In 1974, Reg and Catherine Hamlin established the world-renowned Addis Ababa Fistula Hospital. The institution’s purpose is to address the unmet needs of thousands of Ethiopian woman who suffer obstetric fistulae. Within the past 12 or more years the hospital’s physiotherapy service has been developed, and in 2010, a new department specifically for physiotherapy was opened. This is currently staffed by a physiotherapist, specialist nurse and dedicated team of experienced department and ward-based aides.Since 2003 the team has been offered ongoing support and education by UK physiotherapists. This has included visits to the department and regular email contact.
Despite successful fistula repair, some 15-20% women (Hancock 2009) and possibly considerably more (Murray et al. 2002) suffer from residual urinary incontinence. This inevitably has a profound effect on their quality of life and reintegration into their communities. In an effort to prevent and/or treat these symptoms, pelvic floor physiotherapy is a vital component of the multidisciplinary care offered to women in Addis and the Hamlin outreach centres. During my most recent visit I was able to work in clinic and on the ward with the newest recruit to the team, physiotherapist Selam Aregawi, see photo. She joined the staff in 2014, shortly before the departure of the previous head of physiotherapy, Azeb Befekadu Tessema. In addition to our clinical work together, we had time to complete a short educational programme on relevant anatomy & physiology, pelvic floor muscle assessment & exercises and other treatment modalities such as biofeedback and neuromuscular stimulation.
Strong evidence supports the practice of pelvic floor muscle training as the first line treatment for the management of some types of urinary incontinence. However, women who have suffered an obstetric fistula are a very different group. These women may have a decreased bladder capacity and considerable urethral and vaginal changes which can impact on their continence mechanism. It is therefore promising to read emerging evidence on the positive impact of pre and post-operative physiotherapy with women who are undergoing repair of vesico-vaginal fistula. (Castille et al. 2014 & 2015; Keyser et al. 2014)
Picture of Selam Aregawi (right) courtesy of Nigel Brennan
Article by Gill Brook on behalf of the Fistula Committee
References
- Castille Y-J et al. (2014) Impact of a programme of physiotherapy and health education on the outcome of obstetric fistula surgery. International Journal of Gynecology & Obstetrics. 124(1): 77-80
- Castille Y-J et al. (2015) One-year follow-up of women who participated in a physiotherapy and health education program before and after obstetric fistula surgery. International Journal of Gynecology & Obstetrics. 128(3): 264-266
- Hancock B (2009) Practical obstetric fistula surgery. Royal Society of Medicine Press Ltd, London
- Keyser L et al. (2014) Analysis of a pilot program to implement physical therapy for women with gynecologic fistula in the Democratic Republic of Congo. International Journal of Gynecology & Obstetrics. 127(2): 127-131
- Murray C, Goh JT, Fynes M, Carey MP (2002) Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula. BJOG 109:828-830