Abstract
Obstetric fistula, a devastating condition that almost exclusively affects women in low- and middle-income countries (LMICs), is only one of many pelvic floor disorders related to childbirth. This chapter encourages readers to re-focus attention to the larger unattended crisis of childbirth-related pelvic floor disorders. These include pelvic organ prolapse, persistent urinary incontinence after successful repair of obstetric fistula, nonfistula-related urinary and anal incontinence, and musculoskeletal disorders of the pelvic floor. Women in LMICs are at a high risk for these conditions where access to family planning and timely obstetric care is limited; repeated trauma from multiple deliveries and prolonged obstructed labor is prevalent; and there is lack of access to timely care for pelvic floor injuries. Further, there is a massive shortage in trained health workers to address the large unmet need of pelvic floor disorders in these regions. A paradigm shift is needed in order to address this gap. In addition to specialized training in pelvic medicine and reconstructive surgery, we need to strengthen the overall health system needed to provide safe and quality care for these patients. We call upon humanitarian groups, charity organizations, health institutions, ministries of health, and national and international scientific societies to leverage their resources and expertise to promote women’s pelvic floor health globally.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abrams, P., Cardozo, L., Fall, M., Griffiths, D., Rosier, P., Ulmsten, U., et al. (2003). The standardisation of terminology in lower urinary tract function: Report from the standardisation sub-committee of the International Continence Society. Urology, 61(1), 37–49. https://doi.org/10.1016/s0090-4295(02)02243-4
Aguiar, M., Farley, A., Hope, L., Amin, A., Shah, P., & Manaseki-Holland, S. (2019). Birth-related perineal trauma in low- and middle-income countries: A systematic review and meta-analysis. Maternal and Child Health Journal, 23(8), 1048–1070. https://doi.org/10.1007/s10995-019-02732-5
Akmel, M., & Segni, H. (2012). Pelvic organ prolapse in Jimma university specialized hospital, Southwest Ethiopia. Ethiopian Journal of Health Sciences, 22(2), 85–92. Retrieved August 20, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/22876071
American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. (2016). Practice bulletin no. 165: Prevention and management of obstetric lacerations at vaginal delivery. Obstetrics & Gynecology, 128(1), e1–e15. https://doi.org/10.1097/AOG.0000000000001523
Angioli, R., Gómez-Marín, O., Cantuaria, G., & O’Sullivan, M. J. (2000). Severe perineal lacerations during vaginal delivery: The University of Miami experience. American Journal of Obstetrics and Gynecology, 182(5), 1083–1085. https://doi.org/10.1067/mob.2000.105403
Arrowsmith, S., Hamlin, E. C., & Wall, L. L. (1996). Obstructed labor injury complex: Obstetric fistula formation and the multifaceted morbidity of maternal birth trauma in the developing world. Obstetrical & Gynecological Survey, 51(9), 568–574. Retrieved January 15, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/8873157
Avery, K., Donovan, J., Peters, T. J., Shaw, C., Gotoh, M., & Abrams, P. (2004). ICIQ: A brief and robust measure for evaluating the symptoms and impact of urinary incontinence. Neurourology and Urodynamics, 330(May), 322–330. https://doi.org/10.1002/nau.20041
Ballard, K., Ayenachew, F., Wright, J., & Atnafu, H. (2016). Prevalence of obstetric fistula and symptomatic pelvic organ prolapse in rural Ethiopia. International Urogynecology Journal, 27(7), 1063–1067. https://doi.org/10.1007/s00192-015-2933-0
Bartlett, L., Nowak, M., & Ho, Y.-H. (2009). Impact of fecal incontinence on quality of life. World Journal of Gastroenterology: WJG, 15(26), 3276. https://doi.org/10.3748/WJG.15.3276
Bashah, D. T., Worku, A. G., & Mengistu, M. Y. (2018). Consequences of obstetric fistula in sub Sahara African countries, from patients’ perspective: A systematic review of qualitative studies. BMC Women’s Health, 18(1), 106. https://doi.org/10.1186/s12905-018-0605-1
Bengtson, A. M., Kopp, D., Tang, J. H., Chipungu, E., Moyo, M., & Wilkinson, J. (2016). Identifying patients with vesicovaginal fistula at high risk of urinary incontinence after surgery. Obstetrics & Gynecology, 128(5), 945–953. https://doi.org/10.1097/AOG.0000000000001687
Bharucha, A. E., Dunivan, G., Goode, P. S., Lukacz, E. S., Markland, A. D., Matthews, C. A., et al. (2015). Epidemiology, pathophysiology, and classification of fecal incontinence: State of the science summary for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) workshop. The American Journal of Gastroenterology, 110(1), 127–136. https://doi.org/10.1038/ajg.2014.396
Blomquist, J. L., Muñoz, A., Carroll, M., & Handa, V. L. (2018). Association of delivery mode with pelvic floor disorders after childbirth. JAMA, 320(23), 2438–2447. https://doi.org/10.1001/jama.2018.18315
Boreham, M. K., Richter, H. E., Kenton, K. S., Nager, C. W., Gregory, W. T., Aronson, M. P., et al. (2005). Anal incontinence in women presenting for gynecologic care: Prevalence, risk factors, and impact upon quality of life. American Journal of Obstetrics and Gynecology, 192(5), 1637–1642. https://doi.org/10.1016/j.ajog.2004.11.030
Browning, A. (2006). Risk factors for developing residual urinary incontinence after obstetric fistula repair. BJOG: An International Journal of Obstetrics and Gynaecology, 113(4), 482–485. https://doi.org/10.1111/j.1471-0528.2006.00875.x
Bump, R. C., & Norton, P. A. (1998). Epidemiology and natural history of pelvic floor dysfunction. Obstetrics and Gynecology Clinics of North America, 25(4), 723–746. https://doi.org/10.1016/S0889-8545(05)70039-5
Carroli, G., & Mignini, L. (2009). Episiotomy for vaginal birth. Cochrane Database of Systematic Reviews, (1), CD000081. https://doi.org/10.1002/14651858.CD000081.pub2
Caruso, S., Bandiera, S., Cavallaro, A., Cianci, S., Vitale, S. G., & Rugolo, S. (2010). Quality of life and sexual changes after double transobturator tension-free approach to treat severe cystocele. European Journal of Obstetrics & Gynecology and Reproductive Biology, 151(1), 106–109. https://doi.org/10.1016/j.ejogrb.2010.03.016
Combs, C. A., Robertson, P. A., & Laros, R. K. (1990). Risk factors for third-degree and fourth-degree perineal lacerations in forceps and vacuum deliveries. American Journal of Obstetrics and Gynecology, 163(1 Pt 1), 100–104. https://doi.org/10.1016/s0002-9378(11)90678-4
Coyne, K. S., Wein, A. J., Tubaro, A., Sexton, C. C., Thompson, C. L., Kopp, Z. S., & Aiyer, L. P. (2009). Evaluating the effect of LUTS on health-related quality of life, anxiety and depression: EpiLUTS. BJU International, 103(Supp 3), 4–11.
Culligan, P. J. (2012). Nonsurgical management of pelvic organ prolapse. Obstetrics & Gynecology, 119(4), 852–860. https://doi.org/10.1097/AOG.0b013e31824c0806
de Leeuw, J. W., Struijk, P. C., Vierhout, M. E., & Wallenburg, H. C. (2001). Risk factors for third degree perineal ruptures during delivery. BJOG : An International Journal of Obstetrics and Gynaecology, 108(4), 383–387. Retrieved August 21, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/11305545
Ditah, I., Devaki, P., Luma, H. N., Ditah, C., Njei, B., Jaiyeoba, C., et al. (2014). Prevalence, trends, and risk factors for fecal incontinence in United States adults, 2005–2010. Clinical Gastroenterology and Hepatology, 12(4), 636–643.e2. https://doi.org/10.1016/j.cgh.2013.07.020
Dolan, L., Dixon, W., & Hilton, P. (2008). Urinary symptoms and quality of life in women following urogenital fistula repair: A long-term follow-up study. BJOG: An International Journal of Obstetrics & Gynaecology, 115(12), 1570–1574. https://doi.org/10.1111/j.1471-0528.2008.01927.x
Drew, L. B., Wilkinson, J. P., Nundwe, W., Moyo, M., Mataya, R., Mwale, M., & Tang, J. H. (2016). Long-term outcomes for women after obstetric fistula repair in Lilongwe, Malawi: A qualitative study. BMC Pregnancy and Childbirth, 16, 2. https://doi.org/10.1186/s12884-015-0755-1
Fenner, D. E., Genberg, B., Brahma, P., Marek, L., & DeLancey, J. O. (2003). Fecal and urinary incontinence after vaginal delivery with anal sphincter disruption in an obstetrics unit in the United States. American Journal of Obstetrics and Gynecology, 189(6), 1543–1549. https://doi.org/10.1016/j.ajog.2003.09.030
FitzGerald, M. P., Weber, A. M., Howden, N., Cundiff, G. W., Brown, M. B., & Pelvic Floor Disorders Network. (2007). Risk factors for anal sphincter tear during vaginal delivery. Obstetrics & Gynecology, 109(1), 29–34. https://doi.org/10.1097/01.AOG.0000242616.56617.ff
Friedman, T., Eslick, G. D., & Dietz, H. P. (2018). Risk factors for prolapse recurrence: Systematic review and meta-analysis. International Urogynecology Journal, 29(1), 13–21. https://doi.org/10.1007/s00192-017-3475-4
Gjerde, J. L., Rortveit, G., Adefris, M., Belayneh, T., & Blystad, A. (2018). Life after pelvic organ prolapse surgery: A qualitative study in Amhara region, Ethiopia. BMC Women’s Health, 18(1), 74. https://doi.org/10.1186/s12905-018-0568-2
Goh, J. T. W., Krause, H., Tessema, A. B., & Abraha, G. (2013). Urinary symptoms and urodynamics following obstetric genitourinary fistula repair. International Urogynecology Journal, 24(6), 947–951. https://doi.org/10.1007/s00192-012-1948-z
Hagan, K. A., Erekson, E., Austin, A., Minassian, V. A., Townsend, M. K., Bynum, J. P. W., & Grodstein, F. (2018). A prospective study of the natural history of urinary incontinence in women. American Journal of Obstetrics and Gynecology, 218(5), 502.e1–502.e8. https://doi.org/10.1016/j.ajog.2018.01.045
Hallock, J. L., & Handa, V. L. (2016). The epidemiology of pelvic floor disorders and childbirth: An update. Obstetrics and Gynecology Clinics of North America, 43(1), 1. https://doi.org/10.1016/J.OGC.2015.10.008
Handa, V. L., Danielsen, B. H., & Gilbert, W. M. (2001). Obstetric anal sphincter lacerations. Obstetrics and Gynecology, 98(2), 225–230. https://doi.org/10.1016/s0029-7844(01)01445-4
Hannestad, Y. S., Rortveit, G., Daltveit, A. K., & Hunskaar, S. (2003). Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT study. BJOG : An International Journal of Obstetrics and Gynaecology, 110(3), 247–254. Retrieved August 20, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/12628262
Hartmann, K., Viswanathan, M., Palmieri, R., Gartlehner, G., Thorp, J., & Lohr, K. N. (2005). Outcomes of routine episiotomy: A systematic review. JAMA, 293(17), 2141. https://doi.org/10.1001/jama.293.17.2141
Hefni, M., Barry, J. A., Koukoura, O., Meredith, J., Mossa, M., & Edmonds, S. (2013). Long-term quality of life and patient satisfaction following anterior vaginal mesh repair for cystocele. Archives of Gynecology and Obstetrics, 287(3), 441–446. https://doi.org/10.1007/s00404-012-2583-0
Hilton, P., & Dolan, L. M. (2004). Pathophysiology of urinary incontinence and pelvic organ prolapse. BJOG: An International Journal of Obstetrics & Gynaecology, 111, 5–9. https://doi.org/10.1111/j.1471-0528.2004.00458.x
Howard, D. H., & Hockenberry, J. (2019). Physician age and the abandonment of episiotomy. Health Services Research, 54(3), 650–657. https://doi.org/10.1111/1475-6773.13132
Hu, T.-W., & Wagner, T. H. (2005). Health-related consequences of overactive bladder: An economic perspective. BJU International, 96(s1), 43–45. https://doi.org/10.1111/j.1464-410X.2005.05654.x
Hudelist, G., Gelle’n, J., Singer, C., Ruecklinger, E., Czerwenka, K., Kandolf, O., & Keckstein, J. (2005). Factors predicting severe perineal trauma during childbirth: Role of forceps delivery routinely combined with mediolateral episiotomy. American Journal of Obstetrics and Gynecology, 192(3), 875–881. https://doi.org/10.1016/j.ajog.2004.09.035
Hunskaar, S. (2008). A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourology and Urodynamics, 27(8), 749–757. https://doi.org/10.1002/nau.20635
Irwin, D. E., Kopp, Z. S., Agatep, B., Milsom, I., & Abrams, P. (2011). Worldwide prevalence estimates of lower urinary tract symptoms, overactive bladder, urinary incontinence and bladder outlet obstruction. BJU International, 108, 1132–1139. https://doi.org/10.1111/j.1464-410X.2010.09993
Irwin, D. E., Mungapen, L., Milsom, I., Kopp, Z., Reeves, P., & Kelleher, C. (2009). The economic impact of overactive bladder syndrome in six Western countries. BJU International, 103(2), 202–209. https://doi.org/10.1111/j.1464-410X.2008.08036.x
Islam, R. M., Oldroyd, J., Karim, M. N., Hossain, S. M., Md Emdadul Hoque, D., Romero, L., & Fisher, J. (2017). Systematic review and meta-analysis of prevalence of, and risk factors for, pelvic floor disorders in community-dwelling women in low- and middle-income countries: A protocol study. BMJ Open, 7(6), 1–6. https://doi.org/10.1136/bmjopen-2016-015626
Islam, R. M., Oldroyd, J., Rana, J., Romero, L., & Karim, M. N. (2019). Prevalence of symptomatic pelvic floor disorders in community-dwelling women in low- and middle-income countries: A systematic review and meta-analysis. International Urogynecology Journal, 30(12), 2001–2011. https://doi.org/10.1007/s00192-019-03992-z
Jandér, C., & Lyrenäs, S. (2001). Third and fourth degree perineal tears. Predictor factors in a referral hospital. Acta Obstetricia et Gynecologica Scandinavica, 80(3), 229–234. Retrieved August 21, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/11207488
Jangö, H., Langhoff-Roos, J., Rosthøj, S., & Saske, A. (2018). Long-term anal incontinence after obstetric anal sphincter injury—Does grade of tear matter? American Journal of Obstetrics and Gynecology, 218(2), 232.e1–232.e10. https://doi.org/10.1016/j.ajog.2017.11.569
Kelleher, C. J., Cardozo, L. D., Khullar, V., & Salvatore, S. (1997). A new questionnaire to assess the quality of life of urinary incontinent women. British Journal of Obstetrics and Gynaecology, 104(12), 1374–1379. Retrieved March 19, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/9422015
Kenton, K., & Mueller, E. R. (2006). The global burden of female pelvic floor disorders. BJU International, 98(SUPPL. 1), 1–5. https://doi.org/10.1111/j.1464-410X.2006.06299.x
Kopp, D., Tang, J., Bengtson, A., Chi, B., Chipungu, E., Moyo, M., & Wilkinson, J. (2018). Continence, quality of life, and depression following surgical repair of obstetric vesicovaginal fistula: A cohort study. BJOG: An International Journal of Obstetrics & Gynaecology. https://doi.org/10.1111/1471-0528.15546
Krause, H. G., Hall, B. A., Ng, S.-K., Natukunda, H., Singasi, I., & Goh, J. T. W. (2017). Mental health screening in women with severe pelvic organ prolapse, chronic fourth-degree obstetric tear and genital tract fistula in western Uganda. International Urogynecology Journal, 28(6), 893–897. https://doi.org/10.1007/s00192-016-3177-3
Linde, J. M., Nijman, R. J. M., Trzpis, M., & Broens, P. M. A. (2017). Urinary incontinence in the Netherlands: Prevalence and associated risk factors in adults. Neurourology and Urodynamics, 36(6), 1519–1528. https://doi.org/10.1002/nau.23121
Maher, C., Baessler, K., Glazener, C. M. A., Adams, E. J., & Hagen, S. (2008). Surgical management of pelvic organ prolapse in women: A short version Cochrane review. Neurourology and Urodynamics, 27(1), 3–12. https://doi.org/10.1002/nau.20542
Maher, C., Feiner, B., Baessler, K., & Schmid, C. (2013). Surgical management of pelvic organ prolapse in women. Cochrane Database of Systematic Reviews, (4), CD004014. https://doi.org/10.1002/14651858.CD004014.pub5.
Megabiaw, B., Adefris, M., Rortveit, G., Degu, G., Muleta, M., Blystad, A., et al. (2013). Pelvic floor disorders among women in Dabat district, Northwest Ethiopia: A pilot study. International Urogynecology Journal, 24(7), 1135–1143. https://doi.org/10.1007/s00192-012-1981-y
Meyer, I., & Richter, H. E. (2015). Impact of fecal incontinence and its treatment on quality of life in women. Women’s health (London, England), 11(2), 225. https://doi.org/10.2217/WHE.14.66
Milsom, I., & Gyhagen, M. (2019). The prevalence of urinary incontinence. Climacteric, 22(3), 217–222. https://doi.org/10.1080/13697137.2018.1543263
Murray, C., Goh, J. T., Fynes, M., & Carey, M. P. (2002). Urinary and faecal incontinence following delayed primary repair of obstetric genital fistula. BJOG: An International Journal of Obstetrics and Gynaecology, 109(7), 828–832. https://doi.org/10.1016/S1470-0328(02)00124-6
Nardos, R., Ayenachew, F., Roentgen, R., Abreha, M., Jacobson, L., Haile, A., et al. (2020). Capacity building in female pelvic medicine and reconstructive surgery: Global Health Partnership beyond fistula care in Ethiopia. International Urogynecology Journal, 31(2), 227–235. https://doi.org/10.1007/s00192-019-04197-0
Nardos, R., Phoutrides, E. K., Jacobson, L., Knapper, A., Payne, C. K., Wall, L. L., et al. (2020). Characteristics of persistent urinary incontinence after successful fistula closure in Ethiopian women. International Urogynecology Journal, 31(11), 2277–2283. https://doi.org/10.1007/s00192-020-04265-w
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. American Journal of Obstetrics and Gynecology, S0002-9378(22)00178-8. https://doi.org/10.1016/j.ajog.2022.03.008. Epub ahead of print. PMID: 35283092
Nygaard, I., Barber, M. D., Burgio, K. L., Kenton, K., Meikle, S., Schaffer, J., et al. (2008). Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 300(11), 1311. https://doi.org/10.1001/jama.300.11.1311
Nygaard, I., Brubaker, L., Zyczynski, H. M., Cundiff, G., Richter, H., Gantz, M., et al. (2013). Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse. JAMA, 309(19), 2016. https://doi.org/10.1001/jama.2013.4919
Oliphant, S. S., Lowder, J. L., Lee, M., & Ghetti, C. (2014). Most older women recover baseline functional status following pelvic organ prolapse surgery. International Urogynecology Journal, 25(10), 1425–1432. https://doi.org/10.1007/s00192-014-2394-x
Poma, P. A. (2000). Nonsurgical management of genital prolapse. A review and recommendations for clinical practice. The Journal of Reproductive Medicine, 45(10), 789–797. Retrieved August 20, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/11077625
Richter, H. E., Brumfield, C. G., Cliver, S. P., Burgio, K. L., Neely, C. L., & Varner, R. E. (2002). Risk factors associated with anal sphincter tear: A comparison of primiparous patients, vaginal births after cesarean deliveries, and patients with previous vaginal delivery. American Journal of Obstetrics and Gynecology, 187(5), 1194–1198. https://doi.org/10.1067/mob.2002.126977
Robinson, J. N., Norwitz, E. R., Cohen, A. P., McElrath, T. F., & Lieberman, E. S. (1999). Episiotomy, operative vaginal delivery, and significant perinatal trauma in nulliparous women. American Journal of Obstetrics and Gynecology, 181(5 Pt 1), 1180–1184. https://doi.org/10.1016/s0002-9378(99)70104-3
Roslani, A. C., Ramakrishnan, R., Azmi, S., Arapoc, D. J., & Goh, A. (2014). Prevalence of faecal incontinence and its related factors among patients in a Malaysian academic setting. BMC Gastroenterology, 14, 95. https://doi.org/10.1186/1471-230X-14-95
Saldana Ruiz, N., & Kaiser, A. M. (2017). Fecal incontinence - challenges and solutions. World Journal of Gastroenterology, 23(1), 11–24. https://doi.org/10.3748/wjg.v23.i1.11
Samuelsson, E. C., Victor, F. T., Tibblin, G., & Svärdsudd, K. F. (1999). Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. American Journal of Obstetrics and Gynecology, 180(2 Pt 1), 299–305. https://doi.org/10.1016/s0002-9378(99)70203-6
Sanses, T. V. D., Schiltz, N. K., Couri, B. M., Mahajan, S. T., Richter, H. E., Warner, D. F., et al. (2016). Functional status in older women diagnosed with pelvic organ prolapse. American Journal of Obstetrics and Gynecology, 214(5), 613.e1–613.e7. https://doi.org/10.1016/j.ajog.2015.11.038
Sexton, C. C., Coyne, K. S., Thompson, C., Bavendam, T., Chen, C. I., & Markland, A. (2011). Prevalence and effect on health-related quality of life of overactive bladder in older americans: Results from the epidemiology of lower urinary tract symptoms study. Journal of the American Geriatrics Society, 59(8), 1465–1470. https://doi.org/10.1111/j.1532-5415.2011.03492.x
Siddiqui, N. Y., Levin, P. J., Phadtare, A., Pietrobon, R., & Ammarell, N. (2014). Perceptions about female urinary incontinence: A systematic review. International Urogynecology Journal, 25(7), 863–871. https://doi.org/10.1007/s00192-013-2276-7
Siddle, K., Vieren, L., & Fiander, A. (2014). Characterising women with obstetric fistula and urogenital tract injuries in Tanzania. International Urogynecology Journal, 25(2), 249–255. https://doi.org/10.1007/s00192-013-2185-9
Swift, S. E., Tate, S. B., & Nicholas, J. (2003). Correlation of symptoms with degree of pelvic organ support in a general population of women: What is pelvic organ prolapse? American Journal of Obstetrics and Gynecology, 189(2), 372–377; discussion 377-9. https://doi.org/10.1067/s0002-9378(03)00698-7
The World Health Organization. (1997). Care in normal birth: A practical guide. Technical working group, World Health Organization. Birth (Berkeley, Calif.), 24(2), 121–123. Retrieved September 2, 2019, from http://www.ncbi.nlm.nih.gov/pubmed/9271979
The World Health Organization. (2017). Integrated care for older people (ICOPE) Guidelines on community-level interventions to manage declines in intrinsic capacity. Retrieved August 6, 2019, from https://www.who.int/ageing/health-systems/icope/evidence-centre/ICOPE-evidence-profile-urinary-incont.pdf
The World Health Organization. (2018). Maternal Mortality Fact Sheet. Retrieved August 21, 2019, from http://www.who.int/news-room/fact-sheets/detail/maternal-mortality
UNICEF. (2009). The state of the World’s children.
Vergeldt, T. F. M., Weemhoff, M., IntHout, J., & Kluivers, K. B. (2015). Risk factors for pelvic organ prolapse and its recurrence: A systematic review. International Urogynecology Journal, 26(11), 1559–1573. https://doi.org/10.1007/s00192-015-2695-8
Vitale, S. G., Caruso, S., Rapisarda, A. M. C., Valenti, G., Rossetti, D., Cianci, S., & Cianci, A. (2016). Biocompatible porcine dermis graft to treat severe cystocele: Impact on quality of life and sexuality. Archives of Gynecology and Obstetrics, 293(1), 125–131. https://doi.org/10.1007/s00404-015-3820-0
Walker, G. J. A., & Gunasekera, P. (2011). Pelvic organ prolapse and incontinence in developing countries: Review of prevalence and risk factors. International Urogynecology Journal, 22(2), 127–135. https://doi.org/10.1007/s00192-010-1215-0
Wall, L. L. (2016). Residual incontinence after obstetric fistula repair. Obstetrics & Gynecology, 128(5), 943–944. https://doi.org/10.1097/AOG.0000000000001734
Wall, L. L., Arrowsmith, S. D., Lassey, A. T., & Danso, K. (2006). Humanitarian ventures or “fistula tourism?”: The ethical perils of pelvic surgery in the developing world. International Urogynecology Journal, 17(6), 559–562. https://doi.org/10.1007/s00192-005-0056-8
Whitehead, W. E., Borrud, L., Goode, P. S., Meikle, S., Mueller, E. R., Tuteja, A., et al. (2009). Fecal incontinence in US adults: Epidemiology and risk factors. Gastroenterology, 137(2), 512–517, 517.e1–2. https://doi.org/10.1053/j.gastro.2009.04.054
Whiteside, J. L., Weber, A. M., Meyn, L. A., & Walters, M. D. (2004). Risk factors for prolapse recurrence after vaginal repair. American Journal of Obstetrics and Gynecology, 191(5), 1533–1538. https://doi.org/10.1016/j.ajog.2004.06.109
Williams, G., Browning, A., & Petros, P. E. (2018). The integral theory and its tethered vagina syndrome revisited: Vaginal scarring may cause massive urinary incontinence. BJU International, 122(4), 532–534. https://doi.org/10.1111/bju.14218
Wright, J., Ayenachew, F., & Ballard, K. (2016). The changing face of obstetric fistula surgery in Ethiopia. International Journal of Women’s Health, 8, 243–248. https://doi.org/10.2147/IJWH.S106645
Wu, J. M., Matthews, C. A., Conover, M. M., Pate, V., & Funk, M. J. (2014). Lifetime risk of stress incontinence or pelvic organ prolapse surgery. Obstetrics and Gynecology, 123(6), 1201–1206. https://doi.org/10.1097/AOG.0000000000000286
Zeleke, B. M., Ayele, T. A., Woldetsadik, M. A., Bisetegn, T. A., & Adane, A. A. (2013). Depression among women with obstetric fistula, and pelvic organ prolapse in Northwest Ethiopia. BMC Psychiatry, 13(1), 236. https://doi.org/10.1186/1471-244X-13-236
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2022 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Nardos, R., Jacobson, L. (2022). Comprehensive Pelvic Floor Health: Beyond the “Hole” in the Wall. In: Drew, L.B., Ruder, B., Schwartz, D.A. (eds) A Multidisciplinary Approach to Obstetric Fistula in Africa. Global Maternal and Child Health. Springer, Cham. https://doi.org/10.1007/978-3-031-06314-5_33
Download citation
DOI: https://doi.org/10.1007/978-3-031-06314-5_33
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-031-06313-8
Online ISBN: 978-3-031-06314-5
eBook Packages: MedicineMedicine (R0)