About the Author: Dr. Almieda D. Cepedoza, known affectionately as Doc Apple, holds Fellowships in the Philippine Obstetrical and Gynecological Society, Philippine College of Surgeons, Philippine Society of Climacteric Medicine (Menopause Specialty), Association of Women Surgeons of the Philippines, and Academy of Medicine of the Philippines. She is affiliated with the different hospitals in Tagbilaran City, Bohol and operates her clinic at Ground Floor, Lim Hong Khu Medical Arts and Wellness Building, Celestino Gallares St., Tagbilaran City, Bohol. Her clinic hour is by appointment only through call or text: 0933-0429362.
Breaking the Silence on ‘Nabotbot’: A Doctor’s Note on Pelvic Organ Prolapse
This week in my practice, I was reminded of a condition that affects countless women yet is shrouded in silence and shame. I remember her sitting across from me, hesitant, before finally saying, “Doctor, naa koy bati nga pamati sa akong botbot. Murag naa’y nag ung-ung, maglisud ko ihi, murag nanus-us.”
Her words, though whispered, are heard courageously in OB-GYN clinics. The condition she described—pelvic organ prolapse, known to many simply as ‘Nabotbot’ or ‘Pag-us-us’—is far more common than we talk about. My goal today is to break that silence. If you feel this way, please know: you are not alone, and this condition is treatable.
What Exactly is ‘Nabotbot’?
Think of your pelvis as having a strong, supportive hammock made of muscles and ligaments. This hammock holds your uterus, bladder, and bowels in place. When this support system weakens, these organs can sink downward—what we call ‘na-us-us’—into the vaginal canal. Sometimes, they may even create a visible bulge, a sensation women often describe as ‘nag-ung-ung’ or ‘natagak’(something is peeking out or protruding). This is a prolapse.
Why Does it Happen?
This weakening can occur for several reasons:
- Pregnancy and Childbirth: This is the most common cause. The process of carrying a baby and ‘pagpanganak’ (childbirth), especially multiple vaginal deliveries, can stretch and strain these supportive tissues.
- Aging and Menopause: As estrogen levels naturally decline with age and menopause, the pelvic tissues can lose strength and elasticity, making them more susceptible to prolapse.
- Pag asnat ug bug-at: The chronic, heavy lifting of children, laundry, or farm goods creates constant pressure that can overwhelm the pelvic floor over time.
- Chronic Pressure: Conditions like a persistent cough, severe constipation, or obesity can also contribute by putting extra strain on the abdomen.
How Will I Know if I Have It? Listen to Your Body.
Don’t ignore the signs or wait until it becomes severe. Your body is giving you signals:
- A distinct feeling of heaviness, pressure, or ‘kabug-aton’ in your pelvic area.
- The unmistakable sensation that something is ‘nag-ung-ung’ or bulging inside your vagina.
- New problems with bladder control or bowel movements. “Sige pangihi, mag lisud ihi or libang” or urinary frequency, hesitancy, incontinence and a feeling of incomplete voiding.
- A feeling of fullness or discomfort that improves when you lie down.
- Actually seeing or feeling a bulge at the vaginal opening.
‘Ayaw Kahadlok!’ Don’t Be Afraid – Help is Available.
This is the most important message I can share: ‘Ayaw kahadlok o maulaw nga mo-adto sa doktor.’This is not a normal part of being a woman or aging that you must simply endure.
Treatment is available and depends on how ‘grabe’ (severe) the prolapse is, and your personal needs:
- For mild cases: Kegel exercises (focused clenching of the pelvic muscles) can build strength and provide significant support.
- For more significant cases: A simple, removable medical device called a pessary can be inserted to hold the organs in place and provide immediate relief.
- For severe cases: Surgery can effectively repair the supportive tissues and restore the organs to their proper position. This was what I did on my patient.
You do not have to suffer in silence. Many women experience ‘nabotbot’, but embarrassment keeps them from seeking the help they deserve. Talking about it is the first step toward recovery and reclaiming your comfort and quality of life. Your health, comfort, and well-being are always worth it.