Obstetric fistula: The role of physiotherapy: A report from the Physiotherapy Committee of the International Continence Society

Abstract

Aims: To discuss the role of physiotherapy in the management of women who have suffered an obstetric fistula, referring to research findings when appropriate and available, and the experiences of clinical specialists in the field. Methods: The experiences of physiotherapists who have worked in countries where obstetric fistula is prevalent, and the limited literature available, were considered in producing this consensus document on behalf of the ICS Physiotherapy Committee. Results: The role of physiotherapy both pre-and post-fistula repair was identified, and is multi-faceted. Women may have general rehabilitation needs based on the obstructed labor itself and subsequent care. All affected women may benefit from pelvic floor muscle assessment, education and exercises to optimize the outcome of their surgery; further pelvic floor physiotherapy may be indicated for those who experience persistent genitourinary dysfunction following closure of the fistula. Conclusions: Further robust research is required to confirm the effectiveness of physiotherapy in the management of women who have suffered an obstetric fistula and the optimum development of such services. Based on the available literature and the experience of physiotherapists in the field, there was consensus within the ICS Physiotherapy Committee that patient outcomes can be improved if physiotherapy is provided as part of the multidisciplinary team. Physiotherapy should not be overlooked when fistula services are being developed. K E Y W O R D S physiotherapy, rectovaginal fistula, vesicovaginal fistula

Rehabilitation and reintegration programming adjunct to female genital fistula surgery: A systematic scoping review

“…Preliminary evidence supports short‐term facility‐based psychological intervention . Physical therapy has also been recommended, as has improvement of economic independence . Research synthesis on the reintegration process, evaluation, and service provision is important for developing evidence‐based service prioritization to meet the health needs of women recovering from genital fistula.…”

An International Continence Society (ICS) report on the terminology for female pelvic floor fistulas

“…8.4.1 Pelvic physiotherapy—General: Assessment, prevention, and/or treatment of pelvic floor dysfunction, performed by a pelvic physiotherapist. The therapy aims at reducing symptoms of fistula and post‐fistula treatment incontinence symptoms as well as improvement of pelvic floor function 56 . The role of continence nurses amongst other allied health professionals in performing some of these specialized therapies is acknowledged.…”

“…The therapy aims at reducing symptoms of fistula and postfistula treatment incontinence symptoms as well as improvement of pelvic floor function. 56 The role of continence nurses amongst other allied health professionals in performing some of these specialized therapies is acknowledged. In those fistula patients with flexure injuries, and/or foot drop, musculo-skeletal physiotherapy can be helpful in preparing the patient for surgery.…”