s dive into more on that topic!
The human body is incredible in its ability to heal and remodel tissue. I’ve seen impressive resolution of prolapse, and I’ve also seen prolapse that remains unchanged over time. Some women have the potential to heal completely, others have the potential to heal some, and others can live life without worrying about their prolapse at all, even though the grade doesn’t change. They have learned to manage it.
Step one : Assess the state of the pelvic floor muscles. Are they tight? Weak? Strong? What needs to happen to optimize strength? In some cases, it’s release work and relaxation. In other cases
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