Functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic
Introduction and hypothesis
Limited existing evidence suggests that there is a high prevalence of female pelvic organ prolapse (POP) amongst Nepali women. However, to date, no comprehensive assessment of pelvic floor functional anatomy has been undertaken in this population. Our study aimed to determine functional pelvic floor anatomy in Nepali women attending a general gynaecology clinic.
One hundred and twenty-nine consecutive women attending the clinic were offered an interview, clinical examination [International Continence Society Pelvic Organ Prolapse Quantification system (ICS/POP-Q)] and 4D translabial ultrasound (TLUS). Most presented with general gynaecological complaints. Five were excluded due to previous pelvic surgery, leaving 124.
A POP-Q exam was possible in 123 women, of whom 29 (24%) were diagnosed with a significant cystocele, 50 (41%) significant uterine prolapse and seven (6%) significant posterior compartment prolapse. Evaluation of 4D TLUS data sets was possible in 120 women, of whom 25 (21%) had a significant cystocele, 45 (38%) significant uterine prolapse and ten (8%) significant descent of the rectal ampulla. In 13 cases, there was a rectocele with a mean depth of 14 (10–28) mm. Of 114 women in whom uterine position could be determined, 68 (60%) had a retroverted uterus associated with significant uterine prolapse (P 0.038).
POP is common in Nepali women attending a general gynaecology clinic, with a high prevalence of uterine prolapse (40%). Uterine retroversion was seen in 60% and was associated with uterine prolapse. Patterns of POP in Nepal seem to be different from patterns observed in Western populations.
KeywordsNepal Pelvic floor Pelvic organ prolapse Translabial ultrasound Uterine prolapse
International Continence Society, Pelvic Organ Prolapse Quantification system
4D Translabial ultrasound
Pelvic organ prolapse
Visual analogue scale
Pelvic floor muscle
Pelvic floor muscle contraction
Levator ani muscle
External anal sphincter
Chronic obstructive pulmonary disease
The authors thank the women who participated in this study. We also thank staff at Kathmandu Model Hospital for their assistance and generosity with their limited space. We are especially grateful to Dr. Vishal Kumar Trivedi for excellent assistance during data collection.
Compliance with ethical standards
Conflict of interest
H.P. Dietz has received unrestricted educational grants from GE Medical. F. Turel and D. Caagbay have no conflict of interest to declare.
- 8.Center for Agro-Ecology and Development (CAED) (2006) Uterine prolapse widespread. Post Report. Nepal. Available from: http://www.advocacynet.org/partners_archive/womens-reproductive-rights-program/
- 10.Subba B, Adhikari D, Bhattarai T. The neglected case of the fallen womb. Nepal: Himal South Asian; 2003.Google Scholar
- 11.Gurung G, Rana A, Amatya A, Bista KD, Joshi AB, Sayami J. Pelvic organ prolapse in rural Nepalese women of reproductive age groups: what makes it so common? Nepal J Obstet Gynaecol. 2007;2(2):35–41.Google Scholar
- 28.Pixton S, Caudwell Hall J, Turel F, Dietz HP. Predictors of ring pessary success in women with pelvic organ prolapse. Int Urogynecol J. 2017; in print.Google Scholar