When a woman with an obstetric fistula is finally able to get to a fistula treatment center, in many cases decades after the injury happened, she is finally hope for a change. The development of a fistula commonly occurs when a birth is arrested and the fetus does not survive. Hope grows with the prospect of help, hope that the despair and societal isolation will come to an end, and there is the anticipation of becoming dry. Indeed, fistula surgeries are in many ways life-saving for women who suffer significant trauma during childbirth. These surgeries to repair holes between the vagina and bladder or rectum, or both, have a high success rate of about 90%.
This hope can, however, be fragile. After successful fistula repair, she may still not be dry, she may be weakly unable to work, or she may have pain. Hope does not always last, and in some cases, she may be considered accursed by members of her community because she does not heal and continued to leak even after surgery. Up to 55% of women may experience persistent urinary incontinence after successful surgery. But, rehabilitation can bring hope back. Stress urinary incontinence, a common condition of any woman who has had a vaginal birth, can be improved with pelvic floor rehabilitation. Unfortunately, in Africa, rehabilitation for women who have had post-surgical repair of a fistula is not commonly offered. The need is great for rehabilitation post fistula repair; physical therapy programs that address residual leg weakness, and specific care for the treatment of stress urinary incontinence can provide women with hope again. Not only can physical therapy help incontinence but the strengthening and education about how to safely regulate intra-abdominal pressure can be protective too. Poor regulation of intra-abdominal pressure during activities of daily living, defecation, and coughing could result in the failure of a previously successfully closed fistula. More rehabilitation programs are needed worldwide.
GWHI is committed to the fight to end obstetric fistulas by raising awareness and resources to support global women’s health, collaborating with other health professionals, increasing the involvement of physical therapists around the globe, and improving the lives of girls and women who are suffering or recovering from fistulas. Please help GWHI bring HOPE.
References:
- Castille YJ, Avocetien C, Zaongo D, Colas JM, Peabody JO, Rochat CH. Impact of a program of physiotherapy and health education on the outcome of obstetric fistula surgery. Int J Gynaecol Obstet. Vol 124. Ireland: 2013.; 2014:77-80.
- Donnelly K, Oliveras E, Tilahun Y, Belachew M, Asnake M. Quality of life of Ethiopian women after fistula repair: implications on rehabilitation and social reintegration policy and programming. Cult Health Sex. 2015;17(2):150-164.
- Drew LB, Wilkinson JP, Nundwe W, et al. Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: a qualitative study. BMC Pregnancy Childbirth. 2016;16:2.
- Hawkins L, Spitzer RF, Christoffersen-Deb A, Leah J, Mabeya H. Characteristics and surgical success of patients presenting for the repair of obstetric fistula in western Kenya. Int J Gynaecol Obstet. Vol 120. Ireland: 2012 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd; 2013:178-182.
- Nielsen HS, Lindberg L, Nygaard U, et al. A community-based long-term follow-up of women undergoing obstetric fistula repair in rural Ethiopia. BJOG. Vol 116. England2009:1258-1264.
- Stephenson R, Spitznagle T, Brook G, Broom R, Daniel J. Trauma-induced pelvic floor disorders: implications for physical therapists. Presented at: IOPTWH Subgroup Seminar, World Confederation for Physical Therapy Congress; May 1-5, 2015. Singapore. http://www.wcpt.org/sites/wcpt.org/files/files/wpt15/SG-8-WomensHealth-handout.pdf. Accessed May 12, 2016
- Tennfjord MK, Muleta M, Kiserud T. Musculoskeletal sequelae in patients with obstetric fistula – a case-control study. BMC Women’s Health. 2014;14:136.