Efficacy of Abzan of Habbul Aas, Izkhar and Post Anar with Pelvic Floor Muscle Exercises in Nutu al Rahim Uterovaginal Prolapse : A Randomized Standard Controlled Study

Nutu al Rahim uterovaginal prolapse is a protrusion of the vaginal walls and or uterus. resulting from the descent of the pelvic organs. It is a common gynecological condition seen in elderly women. Pelvic Organ Prolapse POP is a pelvic floor disorder that affects the quality of life in millions of women in the US and around the world. World Health Organization estimates the Global prevalence of uterovaginal prolapse as 2 to 20 percent among women younger than 45 years of age. The prevalence of symptomatic POP, which includes uterine prolapse, was 33 percent in pre menopausal women and 10percent in post menopausal women. In India, Utero Vaginal Prolapse UVP is the most frequent cause of gynecological morbidity. Women with UVP typically report symptoms such as sensation of vaginal protrusion, a feeling of a bulge, and heaviness in the lower abdomen. In addition to these sensations, some women may experience urinary issues like urinary incontinence, voiding dysfunction, bowel problems like constipation or fecal incontinence or sexual dysfunction dyspareunia.

The treatment of choice in modern medicine is preventive, pessary and surgery. Though surgery is effective for significant prolapse, it increases the economic burden and has 5 percent post operative complications and a 12 percent recurrence rate respectively. Hence there is a need for alternative treatment that is safe, effective, easily available, free from side effects, and non surgical.

In Classical Unani Literature, Nutu al Rahim is mentioned as, a condition in which the uterus descends into the vagina or outside the introitus from its normal place. It is predominantly caused by the accumulation of Balgham Lazij in Ribatat al Rahim which causes its weakness leading to Nutu al Rahim. It usually occurs in older women having excessive Rutubat in their bodies. The Unani system of medicine uses various drugs and regiminal therapies for uterovaginal prolapse. Abzan is one such procedure where the patient sits in a tub filled with plain or medicated water such as Joshanda or khaisanda up to the level of the umbilicus. Unani physicians frequently recommend it for gynecological disorders like genital prolapse, vaginal infections, pelvic inflammatory disease, menstrual disorder, healing of episiotomy wounds, and hemorrhoids.

In Unani medicine, many single, compound drugs, and regiminal therapies are mentioned in the management of Nutu al Rahim, of these Abzan of Habbul Aas, Izkhar, and Post Anar has been selected for the treatment in the present study. These drugs have properties of Habis hemostatic, Qabiz astringent,  Muqawwi i Rahim uterine tonic, Mujaffif desiccant, and Musakkin Alam analgesic properties, they can help in the stimulation of instinct heat and strengthening the body. They have pharmacological properties like antioxidant, anti-inflammatory, antimicrobial, antifungal, antibacterial, antiviral, and diuretic Therefore, the present study has been taken up to determine the effect of this Unani formulation along with pelvic floor muscle exercises in 1st and 2nd degree uterovaginal prolapse.