Female urinary incontinence in sub‐Saharan Africa

Abstract

Urinary incontinence (UI) is highly prevalent amongst women around the world. In this review article we explore UI, its consequences and treatment in sub-Saharan Africa, providing specific examples from Uganda and Malawi. In sub-Saharan Africa the prevalence of UI is difficult to assess because of the wide variation in reporting resulting from patients hiding their condition due to the associated stigma in many communities. Whilst much of the literature from low-or lowmiddle-income countries focuses on UI from pelvic floor fistula, recent evidence demonstrates that non-fistulous stress, urgency and mixed UI are highly prevalent in sub-Saharan Africa. Incontinence secondary to vesico-vaginal fistula can be related to obstetric causes, mainly obstructed labour. The risk factors for non-fistulous incontinence are similar to those identified in high-income countries, including high parity, vaginal and assisted delivery, gestational age, constipation, obesity, chronic cough and ageing. Urinary incontinence has significant social and emotional consequences, with a high proportion of women in African countries reporting relationship problems, depression and suicidal ideation. There is poor understanding of the perceived aetiology of incontinence in sub-Saharan Africa, which may, in part, act as a barrier for women to seek medical advice. Innovative solutions have been found to manage the large number of obstetric fistulas that are prevalent across Africa, but a lack of capacity in specialists trained to treat women with UI means that more doctors, medical officers and better resource prioritization will be required to help the, as yet unquantified, number of women with non-fistulous leakage. Better patient peri-natal education may reduce the incidence of fistula still further, especially if the stigma felt by women with incontinence is overcome and they are encouraged to seek treatment.

Urinary incontinence following successful closure of obstetric vesicovaginal fistula repair in Southern Ethiopia

“…Despite the highest successful closure of VVF repair, UI is a common and challenging public health problem among patients who underwent VVF repair [ 11 , 13 , 14 ]. Patients with UI experience wetness, odor, and discomfort [ 15 ], which have significant consequences for social and emotional problems such as relationship problems, depression, and suicidal ideation [ 16 ] and can affect women’s quality of life [ 17 – 19 ]. This also led to patients having long waits at the center (2–4 weeks) and a burden for fistula treatment facilities or centers [ 20 ].…”

“…The management of UI can include lifestyle changes, physical therapy, behavioral therapy, pelvic floor exercise, medication, a sling procedure, the use of an autologous sling, or follow-up [ 16 , 30 ]. During surgical repair of VVF patients, surgeons might use facial slings such as rectus slings or pubococcygeus slings, and skin grafts, which are highly important for reducing the burden of UI after successful obstetric VVF closure [ 20 ].…”

Urinary incontinence among women in sub-Saharan Africa – an overview

“…The incidence of non-fistulous incontinence, which includes stress incontinence, urge incontinence, and mixed urinary incontinence, is frequently associated with various risk factors, including high parity, vaginal and assisted delivery, number of abortions, constipation, obesity, menopause, recurrent urinary tract infection, hysterectomy, foetal weight, aging, and comorbid such as diabetes and chronic pulmonary disease. Vesicovaginal fistula can cause incontinence, which is often associated with obstetric causes, particularly obstructed labour (2). Though not life-threatening, urinary incontinence can negatively impact the psychological, physical, and social wellbeing of the affected individual.…”