A Pre-experimental Study to assess the Effectiveness

of Nursing Intervention Package on Management of

Pelvic Organ Prolapse among Women
Priyanka, Sukhjit Kaur, Amarjeet Singh, Neelam Aggrawal

Abstract : Pelvic Organ Prolapse is one of the common Gynaecological morbidities among women
which compromise the quality of their lives. Pelvic Organ Prolapse is not the problem for old ladies only. In fact it
is estimated that Fifty percent of women of childbearing age will experience some level of Pelvic organ prolapse.
A pre-experimental study was conducted with the objectives to develop a protocol of Nursing Intervention
Package for women with Pelvic Organ Prolapse and to assess the effectiveness of Nursing Intervention Package
on the management of Pelvic Organ Prolapse among women attending the Gynae OPD, PGIMER, Chandigarh.
Fifty women who fulfilled the inclusion criteria i.e. Women with Stage 1, 2, and 3 pelvic organ prolapse, more
than 20 yrs of age, who could read manual themselves and got it read by somebody else and were willing to
come for follow up visit, were chosen as sample using purposive sampling technique and study was conducted
for a period of four months from July to December, 2014. A structured interview schedule was used to gather
information regarding Demographic data and Clinical profile records. The pelvic organ prolapse-symptoms
score and pelvic organ prolapse quantification system were used to assess the clinical course of Pelvic Organ
Prolapse before and after nursing Intervention Package. Nursing Intervention Package (Education regarding
introduction, prevention and conservative management of pelvic organ prolapse and Customized Kegel
Exercise training were administered to the women. At the end of the session a daily Customized Kegel exercise
dairy was given to each woman to assess their health status and to encourage them to adhere to the homecare
protocol. Follow up was done at 6 weeks and 4 months after Intervention Package. Results Showed that there
were significant changes in the Mean score of POP-ss score and grade from baseline to follow- up visit at 6
weeks (< 0.001) and 4 months(<0.001). Shift in the staging of pelvic organ prolapse after 6 weeks and 4 months
of nursing intervention package was also seen in the subjects and none of the subjects was found in stage 2 and
3 at 4 months after intervention. So it is concluded that nursing Intervention Package was effective in reduction
of symptoms of Pelvic Organ Prolapse among women.
Keywords Introduction
Pelvic Organ Prolapse, Nursing Pelvic Organ Prolapse (POP)
Intervention Package, Customized Kegel represents a broad range of conditions that
Exercise tends to affect women older than 40 years of
1
age. Approximately 50 percent of all parous
Correspondence at women present with some degree of
prolapse; however only 10-20 percents are
2
Dr Sukhjit Kaur symptomatic. Furthermore; POP is one of
Clinical Instructor the most frequent causes of gynecological
3
NINE, PGIMER, Chandigarh morbidities among women in India. The
symptoms of Pelvic Organ Prolapse can be
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015 131
extremely debilitating and have an
4
appreciable impact on quality of life.
Pelvic organ prolapse is defined
anatomically as the descent of a pelvic organ
or organs into or beyond the vaginal canal.
5 performed in sitting, standing and lying
Pelvic organ prolapse may involve the
uterus (uterine prolapse), bladder prolapse
(Cystocoele), urethral prolapse
(Urethrocele), Intestinal prolapse
(Enterocele), rectal prolapse (Rectocele)
and vagina (vaginal vault prolapse). Most
6 and standing position.
common problems are Cystocele (56%),
uterine prolapse (53.6%) and rectocele
(40%).
7 position according to the degree of
The condition is most common in
8
multiparous and post-menopausal women.
The principal cause of prolapse are
obstetrics trauma and post-menopausal
9,5,10
atrophy. Carrying extra weight or
physical activity increases the gravitational
8
forces against this muscles. like other
muscles in the body, the muscles in the
pelvic floor are subject to fatigue and injury.
1 The investigator while working in
they can also be actively exercised to
increase their tone and size to prevent
fatigue and injury.
11,6,9
Treatment option for Pelvic Organ
Prolapse includes both surgical and non
surgical intervention. The development of
POP is indication for major surgery among
20% of all women. Nevertheless, recurrence
of POP is detected among 58% of patient
4
after surgery. This highlights the need for
preventive measure for reducing the impact
of pelvic organ prolapse. This includes
training of Kegel exercises and life style
changes. These exercises have been found
to be effective in patients with urinary
incontinence and pelvic organ prolapse.
There are studies, “Effect of Kegel exercise
on the urinary incontinence have been
conducted in 2007 by Kumari S. and
12
“Comparative effect of 2 package of pelvic
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015
floor muscle training on Clinical Course of
pelvic organ prolapse” has done by Kashyap
13
R. in 2011, Chandigarh, India. According
to these studies, Kegel exercise can be
13
position. But if Kegel exercise is done in
sitting and standing position in stage 2 and
3, it can lead to more eversion. Because
Gravity tires the pelvic floor muscles and
pulls the prolapse further down in sitting
2, 14
So, Customized
Kegel Exercise can be done in that case. It
refers to Training of Kegel exercise in varied
prolapse.In Stage -1, Kegel exercise to be
done in sitting and lying position. But in
Stage- 2 and Stage-3, Kegel exercise to be
done in lying down position with slightly
raised hips higher than head end with a
pillow under bottom or raised foot-end of
the bed if possible along with pushing the
vaginal Eversion in third Stage.
clinical area and community experience
observed that women suffering from pelvic
organ prolapse had lack of knowledge about
pelvic organ prolapse and measure taken to
prevent it. By improving the knowledge
about pelvic organ prolapse and its
prevention help in reducing the
gynecological morbidities among women in
India. Above mentioned evidences also
reveals that Early Stage prolapse can be
reversed and corrected by Pelvic floor
exercises (Kegel exercises) and other
behaviour modifications, if routinely done
by the women, it helps to maintain their
pelvic floor muscle strength.
However, clear evidence of the
Customized Kegel Exercise in the
management of POP is lacking. Hence the
present study was conducted with an
objective to develop a protocol of Nursing
132
Intervention Package for women with Pelvic
Organ Prolapse and to evaluate the
effectiveness of Nursing Intervention
Package on Pelvic Organ Prolapse, in
women attending Gynae OPD, PGIMER,
Chandigarh.
Material and Method
This was pre-experimental study
conducted in Obstetrics and Gynae
outpatient Department (OPD) at Post
Graduate Institute of Medical Education and
Research (PGIMER), Chandigarh. Target
population consisted of all women
diagnosed to have pelvic organ prolapse.
The present study population comprised of
fifty Women with stage 1, 2 and 3 Pelvic
Organ Prolapse attended Gynae OPD at
PGIMER Chandigarh. Purposive Sampling
Technique was used to select the subjects
for the study.
Development of the study instruments
was done by review of relevant literature,
expert's opinion, Investigator's own
experience and validated by experts from
Nursing, Department of Obstetrics and
Gynaecology and Department of
Community Medicine. Tool for data
collection were included interview schedule
which comprised of following parts a)
Socio-demographic profile record, b) Pelvic
organ prolapse-symptoms score (POP-ss)
c) Pelvic organ prolapse Quantifications
system and d) Dairy records. Pelvic organ
prolapse symptoms score, a structured
questionnaire to score the symptoms of
pelvic organ prolapse was used. 10 items
included in the POP-ss questionnaire. The
symptoms were assessed objectively on a
5-points Likert response. (0=never,
1=occasionally, 2=sometimes, 3=most of
the time, 4=all the time). The total number of
question was 10, the maximum score was
40 and minimum score was 0. A total score
(range 0–40) was calculated by summing
the ten individual symptom responses.
Pelvic Organ Prolapse - Quantification
staging was used to rule out the clinical
staging 1, 2 and 3 pelvic organ prolapse
through per-vaginal examination (Table-1)
before and after Nursing Intervention
Package.

Table-1: Pelvic Organ Prolapse - Quantification staging

Stages Characteristics of stages of POP
Stage 0 No prolapse ( the apex can descend as far as 2 cm relative to the total vaginal length
Stage 1 The most distal portion of the prolapse descend to a point greater than 1 cm above the
hymen
Stage 2 Maximum extent of the prolapse is within 1 cm of the hymen(outside or inside the vagina)
Stage 3 Prolapse extends more than 1 cm beyond the hymen but no more than within 2 cm of total
vaginal length
Stage 4 Complete eversion, or extension to within 2 cm of the total vaginal length.

A dairy was given to women and advised to put an X mark on the date and 1/2/3/4 times
exercise on the square on the date (Table -2) as shown on date 1*.

Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015 133
 Table-2 Dairy maintained by the women
Mon Tue Wed Thu
2 3 4 5
9 10 11 12
16 17 18 19
23 24 25 26
30 31
An informational booklet was
developed through literature review for
women with pelvic organ prolapse to help
them to have a better understanding of
disease condition, conservative
management, and prevention of pelvic
organ prolapse and steps of performing
Customized Kegel exercise and validated by
the experts from Nursing, Department of
Obstetrics and Gynecology and Department
of Community Medicine. The booklet was
initially written in English and later on
translated in to Hindi and validated by Hindi
expert.
Ethical approval for the study was
obtained from the Ethical Committee of the
institution. The data was collected in the
month of July to December, 2014. All
concerned Gynecologists were requested to
refer the patients with Stage 1, 2 and 3 pelvic
organ prolapse cases to the investigator
stationed at the behavior therapy room,
functioning in the Gynae OPD, PGIMER
Chandigarh. The Women with Stage 1, 2,
and 3 pelvic organ prolapse, Age >20 yrs
and Women who could read manual
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015
Fri Sat Sun
1
XXXX*
6 7 8
13 14 15
20 21 22
27 28 29
themselves and got it read by somebody
else and were willing to come for follow up
visit were included in the study. The written
informed consent was taken. Full autonomy
was given to the study subjects to
participate in research and withdraw any
time. Interview schedule and observation
were used for the data collection.
In order to obtain a free and true
response, self-introduction and purpose of
the data collection was explained to the
samples. They were made to sit in chair and
feel comfortable and relaxed. Initial record
of the socio-demographical data was done.
Pelvic organ prolapse symptoms (POP-ss)
questionnaire was used to do Baseline
assessment of the symptoms of the
prolapse. Pelvic Organ Prolapse -
Quantification staging was used to rule out
the clinical staging 1, 2 and 3 pelvic organ
prolapse through per-vaginal examination.
Initial per-vaginal examination was done by
the gynecologist in Gynae OPD examination
room and at 1st follow up at 6 weeks and
2nd follow at 4 months per-vaginal
assessment was done by researcher in
behavior therapy room.
134
 The Protocol Booklet regarding the data is presented in the form of tables,
conservative management and prevention figures, and other bar diagrams.
of the pelvic organ prolapse was taught and Comparison was done between total POP-
instructions of doing Customized Kegel symptom score before and after Nursing
exercises were given to the respondents. Intervention Package at 6 weeks and at 4
Training of Customized Kegel exercise was months by using Wilcoxan signed rank test.
comprised of one to one instruction of Kegel Results:
exercise and continued supervision of
training and included the four sets of Socio-demographic profile of subjects
exercises daily. One set consisted of up to 15 Table-3: Depict that nearly half of the
maximum voluntary contractions, each held subjects belongs to the age of 41-60 years.
for 4 seconds with 4 seconds rest in The mean age of the subjects was 45 years
between. These were to be repeated three and ranged from 22 to 80. Most of
times a day. The investigator spent 30 population (80%) was literate. Almost all
minutes to complete the Teaching and (94%) of the subjects were married and
Training. A diary was given to the women for most of (88%) were housewives.
recording the compliance advised to put an
X mark on the date and 1/2/3/4 times
exercise on the square on the date and bring Table-3: Distribution of the subjects
the diary during follow-up visits. The according to Socio-demographic profile
training booklet was given as an aid to the N= 50
women and was read by all women either Socio-demographic Profile n(%)
themselves or got it read from somebody
else at home. And as said by patients it is Age( in years)*
very difficult to retain all the concepts which 21-40 19(38)
are taught. So it is easy to understand and 41-60 24(48)
memorize all the points with the help of 61-80 07(14)
booklet. Motivational call was done every 2
Education
weeks to remind and make them compliant
with protocol. Illiterate 10(20)
Primary 07(14)
After the 6 weeks and 4 months Post Metric 18(36)
assessment of POP was taken done by Hr. secondary 08(16)
using POP-symptoms score, POP- Graduate+ 07(14)
Quantification scoring. Women who did not
turn up for follow up for 10 days even after Marital status
the date given to them. Phone reminder was Married 47(94)
sent and Motivational call was also made to Divorced 01(02)
remind and motivate them to come for Widow 02(04)
follow up after 6 weeks and at 4 months. By
making repeated calls the subjects turned Occupation
up for follow-up and their post assessment Working 06(12)
was done. Collected data was coded and Non-working 44(88)
entered in the SPSS (Statistical Package for *Mean±SD (range) =45±1.34 (22-80)
Social Sciences) 16.0.Version. The analyzed
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015 135
Obstetrical and gynecological profile of Disease history of subjects:
subjects: Table-5: Depict that 3(6%) of women
Table-4: Reveals that 19(38%) were suffering from tuberculosis,
subjects were postmenopausal. Nearly half hemorrhoids and Perineal tear as per past
24(48%) had menarche during 13-15 year history. According to present history,
of age. Mean parity was 3 children ranging Constipation and backache were the most
from 0 to 6. Nearly half (48%) of women common problem faced by 36(72%)
were delivered at home, 23(46%) women subjects followed by obesity 27(54%).
had hospital delivery and 3(6%) women Hypertension, Diabetes, Hypothyroidism
were delivered one child at home and and cough was present in 2(4%) subjects
another at hospital. Majority of the women and Hypertension and Diabetes mellitus,
(98%) had normal vaginal deliveries. Gall bladder stone was present in 1(2%)
subjects.
Table-4: Obstetrical and gynecological Table-5: History of co-morbidities
profile of subjects among subjects
N= 50 N= 50
Obstetrical variables n(%) History n(%)
Past history:
Menstrual pattern Tuberculosis 01(02)
Regular 23(46) Hemorrhoids 01(02)
Irregular 08(16) Perineal tear 01(02)
Postmenopausal 19(38) Present history:
Constipation 36(72)
Menarche (in yrs.) Backache 36(72)
10-12 06(12) Obesity 27(54)
13-15 24(48) Hypertension 02(04)
16-18 20(40) Diabetes 02(04)
Hypothyroidism 02(04)
Parity * Cough 02(04)
No child 01(02) Hypertension and Diabetes mellitus 01(02)
Gall bladder stone 01(02)
1-2 children 23(56)
3-4 children 22(44) Baseline Pelvic organ Prolapse-
5-6 children 04(06) Quantification Staging and types
Place of previous delivery Table-6: shows the stages and types of
pelvic organ prolapse on the basis of Pelvic
Home 24(48)
organ Prolapse-Quantification staging for
Hospital 23(46) Rectocele, Cystocele, UV prolapse and
Home and hospital 03(06) Cystocele +Rectocele+UV prolapse.
29(58%), 18(36%) and 3(6%) of the
Method of delivery
subjects were in stage 2, 1 and 3
Normal vaginal delivery 49(98) respectively. One third of the subjects
Ventouse 01(02) 19(38%) were suffering from all pelvic
organ prolapsed i.e. Cystocele+ Rectocele+
* (Mean ±SD)range= 3±1 (0-6) UV prolapse.
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015 136
Table-6: Baseline Pelvic organ Prolapse- Impact of Nursing Intervention package on
Quantification Stage and types intensity of each symptoms of pelvic organ
N= 50 prolapse as per POP-ss
Types n(%) Figure-1: shows intensity of pelvic
organ prolapse symptoms. The intensity of
Stage 1 18(36) the symptoms reduced after intervention.
Cystocele 04(08) Maximum intensity was observed in feeling
UV prolapse* 04(08) of something coming out of vagina. Mean
Cystocele+UV prolapse 02(04) intensity of 3.9 and after intervention
reduced to 2.5 and 1.6 at 6 weeks and at 4
Cystocele+Rectocele 02(04)
months respectively. Other symptoms i.e.
(Cystocele+Rectocele+UV prolapse 06(12) uncomfortable feeling or pain in vagina
Stage 2 29(58) worse when standing, Heaviness or
dragging feeling in lower abdomen, Feeling
Cystocele 01(02)
that bladder has not emptied completely and
UV prolapse 08(16) Passage of urine with coughing and
Cystocele+UV prolapse 01(02) straining had mean intensity between 2.5 to
Rectocele+UV prolapse 01(02) 3.3. All these symptoms reduced in
Cystocele+Rectocele 02(04)
intensity. After intervention the intensity of
these symptoms reduced to 1.4 to 2 after 6
(Cystocele+Rectocele+UV prolapse 10(20) weeks of intervention and further reduced to
Stage 3 03(06) 1.3 to 0.7 after 4 months of intervention.
(Cystocele+Rectocele+UV prolapse 03(06)
Similarly other four symptoms had shown
reduction in intensity of symptoms at 6
UV prolapse*= Uterovaginal prolapse weeks and 4 months.

Need to strain to empty bladder follow up 2

Passage of bowel with coughing with straining follow up 1
Passage of urine with coughing and straining baseline
Feeling that bowel has not emptied completely
Symptoms

Difficulty in walking
Passage of urine with coughing and straining
Feeling that bladder has not emptied completely
Heaviness or dragging feeling in lower abdomen
Uncomfortable feeling or pain in vagina which is...
Feeling of something coming out of vagina
0 0.5 1 1.5 2 2.5 3 3.5 4 4.5
Mean
Figure-1 : Intensity of Symptoms of Pelvic Organ Prolapse
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015 137
Effectiveness of nursing intervention
package in terms of Total POP-symptoms
score
Figure-2: Shows decrease in trend of
mean POP-ss score after nursing
intervention package at 6 weeks and 4
months. The total mean score of POP-
symptom score for all the symptom at initial
25
20
15
Mean
10
0
Total POP-SS
preintervention
Figure-2 : Effectiveness of nursing intervention package in terms of total POP SS
Efficacy of Nursing Intervention Package
on pelvic organ prolapses according to
Pelvic organ prolapse Quantification
staging
Table-7: depicts that based on Pelvic
organ prolapse Quantification staging, there
was shift in the staging of pelvic organ
prolapse after 6 weeks and 4 months of
nursing intervention package. There were 3
subjects of stage 3 at initial assessment but
at 6 weeks after intervention the shift of 1
subject was there in stage 2 and at 4 months
after intervention the shift of all subjects of
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015
assessment was 19.70 with range 0-40.
After the nursing intervention package was
given the mean score remarkably decreased
to 11.52 at 6 weeks, and 6.22 at 4 months.
This showed the effectiveness of nursing
intervention package on managing pelvic
organ prolapse.
Total POP-SS Total POP-SS
post-intervention at post-intervention
6 weeks at 4 months
stage 3 to stage 1. At initial assessment 29
subjects were in stage 2 and 18 subjects
were in stage 1 and there were no subjects of
stage 0. At 6 weeks after intervention, 2
subjects were shifted to stage 0, 38 subjects
were in stage 1and 9 subjects were in stage
2. At 4 months after intervention nearly half
of subjects (48%) were shifted to stage 0
and half of subjects (52%) were shifted to
stage 1 and none of the subjects was found
in stage 2 and 3 at 4 months after
intervention.
138
 Table-7: Pelvic organ prolapse Quantification staging of pelvic organ prolapse before
and after Nursing Intervention Package at 6 weeks and 4 months
Stages Pre-intervention n(%) Post intervention
At 6 weeks n (%) At 4 months n (%)
Stage 0 00 02 (04) 24 (48)
Stage 1 18 (36) 38 (76) 26 (52)
Stage 2 29 (58) 09 (18) 00
Stage 3 03 (06) 01 (02) 00

Effectiveness of Nursing Intervention This difference was highly significant

Package on clinical course based on (p<0.001) as per Wilcoxan signed rank test.
Pelvic Organ Prolapse symptoms (POP- After 4 months of intervention the median of
ss)-score total POP-symptoms score was decreased
Table-8: Depicts that the median of to 6 with the intra quartile range 4.0-9.0 this
total POP-symptoms score was 19 with difference was highly significant(p<0.001)
intra quartile range of 17.0-23.0 during pre- as per Wilcoxan signed rank test. This
interventional assessment and after indicated that nursing intervention package
implementation of nursing intervention is effective in managing the symptoms of
package at 6 weeks POP-ss was decreased pelvic organ prolapse.
to 11.5 with intra quartile range 9.0-13.5.
Table-8: Effectiveness of Nursing Intervention Package on clinical
course based on POP-ss score
Comparison Median (IQR) score Z-value P-value
of total POP-ss
Total POP-ss pre-intervention between 19(17.0-23.0) 6.162 <.001*
Total POP-ss post-intervention at 6 week 11.5(9.0-13.5)
Total POP-ss pre-intervention between 19(17.0-23.0) 6.161 <.001*
Total POP-ss post-intervention at 4 months 6(4.0-9.0)
Total POP-ss post-intervention at 6 week between 11.5(9.0-13.5) 6.067 <.001*
Total POP-ss post-intervention at 4 months 6(4.0-9.0)

*Wilcoxan Signed Rank test

Discussion
Pelvic Organ Prolapse (POP)
represents a broad range of conditions that
tends to affect women older than 40 years of
1
age. Approximately 50 percent of all parous
women present with some degree of
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015
prolapse; however only 10-20 percents
2
symptomatic. Furthermore; POP is one of
the most frequent causes of gynecological
1
morbidities among women in India. The
symptoms of Pelvic Organ Prolapse can be
extremely debilitating and have an
appreciable impact on quality of life.
139
 It is curable. However, in countries like
India, women continue to suffer because of
social stigma, “culture of silence” and
“shame” associated with gynecological
problems. Treatment option for Pelvic
Organ Prolapse includes both surgical and
non surgical intervention. The development
of POP is indication for major surgery
among 20% of all women. Nevertheless,
recurrence of POP is detected among 58%
15
of patient after surgery. This highlights the
need for preventive measure for reducing
the impact of pelvic organ prolapse.
The investigator while worked in
clinical area and community experience
observed that women suffering from pelvic
organ prolapse had lack of knowledge about
pelvic organ prolapse and measure taken to
prevent it. By improving the knowledge
about pelvic organ prolapse and its
prevention help in reducing the
gynecological morbidities among women in
India. Early Stage prolapse can be reversed
and corrected by Pelvic floor exercises
(Kegel exercises) and other behaviour
modifications, if routinely done by the
women, it helps to maintain their pelvic floor
muscle strength. Kegel exercise can be
performed in sitting, standing and lying
13
position. But if Kegel exercise is done in
sitting and standing position in stage 2 and
3, it can lead to more eversion. Because
Gravity tires the pelvic floor muscles and
pulls the prolapse further down in sitting
4,13
and standing position. So, In that case
Customized Kegel Exercise can be done. It
refers to Training of Kegel exercise in varied
position according to the degree of
prolapse. In Stage -1, Kegel exercise to be
done in sitting and lying position. But in
Stage- 2 and Stage-3, Kegel exercise to be
done in lying down position with slightly
raised hips higher than head end with a
pillow under bottom or raised foot-end of
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015
the bed if possible along with pushing the
vaginal Eversion inside in third Stage. Hence
need was felt to develop a comprehensive
nursing intervention package and to assess
the effectiveness of package on the pelvis
organ prolapse attending the Gynae OPD,
PGIMER Chandigarh.
In the current study, the most common
symptoms in women were feeling of
something coming out of vagina and
Uncomfortable feeling or pain in your vagina
which is worse when standing which were
present almost in all the women. This is
comparable to the study done by Kashyap
13
R.
In present study, there are significant
changes in Mean POP-ss – score after
intervention at 6 weeks and 4 months. The
result showed significant differences in
reduction of intensity of symptoms and
severity of stages of POP at 6 weeks (p
<.001) and at 4 months (p <.001). Findings
of Kashyap R's study were also in line with
this inference which compared the effect of
2 packages of self instructional module and
SIM and PFMT pelvic floor muscle training
(PFMT) on the clinical course of pelvic organ
prolapse (POP) among women attending a
gynecology outpatient department in
PGIMER, Chandigarh.” Result revealed that
Provision of both 1-to-1 PFMT and SIM led
to greater improvements in POP symptoms
than provision of SIM alone. The result
revealed that prolapse symptoms improved
significantly more in the Pelvic Floor Muscle
Training and these women were also likely to
say that their prolapse was better at follow-
up compared to the start of the study.
13
In present study, one third of the
subjects were suffering from all pelvic organ
prolapse (Cystocele+ Rectocele+ UV
prolapse). A descriptive study done by
16
Sadeghi – Hassanbadi H.et al showed that
140
among the reproductive health problem
faced by women, the most common
problems were Cystocele 56%, uterine
prolapse 53.6% and rectocele 40%.This
reveals that Cystocele is the 1st commonest
nd
problem and uterine prolapse is the 2
commonest problem faced by the women.
Customized Kegel exercise is safe and
effective. This is an inexpensive therapy. It
can have more favorable impact on the
improvement of signs and symptoms of
pelvic organ prolapse. The present study
used teaching method to change the
behavior of the patients especially for
lifestyle modification. This method is
effective in increasing the knowledge and
promoting behavior change which in turn
helped them in managing the problem of
POP.
In the study, the women started feeling
the improvement in their pelvic organ
prolapse symptoms by the end of two weeks
and continued thereafter and became more
prominent at the end of 6 weeks of
intervention. There was improvement in the
Mean POP-ss at 6 weeks of intervention
from baseline 19.7 to 11.5 and subsequently
at 4 months it was 6.22. With regular
exercise, frequency of symptoms decreased
in subsequent months. Similarly, according
to study done by Kashyap R, there was 35%
improvement in the mean POP-ss at 6
weeks of intervention in group A and 11%
13
improvement in Group B. Study on the
effect of behavior therapy and Kegel
exercise on urinary incontinence reported
that behavioral therapy may take 3-4 weeks
12
to become effective.
Most of all the women in the present
study were satisfied with the progress of the
therapy. Respondents stated that doing
Customized Kegel exercise in lying down
position with slightly raised hips higher than
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015
head end with a pillow under bottom is more
comfortable and more effective. Another
respondent of Stage 3 pelvic organ prolapse
stated that by pushing the prolapsed part
inside and doing Customized Kegel exercise
helped to relieve discomfort and also
improved condition within 2 weeks.
The result of this study indicates that
Customized Kegel exercise training along
with education in the form of prepared
booklet regarding the pelvic organ prolapse,
Conservative management and Prevention
of pelvic organ prolapse to women with
pelvic organ prolapse is effective in
prevention, reducing the prolapse
symptoms, severity and need for further
surgery and treatment.
So, There is need to disseminate
information on pelvic organ prolapse
through mass media to the general public at
a large, that the problem of POP can be
prevented and even management can be
done at early stages. Nurses are the primary
caretakers of the patients, thus the
preparation for the discharge and home care
health education should start when contact
of the health professionals occurs with the
women, be at community or at institution
level. All the women who are at risk of
developing POP should be encouraged for
performing customized Kegel exercise for
prevention of POP. Those who are in early
stages should be identified in the beginning
and should encouraged for lifestyle changes
and customized Kegel exercise for
preventing further aggravation of stages of
POP. It is emphasised more about the
preventive and promotive aspects of the
health. Hence, Nurse can monitor and
encourage the women with pelvic organ
prolapse to do Customized pelvic floor
exercise and use conservative therapy
through counseling.
141
 The present health care delivery
system emphasizes more on the preventive
rather than the curative aspect. The study
also implies that the health personnel have
to be properly trained practically on the
levels of preventive aspects of pelvic organ
prolapse. Nursing curriculum should be
such that it prepares the prospective
nursing students to assist the client in all
aspects of health care.
References
1. Kudish BI, Iglesia CB, Sokol RJ, Cochrane B,
Richter HE, Larson J, et al. Effect of weight
change on natural history of Pelvic Organ
Prolapse [Abstract on internet] 2009[cited
2013 June 18]Obstetrics and Gynecology;
113: 81-88.Available from: URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC2684063/
2. Bordman R, Telner D, Jackson B, Little D. Step-
by-step approach to managing Pelvic Organ
Prolapse. Canadian Family Physician;
[Internet] 2007 [cited 2014 Jan 22]; 53: 485-
487. Available from: URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC1949085/
3. Bandyopadhay N. Counseling Unit in Place at
PGIMER on Uterus Prolapsed [Internet]
2013[updated 2014 Jan 16; cited 2014 Mar
1 6 ] . A v a i l a b l e
from:http://www.dailypioneer.com/state-
editions/chandigarh/counselling-unit-in-
place-at-pgimer-on-uterus-prolapsed.html
4. Streicher LF. Uterine prolapse and pelvic
relaxation. Gynecological specialist of
northwestern, [Internet] 2013[cited 2013
D e c . 2 3 ] A v a i l a b l e f r o m :
www.mygyne.info/uterineProlapse.htm
Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015
5. Bump R, Ander M, Brubaker LP, Lancey J,
Klarskov P, Bo K. The standardization of
terminology of female Pelvic Organ Prolapse
and pelvic floor dysfunction. American Journal
of obstetrics and gynecology. [Internet]July
1996 [cited 2013 Dec 28]; 175:10-17.
A v a i l a b l e f r o m : U R L :
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC3056425/
6. Hove MC, Pool-Goudzwaard AL, Eijkemans
MJC, Steegers-Theunissen RPM, Burger CW,
Vierhout ME. Prediction model and prognostic
index to estimate clinically relevant Pelvic
Organ Prolapse ina general female population.
International Urogynecology Journal and
Pelvic [Internet] 2009 May 15[cited 2015 Jan
10]; 20: 1013-1021.Available from:
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC2721134/
7. Klein MC, Gauthier RJ, Jorgensen SH. Does
episiotomy prevent Perineal trauma and pelvic
floor relaxation? J Curr Clin Trials [Abstract on
Internet] 1992[cited 2014 Nov 19]; Doc No 10.
Available from: http://www.ncbi.nlm.nih.gov/
pubmed/1343606
8. Bordman R, Telner D, Jackson B, Little D. Step-
by-step approach to managing Pelvic Organ
Prolapse. Canadian Family Physician;
[Internet] 2007 [cited 2014 Jan 22]; 53: 485-
487. Available from: URL:
http://www.ncbi.nlm.nih.gov/pmc/articles/P
MC1949085/
9. Allard P, Rocchette L. the descriptive
epidemiology of hysterectomy, province of
Quebac, 1981-1988.Annals of Epidemiology.
[Abstract on Internet]1991[cited 2013 Feb.
24]; 1:541-9. Available from:
http://www.researchgate.net/publication/214
85298_The_descriptive_epidemiology_of_hy
sterectomy_Province_of_Quebec_1981-
1988
142
10. Mattingly A. uterine prolapse. [Internet] [cited
2013 April 10]. Available from:
h t t p : / / w w w . p h y s i o -
pedia.com/Uterine_Prolapse
11. Prolapse. Mater Mothers' Hospital [Internet].
[cited 2014 Aug 19]. Available from:
http://brochures.mater.org.au/Home/Brochur
es/Mater-Mothers--Hospitals/Prolapse
15. Onowhakpor E A, Omo-Aghoja L O, Akani C I,
Feyi-Waboso P. Prevalence and determinants
of utero-vaginal prolase in southern Nigeria.
Nigeria Medical Journal [serial online] 2009
[cited 2014 Mar 31]; 50:29-32. Available from:
U R L :
http://www.nigeriamedj.com/text.asp?2009/5
0/2/29/71936

12. Kumari S, Jain V, Mandal AK, Singh AJ. 16. Sadeghi H, Keshavarz E, Setoudeh M, Sarraf Z.
Behavioral therapy for urinary incontinence in Prevalence of reproductive morbidity among
India. International Journal of women of qashqa'i tribe, Islamic Republic of
obstetrics&Gynecology. 2008 Nov; 103(2); Iran. Eastern Mediterranean Health Journal
125-30. [abstract on internet] 1998[Cited 2014 Dec
28]; 4 (2): 312-318.Available from:
13. Kashyap R. comparative effect of packages of
http://www.biomedcentral.com/1471-
pelvic floor muscle training on the clinical
2458/11/863
course of Stage 1-III Pelvic Organ Prolapse,
International journal of gynecology and
obstetrics.2013Jan; 121(1):69-73.
14. Klein MC, Gauthier RJ, Jorgensen SH, et al.
Does episiotomy prevent Perineal trauma and
pelvic floor relaxation? J Curr Clin Trials
[Abstract on Internet] 1992[cited 2014 Nov
19]; Doc No 10. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/13436
06

Nursing and Midwifery Research Journal, Vol-11, No. 3, July 2015 143