http://doi.org/10.33698/NRF0184 – Priyanka, Sukhjit Kaur, Amarjeet Singh, Neelam Aggarwal
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:Pelvic Organ Prolapse, Nursing Intervention Package, Customized Kegel Exercise
Correspondence at: Dr Sukhjit KaurClinical InstructorNINE, PGIMER, Chandigarh
Introduction: Pelvic Organ Prolapse (POP) represents a broad range of conditions that tends to affect women older than 40 years of age.1 Approximately 50 percent of all parous women present with some degree of prolapse; however only 10-20 percents are symptomatic.2 Furthermore; POP is one of the most frequent causes of gynecological morbidities among women in India.3 The symptoms of Pelvic Organ Prolapse can be extremely debilitating and have an appreciable impact on quality of life.4 Pelvic organ prolapse is defined anatomically as the descent of a pelvic organ or organs into or beyond the vaginal canal.5 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).6 Most common problems are Cystocele (56%), uterine prolapse (53.6%) and rectocele (40%).7 The condition is most common in multiparous and post-menopausal women.8 The principal cause of prolapse are obstetrics trauma and post-menopausal atrophy.9,5,10 Carrying extra weight or physical activity increases the gravitational forces against this muscles.8 like other muscles in the body, the muscles in the pelvic floor are subject to fatigue and injury.1 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 after surgery.4 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.12 and “Comparative effect of 2 package of pelvic floor muscle training on Clinical Course of pelvic organ prolapse” has done by Kashyap
- in 2011, Chandigarh, India.13 According to these studies, Kegel exercise can be performed in sitting, standing and lying position.13 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 and standing position.2, 14 So, Customized Kegel Exercise can be done in that case. 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 the bed if possible along with pushing the vaginal Eversion in third Stage.The investigator while working 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. 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 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 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*.
Table-2 Dairy maintained by the women
| Mon | Tue | Wed | Thu | Fri | Sat | Sun |
| 1 | ||||||
| XXXX* | ||||||
| 2 | 3 | 4 | 5 | 6 | 7 | 8 |
| 9 | 10 | 11 | 12 | 13 | 14 | 15 |
| 16 | 17 | 18 | 19 | 20 | 21 | 22 |
| 23 | 24 | 25 | 26 | 27 | 28 | 29 |
| 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, conser vative 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 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.The Protocol Booklet regarding the conservative management and prevention of the pelvic organ prolapse was taught and instructions of doing Customized Kegel exercises were given to the respondents. Training of Customized Kegel exercise was comprised of one to one instruction of Kegel exercise and continued supervision of training and included the four sets of exercises daily. One set consisted of up to 15 maximum voluntary contractions, each held for 4 seconds with 4 seconds rest in between. These were to be repeated three times a day. The investigator spent 30 minutes to complete the Teaching and Training. A diary was given to the women for 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 the diary during follow-up visits. The training booklet was given as an aid to the women and was read by all women either themselves or got it read from somebody else at home. And as said by patients it is very difficult to retain all the concepts which are taught. So it is easy to understand and memorize all the points with the help of booklet. Motivational call was done every 2 weeks to remind and make them compliant with protocol.After the 6 weeks and 4 months Post assessment of POP was taken done by using POP-symptoms score, POP- Quantification scoring. Women who did not turn up for follow up for 10 days even after the date given to them. Phone reminder was sent and Motivational call was also made to remind and motivate them to come for follow up after 6 weeks and at 4 months. By making repeated calls the subjects turned up for follow-up and their post assessment was done. Collected data was coded and entered in the SPSS (Statistical Package for Social Sciences) 16.0.Version. The analyzed data is presented in the form of tables, figures, and other bar diagrams. Comparison was done between total POP- symptom score before and after Nursing Intervention Package at 6 weeks and at 4 months by using Wilcoxan signed rank test.
Results: Socio-demographic profile of subjects
Table-3: Depict that nearly half of the subjects belongs to the age of 41-60 years. The mean age of the subjects was 45 years and ranged from 22 to 80. Most of population (80%) was literate. Almost all (94%) of the subjects were married and most of (88%) were housewives.
Table-3: Distribution of the subjects according to Socio-demographic profile
N= 50
| Socio-demographic Profile | n(%) |
| Age( in years)* | |
| 21-40 | 19(38) |
| 41-60 | 24(48) |
| 61-80 | 07(14) |
| Education | |
| Illiterate | 10(20) |
| Primary | 07(14) |
| Metric | 18(36) |
| Hr. secondary | 08(16) |
| Graduate+ | 07(14) |
| Marital status | |
| Married | 47(94) |
| Divorced | 01(02) |
| Widow | 02(04) |
| Occupation | |
| Working | 06(12) |
| Non-working | 44(88) |
*Mean±SD (range) =45±1.34 (22-80)
Obstetrical and gynecological profile of subjects:Table-4: Reveals that 19(38%) subjects were postmenopausal. Nearly half 24(48%) had menarche during 13-15 year of age. Mean parity was 3 children ranging from 0 to 6. Nearly half (48%) of women were delivered at home, 23(46%) women had hospital delivery and 3(6%) women were delivered one child at home and another at hospital. Majority of the women (98%) had normal vaginal deliveries.
Table-4: Obstetrical and gynecological profile of subjects
N= 50
| Obstetrical variables | n(%) |
| Menstrual pattern
Regular Irregular Postmenopausal |
23(46) 08(16) 19(38) |
| Menarche (in yrs.) | |
| 10-12 | 06(12) |
| 13-15 | 24(48) |
| 16-18 | 20(40) |
| Parity * | |
| No child | 01(02) |
| 1-2 children | 23(56) |
| 3-4 children | 22(44) |
| 5-6 children | 04(06) |
| Place of previous delivery | |
| Home | 24(48) |
| Hospital | 23(46) |
| Home and hospital | 03(06) |
| Method of delivery | |
| Normal vaginal delivery | 49(98) |
| Ventouse | 01(02) |
* (Mean ±SD)range= 3±1 (0-6)
Disease history of subjects:
Table-5: Depict that 3(6%) of women were suffering from tuberculosis, hemorrhoids and Perineal tear as per past history. According to present history, Constipation and backache were the most common problem faced by 36(72%) subjects followed by obesity 27(54%). Hypertension, Diabetes, Hypothyroidism and cough was present in 2(4%) subjects and Hypertension and Diabetes mellitus, Gall bladder stone was present in 1(2%) subjects.
Table-5: History of co-morbidities among subjects N= 50
| History | n(%) |
| Past history: Tuberculosis Hemorrhoids Perineal tear |
01(02) 01(02) 01(02) |
| Present history: | |
| Constipation | 36(72) |
| Backache | 36(72) |
| Obesity | 27(54) |
| Hypertension | 02(04) |
| Diabetes | 02(04) |
| Hypothyroidism | 02(04) |
| Cough | 02(04) |
| Hypertension and Diabetes mellitus | 01(02) |
| Gall bladder stone | 01(02) |
Baseline Pelvic organ Prolapse- Quantification Staging and types:Table-6: shows the stages and types of pelvic organ prolapse on the basis of Pelvic organ Prolapse-Quantification staging for Rectocele, Cystocele, UV prolapse and Cystocele +Rectocele+UV prolapse. 29(58%), 18(36%) and 3(6%) of the subjects were in stage 2, 1 and 3 respectively. One third of the subjects 19(38%) were suffering from all pelvic organ prolapsed i.e. Cystocele+ Rectocele+ UV prolapse.
Table-6: Baseline Pelvic organ Prolapse- Quantification Stage and types
N= 50
| Types | n(%) |
| Stage 1 | 18(36) |
| Cystocele | 04(08) |
| UV prolapse* | 04(08) |
| Cystocele+UV prolapse | 02(04) |
| Cystocele+Rectocele | 02(04) |
| (Cystocele+Rectocele+UV prolapse | 06(12) |
| Stage 2 | 29(58) |
| Cystocele | 01(02) |
| UV prolapse | 08(16) |
| Cystocele+UV prolapse | 01(02) |
| Rectocele+UV prolapse | 01(02) |
| Cystocele+Rectocele | 02(04) |
| (Cystocele+Rectocele+UV prolapse | 10(20) |
| Stage 3 | 03(06) |
| (Cystocele+Rectocele+UV prolapse | 03(06) |
UV prolapse*= Uterovaginal prolapse
Impact of Nursing Intervention package on intensity of each symptoms of pelvic organ prolapse as per POP-ss
Figure-1: shows intensity of pelvic organ prolapse symptoms. The intensity of the symptoms reduced after intervention. Maximum intensity was observed in feeling of something coming out of vagina. Mean intensity of 3.9 and after intervention reduced to 2.5 and 1.6 at 6 weeks and at 4 months respectively. Other symptoms i.e. uncomfortable feeling or pain in vagina worse when standing, Heaviness or dragging feeling in lower abdomen, Feeling that bladder has not emptied completely and Passage of urine with coughing and straining had mean intensity between 2.5 to 3.3. All these symptoms reduced in intensity. After intervention the intensity of these symptoms reduced to 1.4 to 2 after 6 weeks of intervention and further reduced to 1.3 to 0.7 after 4 months of intervention. Similarly other four symptoms had shown reduction in intensity of symptoms at 6 weeks and 4 months.
Figure-1 : Intensity of Symptoms of Pelvic Organ Prolapse
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 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.
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 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 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.
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 Package on clinical course based on Pelvic Organ Prolapse symptoms (POP- ss)-scoreTable-8: Depicts that the median of total POP-symptoms score was 19 with intra quartile range of 17.0-23.0 during pre- interventional assessment and after implementation of nursing intervention package at 6 weeks POP-ss was decreased to 11.5 with intra quartile range 9.0-13.5.This difference was highly significant (p<0.001) as per Wilcoxan signed rank test. After 4 months of intervention the median of total POP-symptoms score was decreased to 6 with the intra quartile range 4.0-9.0 this difference was highly significant(p<0.001) as per Wilcoxan signed rank test. This indicated that nursing intervention package is effective in managing the symptoms of pelvic organ prolapse.
Table-8: Effectiveness of Nursing Intervention Package on clinical course based on POP-ss score
| Comparison | Median (IQR) score of total POP-ss | Z-value | P-value |
| Total POP-ss pre-intervention between
Total POP-ss post-intervention at 6 week |
19(17.0-23.0)
11.5(9.0-13.5) |
6.162 | <.001* |
| Total POP-ss pre-intervention between
Total POP-ss post-intervention at 4 months |
19(17.0-23.0)
6(4.0-9.0) |
6.161 | <.001* |
| Total POP-ss post-intervention at 6 week between Total POP-ss post-intervention at 4 months | 11.5(9.0-13.5)
6(4.0-9.0) |
6.067 | <.001* |
*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 prolapse; however only 10-20 percents symptomatic.2 Furthermore; POP is one of the most frequent causes of gynecological morbidities among women in India.1 The age.1 Approximately 50 percent of all parous women present with some degree of symptoms of Pelvic Organ Prolapse can be extremely debilitating and have an appreciable impact on quality of life.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% of patient after surgery.15 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 position.13 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 and standing position.4,13 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 ofthe 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 R.13In 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 Sadeghi – Hassanbadi H.et al16 showed that 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 problem and uterine prolapse is the 2nd 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% improvement in Group B.13 Study on the effect of behavior therapy and Kegel exercise on urinary incontinence reported that behavioral therapy may take 3-4 weeks to become effective.12 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 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.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.
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