Obstetric and Gynecologic Genitourinary Fistulas

Abstract

Urinary incontinence shortly after childbirth or gynecologic surgery can be the result of obstetric or iatrogenic fistula formation. This can be a confusing and challenging diagnosis for medical providers. While the number of iatrogenic fistula cases is rising worldwide, obstetric fistulas are an issue uniquely particular to resource poor settings. Appropriate treatment of genitourinary fistulas spans beyond surgical intervention of leakage, and includes re-integration into the community, widespread education and counseling, and battling social stigma and cultural biases. Current and future research must focus on rigorous, unified efforts to set evidencebased practices to help the millions of women affected.

Development and Pilot Test of a Group Cognitive Behavioral Intervention for Women Recovering From Fistula Repair Surgery in Ethiopia

“…Obstetric fistula, a hole between the vagina and rectum or bladder (i.e., a hole in the birth canal), is a serious obstetric complication generally caused by prolonged obstructed labor, which leads to medical complications for the woman and nearly always results in the death of the neonate ( 1 , 2 ). While the true rates of obstetric fistulae are difficult to determine due to the lack of reliable population-wide data and inconsistency across prevalence studies ( 3 ), early estimates that over 2 million women suffer from this condition worldwide ( 4 ) are consistent with the WHO's current estimates for sub-Saharan Africa and South Asia ( 5 ), which some contend may even be an underestimate ( 6 ).…”

“…Women who are typically affected by fistulae have underdeveloped pelvic structures or generally possess a small physique ( 7 ). Additional factors associated with the development of obstetric fistulae include low socioeconomic status, the cultural practice of early marriage (before age 18), inadequate access to and education about family planning, lack of comprehensive obstetric care, and long distances from home to health care facilities ( 1 , 6 , 8 ).…”

“…The consequences of obstetric fistulae have been described as “devastating” and “dehumanizing” ( 10 ). As a result of an obstetric fistula, a woman leaks wastes (urine and/or feces), which often results in an odor, burns to the skin along her legs and feet, and progressive complications such as malnourishment, amenorrhea, nerve damage, and foot drop ( 1 , 11 ). While some women report support from family members, including their husbands ( 12 , 13 ), many women with obstetric fistulae face traumatizing social challenges.…”

“…While some women report support from family members, including their husbands ( 12 , 13 ), many women with obstetric fistulae face traumatizing social challenges. Women with fistulae have described experiencing isolation, feeling shame, losing their jobs, having their food rations decreased, feeling unsupported in hospitals, being unable to use public transportation or participate in community or religious events, and loss of familial and/or martial support ( 1 , 14 , 15 ).…”

“…To date, most efforts to address obstetric fistula worldwide have focused on the physical consequences of this problem, yet, according to Muleta et al ( 25 ), “Simply repairing the injuries is not the end of the challenge” (p. 45). Obstetric fistula is a significant problem in low-income countries that is virtually non-existent in high-income countries ( 1 , 27 ). Unfortunately, few intervention efforts have focused on the psychological impacts of this condition, despite many research groups advocating for integration of mental health care into treatment for women suffering from this condition ( 17 , 18 , 22 , 24 , 28 ).…”