To reduce morbidity and the pain attached to prolapse, the Post Graduate Institute of Medical Education and Research has come up with counseling cell, first of its kind in the country, where non-surgical methods are explained to the patient to manage the painful medical condition of uterus prolapses.
Pelvic organ prolapse is one of the common gynecological morbidities among women which compromise the quality of their lives. Around 5-10 percent women suffer from prolapsed uterus. It is not necessary that surgery is done in every case of prolapse say experts from PGI.
“Early stage prolapse can be reversed and corrected by Kegal exercises. Pelvic floor exercises (Kegal exercises) and other behavior modifications, if routinely done by the women, it helps to maintain their pelvic floor muscle strength,” said Dr Amarjeet Singh, School of Public Health PGI.
These exercises are simple and easy to understand. A book based on MD thesis of Dr Rashmi Kashyap proved the efficacy of these exercises in preventing pelvic organ prolapse through her thesis, published in International Journal of Obstetrics and Gynecology in 2013.
Overcrowded Obstetrics and Gynecology OPDs in India compromise the quality of care. Most of the time of specialist doctors is wasted in attending to the routine problems of patients since no screening is done to ensure that at risk cases get more attention.
Adopting a health promoting hospital approach can be useful in resolving this issue. Appropriate counseling, including behavior therapy, exercises can easily provide relief to women with dysmenorrhea, urinary incontinence, uterine prolapse, menopause or infertility without using any medicine or surgery.
Similarly, many of the routine queries of the ante and post-natal women can be safely delegated to a separate counseling room in OBG OPDs.
“Such an approach has not been tried anywhere in India as a composite package. Hence, to popularise it, there is a need to demonstrate its feasibility and benefits. There is a need to reorient and trained OBG experts for adopting health promotion approach in a teaching hospital for reducing patient load in OPDs,” said Dr Rashmi Kashyap.
As a pilot project health promotion orientation package of services through a multipurpose counseling room was implemented in OBG OPD wards of PGIMER, Chandigarh.
All subjects are given a booklet or handouts on relevant management aspects of their problem. IEC material is also displayed in the room. Demonstrations of requisite exercises are also held. Male or female escorts of the women are also invited for counseling.
Earlier, a PhD thesis done in PGIMER, Chandigarh in 2005 proved the efficacy of kegal exercises in providing relief to urinary incontinence case. Based on this idea, a DBT project on “Hospital Based Behaviour Therapy of Urinary Incontinence among Women: A Feasibility Study” was successfully completed during 2010- 2012.
By and large, most patients are also satisfied by discussing their problems at length with the counselors. A Multipurpose Behavior Therapy Room has been set up in Gynecology OPD of PGIMER. Patients are being regularly referred from the main OPD to this room. Most of the women have reported improvement in their health status through the intervention provided by the project team.
Thus, it was possible to convert Interventional research on behavior therapy conducted in OBG deptt into practice.A book on 'Prolapse Uterus 'stresses on non-conservative management of this problem. The book highlights the life style changes, behavior modifications and Kegal exercises for prevention and treatment of initial stages of prolapse of pelvic organs said Dr Amarjeet Singh.