Psychological Symptoms and Social Functioning Following Repair of Obstetric Fistula in a Low-Income Setting

Abstract

Objectives Obstetric fistula is a maternal injury that causes uncontrollable leaking of urine or stool, and most women who develop it live in poverty in low-income countries. Obstetric fistula is associated with high rates of stigma and psychological morbidity, but there is uncertainty about the impact of surgical treatment on psychological outcomes. The objective of this exploratory study was to examine changes in psychological symptoms following surgical fistula repair, discharge and reintegration home. Methods Women admitted for surgical repair of obstetric fistula were recruited from a Tanzanian hospital serving a rural catchment area. Psychological symptoms and social functioning were assessed prior to surgery. Approximately 3 months after discharge, a data collector visited the patients' homes to repeat psychosocial measures and assess self-reported incontinence. Baseline to follow-up differences were measured with paired t tests controlling for multiple comparisons. Associations between psychological outcomes and leaking were assessed with t tests and Pearson correlations. Results Participants (N = 28) had been living with fistula for an average of 11 years. Baseline psychological distress was high, and decreased significantly at follow-up. Participants who self-reported continued incontinence at follow-up endorsed significantly higher PTSD and depression symptoms than those who reported being cured, and severity of leaking was associated with psychological distress. Conclusions Fistula patients experience improvements in mental health at 3 months after discharge, but these improvements are curtailed when women experience residual leaking. Given the rate of stress incontinence following surgery, it is important to prepare fistula patients for the possibility of incomplete cure and help them develop appropriate coping strategies.

Social Experiences of Women with Obstetric Fistula Seeking Treatment in Kampala, Uganda

“…They found it important to educate on the possibility that the repair might not be successful in resulting in complete dryness and to provide coping skills if this was the case. 21 A study in Malawi found similar rates of interest in future childbearing and reported that reintegration was relatively easy for these women. However, women continued to have difficulty in their lives relating to fertility and relationships.…”

Incidence, type and management of ureteric injury associated with vesicovaginal fistulas: Report of a series from a specialized center

“…This is in contrast to low‐income countries where VVF is consequent to obstructed second stage of labor in >95% of cases . Management of VVF varies, with no standardized treatment pathway.…”

“…2 The association of ureteral injuries with VVF is unknown, as there is a variability in the series, with reports ranging between 6 and 25% of cases. 3 However, preoperative diagnosis is essential for the planning of repair surgery. The article by Seth et al 4 presents a large series of 116 patients with VVF, emphasizing the incidence and management of these patients when there is an association of ureteral injury.…”

“…2 This is in contrast to low-income countries where VVF is consequent to obstructed second stage of labor in >95% of cases. 3 Management of VVF varies, with no standardized treatment pathway. Conservative strategies can be attempted in selected cases, with at best modest success, utilizing bladder drainage, fulguration or targeting the fistulas with injectables or fibrin sealants.…”

Persistent depression after obstetric fistula repair

“…Unrepaired obstetric fistula can lead to a life of disability, poverty, and isolation . Not surprisingly, mental health assessment of women with obstetric fistula has demonstrated high rates of depression …”