Women may experience severe urinary incontinence even after fistula closure

USA: In spite of successful fistula closure, women with obstetric fistulas experience significant chronic urine incontinence, says an article published in the American Journal of Obstetrics and Gynecology, on 10th March 2022.

Obstetric fistula is a potentially fatal birth injury. Despite effective fistula closure, 16-55% of women experience recurrent urine incontinence following surgery. R Nardos and colleagues investigated the kind and severity of persistent incontinence following successful fistula closure, as well as its influence on the quality of life of Ugandan women having obstetric fistula surgery, in this research.

Women having a history of obstetric fistula repair who continued to have persistent urine incontinence (cases, N=36) and women without incontinence (controls, N=52) were included in this cross-sectional research. Between 2017 and 2019, data were gathered in central and eastern Uganda. A semi-structured questionnaire was completed by all participants. Cases were evaluated clinically, subjected to a 2-hour pad test, and completed a battery of incontinence questionnaires, including two innovative measures developed to assess incontinence severity in low-literacy groups.

The results of this study stated as follow:

1. Cases were more likely to have had a fistula after their first birth, to have been younger when they got a fistula, and to have had more than two fistula procedures.

2. Cases reported a considerably greater rate of intended home births during their index pregnancy than controls, despite the fact that only 14% of cases and 12% of controls delivered at home.

3. Cases reported increased rates of discomfort during intercourse, but there was no significant difference in recent sexual activity status across the groups.

4. 67% of patients had stress incontinence, 47% had urgency incontinence, and 47% had mixed incontinence.

5. The cough stress test was performed effectively in 92 percent of the patients, and virtually all (97%) of these instances had a positive cough stress test.

6. More over half (53 percent) of those polled evaluated their incontinence as "very serious," which corresponded to objective findings.

7. The 24-hour voiding diary revealed both a high urine frequency (14 on average) and a high number of leaking events (average 20).

8. Two-hour pad testing revealed that 86% of patients saw a >4 gram change in pad weight within two hours.

9. Women who suffered from more severe incontinence had a greater negative impact on their quality of life. The mean ICIQ-QoL score was 62.77 12.76, with a higher score suggesting a stronger influence on the quality of life. Both patients and controls reported significant rates of suicidal thoughts at any stage since acquiring fistula.

In conclusion, according to the findings of the study, women with obstetric fistulas continue to have urine incontinence despite effective surgical closure. The intensity of incontinence is connected with a decline in quality of life. More study on surgical closure approaches and incontinence management in this population is required.

Reference: 

Nardos, R., Jacobson, L., Garg, B., Wall, L. L., Emasu, A., & Ruder, B. (2022). Characterizing Persistent Urinary Incontinence After Successful Fistula Closure: The Uganda Experience. In American Journal of Obstetrics and Gynecology. Elsevier BV. https://doi.org/10.1016/j.ajog.2022.03.008