Interview with

Dr. Kabita Sah Swarnkar

MBBS, MD - Gynaecology & Obstetrics Pokhara Academy of Health Science.

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Team TDO met with Dr Kabita Sah Swarnkar (MBBS, MD in gynaecology & Obstetrics) from Pokhara Academy of Health Science to discuss female health problems in Nepal. The exclusive interview is captured here.

What age-group females come more for this complain?

I have seen females between 20 - 65 years of age coming for uterine prolapse in my OPD. The reasons vary for different age groups. For instance, females between 20 - 30 years get uterine prolapse majorly due to childbirth. For the age-group of 35 - 40 years,
the common reason is any pelvic surgery or pregnancy. After pelvic surgery, if the woman doesn't rest, it puts pressure on the pelvic organs.
During delivery, the trauma and pressure created
throughout the childbirth may weaken the surrounding areas. For women between the age of
45-65 years, the common cause is hormonal imbalance. As estrogen, a hormone, supports the uterus, deficiency of estrogen during old age causes uterine prolapse.

"There
  is
  nothing 
  to be
  ashamed
  of..."

Do they come at an initial stage or later? How do you handle the shyness and taboo regarding such a disease?

As most of the women are unaware of their problem during the initial phase, they mostly come during the later stage. Most of them also avoid talking to a healthcare professional as they feel shy about it.

We have to create awareness about why uterine prolapsed occurs in the first place and measures to event them. Preventive measures like kegel exercise can be done anywhere and thus should be practiced by all females. We should also create awareness about the symptoms. Some of the common symptoms of uterine prolapse are:

  1. Pelvic heaviness or pulling

  2. Increase in vaginal discharge

  3. Difficulties with sexual intercourse

  4. Urinary leakage, retention or bladder infections

  5. Bowel movement difficulties, such as constipation

  6. Lower back pain

  7. Uterine protrusion from the vaginal opening

  8. A feeling of something coming out of the vagina

  9. Weak vaginal tissue

Most common causes for weak pelvic floor muscles

  1. Multiple pregnancies

  2. Vaginal delivery: Including trauma, delivering a large baby

  3. Menopause: Due to decrease of the hormone estrogen

  4. Immediate heavy lifting after delivery

  5. Straining during bowel movements

  6. Smokers: chronic cough

  7. Genetical factors

We can only achieve this by educating masses through media platforms such as newspaper, radio, and television. Moreover, it is important for them to understand that there is nothing to be embarrassed about it and thus, they should not hesitate in discussing their problem. Some precautionary measure includes:

 

  • To perform a proper Kegel: Tighten the pelvic floor muscles, at the time of urination stop and hold for 5 seconds take a 5-second break and repeat for three sets,10 times per day.

  • We can use Vaginal pessary in the 2nd or 3rd stage, it supports and keeps uterus in its position

  • Estrogen therapy during menopause

  • Maintain a healthy weight through diet and exercise

  • Managing chronic cough and quit smoking

  • Avoid heavy lifting works

  • Prevent and treat constipation

Is there advice you would like to give to prevent this problem?

I would like to give them the advice to consult with a doctor on time. Don't hesitate in talking about this problem with your family or friends.

"I am sharing you one case. There is one patient of age 40 years who came to my OPD with the complaint of something coming out of her vagina for 4 years and it goes inside after pushing. Other complaints included: Foul-smelling vaginal discharge, Difficulty in completely evacuating her bladder, abdominal pain while heavy work & Irregular menstruation for one year. This woman has 5 kids and undergone 4 abortions. All this made her pelvic muscle floor really weak. After a lot of counselling, I convinced her to undergo a physical check-up. While examining her, I found a 4th-degree prolapse which would require surgery.  She was asthmatic and a smoker. To control asthma, she was advised to quit smoking. During that time, she used pessary for symptomatic relief. Once her asthma settled, we could do her surgery. If she had come in initial stages, surgery could have been avoided."

My message to all women

"There is nothing to be ashamed of in discussing your problems. Your health comes first. Treatment in the initial stages is easy. So, consult a doctor before it's too late."

:- Dr. Kabita Sah Swarnkar