The experience of women with genital prolapse

Curationis 30(3): x-y The concept genital prolapse indicates the transposition of the pelvic organs. These include the bladder, uterus, vaginal dome and the rectum. Regardless of the stage of genital prolapse, it can have a drastic influence on the quality of a woman’s life. It may lead to incontinence of urine and faeces, sexual problems as well as pelvic discomfort. The way in which a patient experiences these symptoms is of value to the nurse for whom holistic care is important. The aim of this study was, therefore, to describe the experiences of women with a diagnosis of genital prolapse. A qualitative study was carried out from a phenomenological viewpoint. Individual in-depth interviews were used as the method of data collection. The interviews took place in a relaxed, familiar environment. One open-ended question was asked, namely: “Please describe to me how you experience the symptoms o f your condition. ” A total of 19 interviews were conducted of which eight respondents had a Stage I genital prolapse, eight a Stage 2 and only three respondents had a Stage 3 genital prolapse. The data collection and analysis processes were integrated as each interview was transcribed directly afterwards, after which the process of analysis was commenced. The following categories regarding the experience of genital prolapse were identified from the data: emotional experiences, self-esteem, social interaction, physical discomfort and teaching and learning. The findings were that quality of life and social behaviour may be negatively influenced. The self-image of a woman with genital prolapse is affected and emotions that include anxiety, aggression, frustration and despondency may be experienced. Urinary incontinence compelled some of the respondents to wear sanitary pads, and often restricted their social lives. It may be possible to teach women about their condition, symptoms and treatment options by means of information leaflets. Health care workers must be made aware of the uniqueness of each patient and that not everyone experiences symptoms in the same way. Correspondence address: Dr L Roets School o f Nursing Faculty of Health Sciences University o f the Free State Bloemfontein Tel: (051)401-3536 Fax:(051)401-9140 E-mail: gnvklr.md@mail.uovs.ac.za Introduction and problem statement Genital prolapse refers to the downward or forward transposition o f the pelvic organs. These include the bladder, uterus, vaginal dome and the rectum (Scott, Di Saia, Hammond & Spellacy, 1999:713). Genital prolapse can be divided into three stages and the specific stage is determined by means of a vaginal examination as described by Scott, et al. (1999:723): • Stage 1 The most distal part 7 Curationis September 2007 of the prolapse is > lcm above the hymenal ring • Stage 2 The most distal part of the prolapse is between lcm above and lcm below the hymenal ring • Stage 3 The most distal part of the prolapse is > 1 cm below the hymenal ring and not more than 2cm outside the vagina (Scott, etal., 1999:723) It can have a drastic influence on the quality o f a woman’s life, regardless of the stage of genital prolapse (Bonetti, Erpelding & Pathak, 2004:167). It may lead to urinary and faecal incontinence, sexual problems as well as local pelvic d iscom fort (T haker & Stanton, 2002:1258). Symptoms such as urinary incontinence m ay be such a bad experience that patients do not wish to discuss it even with their doctor. They often feel ashamed or think that such sym ptom s may be norm al (Dugan, Roberts, Cohen, Presser, Davis, Bland & Albertson, 2002:4; Kumari, Walia & Sing, 2000:348). The experience of these symptoms by patients with genital prolapse is of value to the nurse for whom holistic nursing is important. Nurses must understand how patients experience their symptoms if they wish to deliver optimum care. The aim of this study was, therefore, to describe how women with a diagnosis of genital p ro lapse experience their symptoms. Research design and technique A qualitative study was undertaken from a phenom enological view point. According to Bums & Grove (2005:31) phenomenological research is ideal for researching and giving meaning to a p e rso n ’s experience in h is/her environm ent, in this case w om en’s experience of genital prolapse (Bassett, 2004:166). Individual in-depth interviews were used as the method o f data collection. The aim of an in-depth interview is to obtain access to another person’s life in an empathetic manner (Silverman, 2005:116) and not to identify the objective truth or to test preconceived hypotheses. They are conducted purely to determine the experience of a condition or event as described by the person involved (Doyle, 2001:4). The in-depth interviews took place in a relaxed, familiar environment, namely the respondents’ homes. Verbal as well as written consent to the interview were obtained from the participants. All interviews were taped and transcribed immediately after the interview. A co­ coder was involved to ensure accurate tran scrip tio n and coding (B rink, 2006:185). O nly one open-ended question was asked, namely: “Please describe to me how you experience the symptoms o f your condition” . All communication skills were used to ensure an open discussion in order to make it possible to describe the experiences.


Introduction and problem statement
Genital prolapse refers to the downward or forward transposition o f the pelvic organs.These include the bladder, uterus, vaginal dome and the rectum (Scott, Di Saia, Hammond & Spellacy, 1999:713).Genital prolapse can be divided into three stages and the specific stage is determined by means o f a vaginal examination as described by Scott, et al. (1999:723) Stage 3 -The most distal part of the prolapse is > 1 cm below the hymenal ring and not more than 2cm outside the vagina (Scott, etal., 1999:723) It can have a drastic influence on the quality o f a woman's life, regardless of the stage o f genital prolapse (Bonetti, Erpelding & Pathak, 2004:167).It may lead to urinary and faecal incontinence, sexual problems as well as local pelvic d isco m fo rt (T h ak er & S tanton, 2002:1258).Symptoms such as urinary in co n tin en ce m ay be such a bad experience that patients do not wish to discuss it even with their doctor.They often feel ashamed or think that such sym ptom s m ay be norm al (D ugan, Roberts, Cohen, Presser, Davis, Bland & Albertson, 2002:4;Kumari, Walia & Sing, 2000:348).
The experience o f these symptoms by patients with genital prolapse is o f value to the nurse for whom holistic nursing is important.Nurses must understand how patients experience their symptoms if they wish to deliver optimum care.
The aim o f this study was, therefore, to describe how women with a diagnosis of g en ital p ro lap se e x p e rien ce th eir symptoms.

Research design and technique
A qualitative study was undertaken from a p h en o m en o lo g ica l view p o in t.
According to Bums & Grove (2005:31) phenomenological research is ideal for researching and giving meaning to a p e rs o n 's e x p e rien ce in h is/h e r environm ent, in this case w om en's experience o f genital prolapse (Bassett, 2004:166).
Individual in-depth interviews were used as the method o f data collection.The aim o f an in-depth interview is to obtain access to another person's life in an empathetic manner (Silverman, 2005:116) and not to identify the objective truth or to test preconceived hypotheses.They are conducted purely to determine the experience o f a condition or event as d esc rib ed by the p erso n in v o lv ed (Doyle, 2001:4).
The in-depth interviews took place in a relaxed, familiar environment, namely the respondents' homes.Verbal as well as written consent to the interview were obtained from the participants.All interviews were taped and transcribed immediately after the interview.A co coder was involved to ensure accurate tra n sc rip tio n and co d in g (B rin k , 2 0 0 6 :1 8 5

Unit of analysis
The unit o f analysis consisted o f white women between the ages of 40 and 80 years who lived in Bloemfontein and who had been d iag n o sed w ith g en ital prolapse.
Possible participants were excluded if they: • Were pregnant; A convenience sample was selected after the diagnoses were confirmed.Each selected p articipant was personally approached to participate in the study.
After they had agreed to take part an appointment was made for the in depth interview at a time and place convenient to the participant.All the interviews were co n d u c te d in the co m fo rt o f the respondents' own homes as this was what they preferred and their privacy could be assured in this way (Brink, 2006:153).
In terv ie w s w ere co n d u cted w ith participants in all stages o f genital prolapse until saturation o f data was achieved.Saturation was achieved when no new themes or descriptions could be identified and no new data were gathered (Polit& Beck, 2004:57).

Data analysis
The data analysis process as described by Colaizzi (in Bassit, 2004:166), was used.Transcriptions were read, re-read and read again in order to identify and group to g e th e r co n c ep ts and experiences.Eventually the following categories regarding experiences o f g en ital p ro lap se w ere id en tified : em otional experiences, self-esteem , social interaction, physical discomfort and teaching and learning.

Trustworthiness
The most important principle regarding the tru stw o rth in e ss o f q u alitativ e research is the ability o f the research to in terp re t the ex p e rien ce s o f the participants very accurately (Speziale & Carpenter,2003:38;Brink, 2006:118).The following important principles and terms must be taken into account according to de Vos, Strydom, Fouché and Delport (2004:351): credibility, transferability, reliability and conformability.

Credibility
O ne o f the b est w ays o f en su rin g credibility is to have been in the field of research for a considerable time (Speziale & Carpenter, 2003:380).The researcher had been involved with the participants during a genital prolapse prevalence study and could therefore follow them up and support them directly after their diagnosis as she had already built a relationship o f trust with them.
Another prerequisite is to ensure that the data given by a participant is regarded as an accurate d escriptio n o f th eir experiences (Brink, 2006:118).The re searc h er show ed the data to the participants in order to ensure that it was a correct reflection o f their feelings.

Transferability
Transferability refers to the possibility that others in similar circumstances can identify with the data.Unfortunately this aspect does not lie with the researcher, but with future users of the data (Speziale & Carpenter, 2003:39).

Dependability
The dependability o f a study means that the data is to be trusted, therefore an audit needs to be done on the gathered data (Brink, 2006:119;Polit & Beck, 2004:435).All the interview s were conducted by the researcher herself after she had successfully com pleted the necessary training in interviewing.The interviews were transcribed directly after they had taken place and a co-coder evaluated the transcriptions for a correct version.The process o f analysis was also carried out with the co-coder.After th is all data w as re tu rn ed to the participants to ensure that it was a correct version o f their experiences.

Confirmability
C o n firm ab ility m eans the assu ran ce th at the reco m m en d atio n s and conclusions are supported by the study data and that the interpretation of the researcher and the actual data correspond (Brink, 2006:119).
All interview s w ere taped, tran sc rib ed , coded and analyzed by the researcher herself after which they were presented to the co-coder for verification and to the participants to ensure that the data could be confirmed.

Ethical aspects
The collection, processing and making known of the data all took place in terms o f ethical principles.Ethical principles comprise, among others, respect for, fairness to, and the safety o f people so that they are never harmed (Bums & Grove, 2005:735;Polit & Beck, 2004:134-154;Babbie, 2004:63).
Written consent was obtained before commencement o f the study from the Ethical Committee of the Faculty of Health Sciences o f the University o f the Free State, as well as from every participant.
Participants were aware o f the fact that they could withdraw at any time should they so wish.They were aware that the in terv iew w ould be taped and transcribed, but that the data would be known only to the researcher and that no identifiable data w ould be made known in the research report.The privacy o f participants and the confidentiality o f the collected data were therefore assured at all times.

Data interpretation and checking of the literature
In view of the fact that the experiences of the participants in all three stages of genital prolapse were predominantly similar, only those aspects that showed su b stantial differences in the three stages, will be discussed.Substantial d iffe ren c es re ferred to d iffe ren t experiences that were expressed by more than one participant.
The experience o f women with genital prolapse will be discussed in terms of the main categories, as identified, after a brief overview o f the unit of analysis has been given.

Description of the unit of analysis
The ages o f the participants varied from 48 to 77 years, with an average of 67 years.Only one woman was a nullipara, six had a parity o f two, six a parity o f three and five a parity o f four, while only one respondent had a parity o f five.Most p artic ip a n ts ( 16), had had vaginal deliveries, followed by two caesarean sections and one assisted delivery.

Emotional experiences
Women with genital prolapse sometimes experience the symptoms very intensely and feel that they do not even want to discuss them with their doctor.They often feel asham ed o f the urin ary incontinence or they believe that it is probably norm al to be in co n tin en t (Dugan et al., 2002:4;and Kumari et al., 2000:348).
The em o tio n al e x p e rien ce s o f the participants are set out in Figure 1.

Aggression and frustration
Three participants experienced a feeling o f ag g ressio n ab o u t th e ir g en ital prolapse.

Despondency
Sixteen participants described their feeling of despondency 32 times and said th a t p ro lap se m ade them re ally despondent.
"... Oh well, so I carry on like this ..." Most responses ( 22) were obtained from participants with stage 1 prolapse.It may be that these participants were still in the early stage of their illness while the others had been living with the symptoms for a long time, as many o f them described it: " ... I 'm so used to this, I suppose i t ' s normal to be like this . . ."

Unpleasant
The experience described as unpleasant w as the resp o n se m ost stated and described by all the participants about their illness.

"... i t ' s very bad, you know. Oh! I fin d it veiy b a d ..."
A ltogether 74 responses about this unpleasantness were given by the 19 respondents.A spects described as unpleasant were urinary incontinence, anal incontinence, constipation, visits to the doctor and urinary retention.
The participants experienced urinary incontinence as the most unpleasant with a total of 51 responses to this aspect.In contrast, the participants with a Stage 1 p ro lap se had not accep ted th eir condition so readily and only two o f the eight indicated that they had done so.It may be that, as is the case with so many o th er d isease s, accep tan c e com es eventually and that these participants had not yet had enough time to accept their condition.
The next category identified from the interviews was that o f self-esteem.

Self-esteem
A ny d ev iatio n from the norm ally acceptable appearance or functioning of body parts may result in a low self-image or self-esteem.A negative self-image often relates to the fact that people focus only on what they can do and accomplish to determ ine their self-im age.They require constant external stim uli to improve it (Tyrrell, 2006:online;Ruy, 2006:online).People who experience symptoms such as urinary incontinence due to genital prolapse may therefore no longer have a good self-image.This category o f responses as identified in the research is reflected in Figure 2. A single participant with Stage 2 genital prolapse m entioned pertinently that genital prolapse had not affected her selfimage.
"... it does not affect my humanity or my fe m in in ity . . ." P o ssib ly th is p a rtic ip a n t h ad a particularly good self-im age or had accepted her illness to such an extent that it had in no way affected her view o f herself.Albertson, 2002:5).The participants confirmed this by describing how they adapted their daily activities around social activities by, for instance, more regular visits to the toilet, the use o f sanitary pads, pelvic muscle exercised as well as physical toilet habits.Compare Figure 3 for a schematic representation o f the groups and them es regarding social intercourse.

Social activities
It is well-known that a good self-image leads to social interaction and intercourse (C ash & Puzinski, 2002:281).It is therefore not surprising that women with u rin ary in co n tin en ce often re stric t themselves socially to try and keep their condition secret (Doughty, 2000:36).

.. I am fa r more housebound, as I d o n ' t like to go to places with people any more
A ccording to D oughty (2000:39) it depends on the type o f incontinence w hether w om en restrict them selves socially.Anal incontinence has a greater effect than urinary incontinence, but in the case o f urinary incontinence urgency places greater limitations on women than stress incontinence.
Finding available toilet facilities can therefore be a great source o f tension to women with incontinence (Newman & Giovannini, 2002:39) as they cannot go out and socialize easily due to the limitation caused by their incontinence. .you must always plan things so that you will always be near a facility . . ." It was interesting to note that not one respondent with Stage 3 genital prolapse mentioned that their social activities were limited.On the contrary, two responses o f the participants with Stage 3 prolapse clearly indicated that they did not limit their social activities.

More frequent visits to the toilet
The specific most frequent response of p a rtic ip a n ts in all stag es, about frequency (32 responses) was the fact that they needed to visit the toilet so often.More visits to the toilet indicates urinary frequency and urgency and can be due to a cystocele and/or urethrocele (Drife & Magowan, 2004:241)  The responses o f the participants show cle a rly th a t so cial in te ra c tio n is negatively influenced.

Sanitary pads
Seventy-three per cent of women with genital prolapse are often obliged to wear sanitary pads because o f their urinary incontinence (Ellerkman, Cundiff, Melick, Nihira, Leffler & Bent, 2001:1334) to ensure dry underwear.
Eight participants in this study stated that they needed to wear sanitary pads and confirm ed that this was due to their urinary incontinence.
.. so u use pads day and night.They just make me fe e l more comfortable.As I say, I d o n ' t have to worry that I may wet myself... " "...

You know, i t ' s terrib ly un co m fo rta b le, as I now w ear pantvliners . . . " Adapting physical toilet habits
There are conflicting reports in the literature about the incidence o f cases w here w om en need to adapt th eir physical toilet habits in order to pass urine or stools.According to Kumari, Walia & Singh (2000:344) it occurs in extrem e cases th at w om en need to support themselves in some way or other in order to be able to urinate or pass a stool.Ellerkman et al. (2001Ellerkman et al. ( :1335) ) found that 40% o f the wom en with genital prolapse had to change their position to make excretion possible.
The need to change position during urination or passing a stool is associated with an increase in the prolapse o f the a n te rio r dom e or u teru s p ro lap se (Donohue, 2001:11).In this study three o f the 19 participants stated that their physical toilet habits had to be adapted."... then it works like a kettle, empties, I stand up fo r a fe w seconds, and bend forw ard again.I empty two or three times at a time . . ."

Experience no activity adaptations
An interesting fact was that 18 o f the p a rtic ip a n ts v e rb a liz e d the above adaptations during the interview, but that they did not experience them as true adaptations.Seventeen participants stated 40 times that they did not really feel that they had adapted their activities.
.. it does not affect my daily activity at a l l ... I carry on with my activities . . ." Yet, as previously mentioned, they wear sanitary pads, visit the toilet more often, need to adapt their position on the toilet, and so forth.It may be that women view genital prolapse as a normal part o f ageing and therefore regard it as "normal" (Dugan, etal., 2002:5).
Eleven participants stated that their sleep pattern was disturbed due to nocturia.Nocturia may be associated with genital prolapse, especially where urgency is associated with incontinence (McCarthy & Hunter, 2003:255)."... all I can say to you is that it is a bother at night, because I have to get up sometimes.I get up M ice in the night, sometimes up to three times a n ig h t. . ." One respondent in each group stated that they found the disturbance o f their sleep pattern irksome."...I am a poor sleeper, so i t ' s bad when my bladder also troubles me . . ." It would appear that all participants did not experience the disturbance o f their sleep pattern negatively."...I suppose i f I was not such a good sleeper it would probably worry me, but you know, I wake up and get up h a lf asleep, go to the toilet, get into bed and sleep ... No it does not worry me . . ."

Hygiene
According to Newman and Giovannini (2 0 0 2 :3 9 ) p atien ts w ith u rin ary incontinence are inclined to concentrate more on their personal hygiene in an attempt to keep their condition a secret.The responses of the participants in this study were in accordance with those findings as reflected in their responses: " ...I ca n ' t handle the smell at all.I wash three times a day, or more, it depends how bad it is ... " "... it definitely affects o n e ... I d o n ' tfeel ...s o clean any more . . ."

Urinary incontinence
U rinary incontinence is one o f the com m o n est sym ptom s o f genital prolapse and 73% of women with this condition suffer from it (Ellerkman et al., 2001(Ellerkman et al., :1332)).Loss of support of the urethra and lower vaginal wall can be associated with urinary incontinence (Scott et al., 1999:724).
In this study 18 o f the respondents ex p e rien ce d a d egree o f u rin ary incontinence -they spoke about the problem 81 times."... when it s ju st a little fu ll and you c a n ' t go to the bathroom immediately it leaks, not much, but it leaks . . ." "... when my bladder is fu ll it simply overflo w s ... when it overflow s, it overflows, it doesn' t ju st drip, it overflows It is clear from the above that the p a rtic ip a n ts ex p erien ced u rin ary incontinence very negatively.

Urinary retention
Loss o f support of the higher vaginal wall and the base o f the bladder as associated with problems related to emptying the bladder (S co tty al., 1999:724).Problems in this regard were also m ooted by participants in this study.

Urinary tract and vaginal infection
Genital prolapse can cause vaginal or urinary tract infections (Bonetti et al. 2004:171).A large cystocele can cause the bladder not to empty completely with the result that recurrent urinary tract infections are common among women with genital prolapse (Drife & Magowan, 2004:241).Participants in this study also complained o f urinary tract and vaginal infections.et al (2002:720) that the prevalence o f anal in c o n tin e n c e in creases as g en ital prolapse becomes worse.Ellerkman et al (2001Ellerkman et al ( :1334) ) found that 66% o f women with genital prolapse experienced constipation, while 43% *8) o f the p a rtic ip a n ts in th is stu d y m entio ned th eir constipation.The respondents in this study stated that they u sed co p in g m echanism s such as adapting their diet or taking laxatives to overcome the problem."...I do ha ve a p ro b lem with constipation, but eating sensibly, fo r instance dried peaches, does help a lot "... sometimes I went fo r up to a week without a bowel movement, it was bad, it was very, very bad.I tried almost everything under the sun.I now take X X X -1 take about two mouthfuls every other day and I have bowel movements and otherwise I have a normal life."

Spastic colon
Genital prolapse may lead to symptoms o f spastic colon (Barber, Kuchibhatla, Pieper & Bump, 2001:1389;Meschia et al., 2002:721).In this study eight o f the participants stated that they suffered from a spastic colon."...I have a thing here that is terribly painful, the doctor days she thinks it is spasm, colon sp asm . . ." " .../ always have stomach-ache.The doctor says it is a spastic colon . . ." A ll the respondents m entioned this spasm twice in their interviews therefore it may be accepted that they found it a very negative experience.

Physical discomfort
T he e x p e rien ce s o f re sp o n d en ts re g a rd in g p h y sical d isco m fo rt are illustrated in Figure 4.

Pain
Genital prolapse may cause lower back pain as well as abdominal pain (Bonnetti et al., 2004:167).Participants in the study also experienced pain and verbalized it as follows: "... my back gets very sore i f I work in This pain can be caused by extension of the utero-sacral ligaments that support the vagina and uterus (Scott et al., 1999:724) and is commonly experienced by patients with genital prolapse.

Discomfort
W om en w ith g en ital pro lap se may experience symptoms o f discomfort due to prolapse o f the uterus or dome.These symptoms include a heavy feeling in the pelvis, discom fort when standing or performing other physical activities, a sensation o f low abdominal pressure or the prolapse in the vagina can be felt (Ellerkman etal., 2001(Ellerkman etal., :1334 In view o f the fact that women are often shy to discuss genital prolapse with others, even with their doctor (Dugan et al., 2002:4), it may be that these women are not informed and taught about the sym ptom s and treatm ent o f genital prolapse.H ealth care workers must therefore be encouraged to broach the subject first and to provide thorough education and information to patients with genital prolapse.

Conclusions and recommendations
A number o f aspects o f a woman's life are influenced by genital prolapse.The quality o f her life may be negatively influenced or her daily activities may be influenced in a manner that many do not even notice.This research study clearly shows that the self-image o f women with genital prolapse is affected.They experience emotions regarding their condition that include sham e, anxiety, aggression, frustration and despondency.Yet they really accept their condition.
Urinary incontinence is one o f the most common symptoms o f genital prolapse, but urinary retention, urinary tract and vaginal infections, anal incontinence, constipation and a spastic colon were also experienced by participants in this study.The respondents had individual ex p e rien ce s th at o ften d iffe red completely from those of others regarding som e o f the sym ptom s.H ow ever, negative feelings about every one of these symptoms were clearly expressed by the participants.As an example, personal hygiene was o f the utm ost im p o rtan ce as u rin ary and anal incontinence led to unpleasant odours, about which these participants were very sensitive.
The social behaviour and experiences o f all the w om en w ith regard to their condition were not influenced to the sam e d egree.T hose w ith u rin ary in co n tin en ce re stric te d them selves socially to a greater extent than women 13 Curationis September 2007 Some o f the participants experienced a great deal o f tension when toilet facilities were not available.Although 95% o f the p artic ip a n ts su ffe red from u rin ary incontinence, only 42% felt the need to wear sanitary pads.Some participants felt too shy even to visit a doctor.Others had accepted their condition and no longer complained about it.
The study show s that wom en could benefit from more information about g enital pro lap se and the treatm en t options.Inform ation leaflets would probably reassure women that they are not alone, that their situation is not normal and that something can be done about it.The information could possibly give them more confidence to discuss their condition with experts.
Nurses, doctors and other health care workers m ust be made aware o f the uniqueness o f each patient and that not everyone experiences symptoms in the same way.
All participants in this study expressed concerns about possible operations that could be perform ed to repair genital prolapse.Although not included in this article, their opinions and concerns regarding this matter must be addressed.

Figure
Figure 1: Emotional experience of genital prolapse "... it ju st makes me angry, because it s a nuisance . . .I d o n ' t fe e l sorry that I have the problem, hm, I fe e l disgusted that I have the problem . . ." P ain or fru stra tio n o ften lead s to aggression although frustration does not alw ay s do so (M o rris & M aisto, 2002:366).In accordance with the results o f a study by Hampel, Artibani, Pons, Haab, Jackson, Rom ero, G avart and Papanicaou (2004:25) in which women with urinary incontinence sometimes experienced frustration as a result o f their condition, participants in this study described their feeling o f frustration and aggressions as follows:

Figure 2 :
Figure 2: Experience of self-esteem "... what Ifin d very bad is when you 're wearing undei~wear and you sneeze or som ething, then yo u r underw ear is always wet.Ifin d that very b a d ..." Acceptance An interesting finding was that all three the participants with Stage 3 genital prolapse stated that they had accepted th e ir co n d itio n .Six o f the eight participants with Stage 2 genital prolapse indicated that they had made peace with their condition."... you know, I always think there are worse things that can happen to you ... I am so used to it now ..." Dugan et al. (2002:5)  is o f the opinion th at 73% o f w om en w ith u rin ary incontinence feel that their self-image has been affected by the condition.In this research six o f the 19 p artic ip a n ts m entioned that genital prolapse had affected their self-image, that is, 32% of the participants... you know, one always feels sort o f self-conscious. . ." With a total o f 12 responses, seven o f which came from the Stage 1 prolapse group, it would appear that women with Stage 1 genital prolapse more often feel 10 Curationis September 2007 ActivitiesA n u m b er o f stu d ies ab o u t the experiences o f genital prolapse have shown that this condition has a definite influence on the quality of life o f women (Bonetti et al., 2004:167; Dugan, Roberts, C o h en , P resser, D avis, B land &

Figure
Figure 3: Experience with regard to social interaction from which these participants suffered. .I go to the toilet more regularly.I f yo u f e e l y o u m ust go, y o u m ust go immediately, not a little later as you would under normal circumstances.You must go im m ediately..." "...I must go to the toilet often . . ." "...I have a need, I must go, but it is so painful, it goes into a spasm and I c a n ' t The response regarding urinary retention increased as the stage o f genital prolapse w orsened.O nly one response o f a participant with Stage 1 genital prolapse to as m any as five resp o n ses o f respon dents w ith Stage 3 prolapse d esc rib ed p ro blem s w ith u rin ary retention.
"...I often get bladder infections . . ." .. the constant vaginal infections are b a d . . ." Anal incontinence Anal incontinence is defined as the involuntary passing o f flatus, fluid or solid stools (M eschia, B uonaguidi, Pifarotti, Somigliana, Spennacchio & Amicarelli, 2002:719).According to El lerkman et al (2001:1334) 31 % of women with genital prolapse experience anal incontinence."... because i f my bowels d o n ' t act, then after a while it ju st comes o u t... "In the research study five o f the 19 participants stated that they experienced anal incontinence.These respondents all suffered from Stage 2 and 3 prolapses which supports the findings o f Meschia

Figure 4 :
Figure 4: Experience of physical discomfort