About Advanced Pelvic Organ Prolapse

Hamlin hospitals offer surgery for a range of childbirth injuries and gynaecological conditions alongside obstetric fistula. One of these is advanced pelvic organ prolapse and last year alone, we provided 2,277 of these life-changing surgeries to women in need.

Surgery for advanced pelvic organ prolapse can mostly be repaired with a single life-changing surgery and for some, this can take just two and a half hours.

What is Advanced Pelvic Organ Prolapse?

Pelvic organ prolapse is a gynaecological problem that can have a huge impact on a woman’s quality of life. A prolapse happens when one or more of the pelvic organs, such as the womb, bowel, bladder or top of the vagina, slip down from their normal position into the vagina causing a bulge.

If prolapse is left untreated, over time it can slowly get worse. In rare cases, advanced prolapse can cause obstruction of the kidneys or even inability to pass urine which can result in infection or damage to the kidneys.

Like obstetric fistula, advanced prolapse can have a devastating impact on women’s lives. Advanced prolapse affects women not just physically, but also psychologically and socially, and in severe cases may contribute to relationship breakdown or divorce.

The challenge in Ethiopia

Prolapse affects women around the world, in countries in the global north and south alike, including the UK. However across Africa, there is a higher burden of women living with the condition, from younger ages, and treatment can be difficult to access.

In Ethiopia, a combination of high fertility rates, early pregnancy, childhood malnutrition, a lack of access to maternal and women’s health care services and high levels of women’s engagement in heavy physical work such as farming result in a significant need for improved treatment services.

In the UK the prevalence of pelvic organ prolapse among women is estimated at 8.4% (1), however in Ethiopia prevalence is estimated at 24% (2), among the highest in the world (3), with many women unable to access treatment.

Services for advanced prolapse in public health facilities are hard to access, often use outdated methods and the cost is unachievable for poor, rural woman. Additionally, many women may avoid seeking help due to fear of social stigma.

As a result, many of the patients who arrive at Hamlin hospitals present with advanced stage prolapse and complications such as infection or ulceration.

Pelvic organ prolapse patient

Emama’s story

Emama, 60, pictured, recently received successful surgery at Hamlin’s Bahir Dar Hospital to treat advanced pelvic organ prolapse that she had suffered with for 10 years.

She told us “I felt ashamed to tell anyone what had happened, even my husband. I separated beds with him and tried to manage it by myself, but the problem has been my everyday worry for the past 10 years”.

Emama explained the free surgery she received from Hamlin has changed her life, “Thank you for curing me and giving me a happy ending to the rest of my life”.

How is Hamlin helping?

Treatment for advanced prolapse, including surgery, can dramatically improve a woman’s health and quality of life.

In Ethiopia there has been little focus on improving public health services for prolapse and there are a limited number of gynaecologists (4) treating this condition. Additionally, gynaecologists do not have access to updated surgery training and the supplies they need.

However, all six Hamlin hospitals offer advanced pelvic organ prolapse treatment and in 2022-23 alone we provided 2,277 prolapse treatments to women. We are committed to growing the number of women we provide treatment to, so no woman has to suffer the burden of untreated prolapse.

The women who receive this life-changing treatment are often too poor to pay. Their treatment is offered free, thanks to generous donors from the UK and around the world. 

We are building capacity in Ethiopia by training fellows from Universities in Ethiopia in surgical techniques, as well as providing training in advanced surgical techniques to fellows taking part in Hamlin’s Fellowship in Urogynecology in collaboration with the University of Mekele and the World-wide Fistula Fund.

In the future, with improved maternal health services, the risk of developing pelvic organ prolapse due to obstetric risk factors can be lowered, and Hamlin’s prevention programme is also contributing to this.

Find out more about how we are working to tackle untreated prolapse in Ethiopia: 

Read stories of women like Emama, whose lives have changed after advanced prolapse treatment:


Footnotes

1.https://www.nice.org.uk/guidance/ng123/chapter/Context#:~:text=The%20prevalence%20of%20pelvic%20organ,is%20as%20high%20as%2019%25.

2. https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-020-01039-w#:~:text=This%20systematic%20review%20and%20meta%2Danalysis%20revealed%20that%20the%20overall,CI%3A%2061.04%2C%2080.24

3. https://www.prb.org/wp-content/uploads/2020/06/Ethiopia-National-Reproductive-Health-Strategy-2016-2020.pdf

4. There are just 700 gynaecologists and obstetricians in the whole of Ethiopia for a population of 120 million.