Women in Nepal frequently carry heavy loads, which increases intra-abdominal pressure and risks pelvic organ prolapse affecting more than 10% of women in reproductive age and up to 24% of postmenopausal women. Pelvic-floor-protective lifting techniques, like consciously co-contracting pelvic floor muscles, helps to cope with high intra-abdominal pressure as it stabilizes the pelvic floor muscles and prevents pelvic floor displacement (1, 2). This workshop-based intervention aimed to train pelvic-floor-protective lifting techniques embedded within a broader study on behavior change regarding pelvic floor health in rural Nepal.

A practical workshop was developed to teach and learn pelvic floor muscle awareness, contraction, relaxation, and lifting techniques using co-contraction and expiration. Materials included anatomy instruction and progressive practice.
The workshop was carefully planned with cultural sensitivity to ensure that the content and delivery were appropriate for the participants' local context. A resource-efficient hybrid design was implemented: A specialized pelvic health physiotherapist taught pelvic-floor-protective lifting skills online via Zoom, while a psychologist, who had been previously trained in these techniques by the specialist physiotherapist, provided in-person support on site in Nepal, where all participants were gathered. The participants were healthcare professionals, allowing for the dissemination of these techniques within the wider community in the context of the broader study.

During the workshop, participants received a short overview of the basic anatomy and function of the pelvic floor muscles, as well as the effects of heavy lifting on the pelvic floor. 
The practical session centered on pelvic floor muscle awareness, contraction and learning pelvic-floor-protective lifting techniques, including the simultaneous contraction of the pelvic floor and controlled exhalation while lifting. Guided by the specialist physiotherapist, participants practiced these methods using everyday objects commonly found in Nepal. Strategies for integrating the exercises into daily life and sharing them within the community were discussed. Finally, participants received materials and recommendations for ongoing implementation in their professional settings.

Integrated into the larger study, the workshop supported behavior change efforts (3).
This workshop format demonstrates clear potential for further development, and several ideas could be pursued: Future workshops may benefit from allocating additional practice time, for example, to deepen pelvic floor awareness, and from giving more in-depth background information. It would be valuable to create opportunities for participants to raise questions after the workshop. Furthermore, the hybrid format could be expanded into hybrid or online blended formats. Emphasizing targeted practice in instructing pelvic-floor-protective lifting techniques, such as role play, would also strengthen the practical application and dissemination of these skills.

The workshop approach not only shows promise within the current study but also holds considerable potential for expansion beyond this research. Further development and implementation of these workshops outside the study could provide a sustainable impact by empowering communities to protect pelvic floor health. By aligning with the United Nations Sustainable Development Goals, particularly those focused on health and wellbeing (Goal 3) and gender equality (Goal 5), this initiative can help foster long-term benefits for women in Nepal and similar contexts. Continued efforts to refine and deliver these interventions will contribute to improved health outcomes and greater gender equity. Future workshops should be rigorously evaluated not only in terms of their learning formats but also with respect to outcomes, to ensure the effectiveness and scalability of the intervention within diverse settings.

Bisworkarma Y, Brandon K, Lohman E, Stafford R, Daher N, Petrofsky J, Thapa U, Berk L, Hitchcock R, Hodges PW. Potential role of physical labor and cultural views of menstruation in high incidence of pelvic organ prolapse in Nepalese women: a comparative study across the menstrual cycle. Front Med (Lausanne). 2024 Feb 29:11:1265067. doi: 10.3389/fmed.2024.1265067. eCollection 2024
Bø K. Can pelvic floor muscle training prevent and treat pelvic organ prolapse?  Acta Obstet Gynecol Scand. 2006;85(3):263-8. doi: 10.1080/00016340500486800
Jonitz VMJ, Shrestha A, Luginbuehl H, Kasaju A, Scarnato Ch, Meierhofer R, Inauen J. Self-efficacy and social support enable women to protect their pelvic floor health: A nonrandomized controlled trial in rural Nepal. J Health Psychol. 2025 Jul;30(8):2013-2029. doi: 10.1177/13591053241283945. Epub 2024 Oct 30