Fistula repair confers mental health benefits

NEW YORK (Reuters Health) - Women who undergo successful surgery to repair a fistula suffered in pregnancy experience marked improvement in their mental health, according to a study.

Obstetric fistula is caused by prolonged labour, which forces the unborn baby's head against a woman's pelvis -- killing the baby and destroying the trapped tissue in the birth canal, the rectum and the urinary tract. The childbirth injury almost unheard of in the developed world currently afflicts as many as two million women in the developing world, with roughly 50,000 to 100,000 new cases occurring each year.

"Obstetric fistula represents a significant global health problem," Dr. Andrew Browning, of Barhirdar Hamlin Fistula Center, Ethiopia, and colleagues write in a report.

Affected women are often divorced and isolated in their communities because of their complete incontinence and resulting poor hygiene. "It has often been stated that women cured from obstetric fistula are incredibly grateful...But until now no one has described the impact on mental health by the treatment of their condition."

In a prospective "before and after" study, Browning's team examined the mental health status of 51 consecutive women with obstetric fistula admitted to the dedicated fistula center in northern Ethiopia.

Of the 51 fistula repairs, three (5.9 percent) were considered failures. Of the 48 remaining women, only three women continued to leak urine and six had mild "stress" incontinence with activity.

All of the women screened positive for mental health problems before surgery but only 18 still showed mental health problems at 2 weeks after the fistula surgery.

Improvement in mental health was "highly dependent on the success of the treatment," Browning and colleagues point out, noting that all six women for whom the operation was not curative -- three failed repairs and three with severe residual incontinence -- still showed signs of mental health problems.

The team advises that, at admission, women should be "realistically informed of the likelihood of success of the operation and of steps that might be taken to help if the operation does not succeed."

SOURCE: British Journal of Obstetrics and Gynecology, November 2007.