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

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.

The Severity and Impact of Pelvic Girdle Pain and Low-Back Pain in Pregnancy: A Multinational Study.

BACKGROUND: Pelvic girdle pain (PGP) and low-back pain (LBP) are the most common musculoskeletal disorders experienced during pregnancy, yet they are not familiar to healthcare providers in some countries. The objective was to compare prevalence, severity, and impact of PGP and LBP among pregnant women in the United States, the United Kingdom, Norway, and Sweden. Women's desires for, access to, and experience of treatment were also examined. MATERIALS AND METHODS: This is a cross-sectional self-reported questionnaire study of pregnant women, recruited at maternity care units in gestational weeks 30-38. Main outcome measures were presence and impact of PGP and/or LBP. RESULTS: A total of 869 pregnant women from the United States (n = 214), the United Kingdom (n = 220), Norway (n = 220), and Sweden (n = 215) were included. PGP and/or LBP were reported by 70%-86%, with lowest prevalence in Scandinavia. Severity and impact differed significantly across countries (p < 0.001), with U.K. women reporting the highest pain intensity (Numeric Rating Scale [NRS] 7/10) and highest mean total score on the Pelvic Girdle Questionnaire (PGQ) (46/100). U.S. women were significantly less afflicted, with mean PGQ total score 35/100 (p ≤ 0.001). The countries differed regarding concern about PGP and/or LBP (p < 0.001), with U.K. women being most affected (NRS 5/10). Norwegian women were most likely to receive treatment (53%) and U.S. women least likely (24%) (p < 0.001). Among women receiving treatment, 68%-87% reported a positive effect. CONCLUSIONS: PGP and/or LBP during pregnancy are common in the United States, the United Kingdom, Norway, and Sweden. Severity, concern, and treatment experiences differed across countries. The majority of women who received treatment reported a positive effect.

Obstetric fistula: the use of urethral plugs for the management of persistent urinary incontinence following successful repair.

INTRODUCTION AND HYPOTHESIS: The objectives of this study are to analyse the effect of a urethral plug as a means of controlling persistent urinary incontinence following successful repair of an obstetric vesicovaginal fistula (VVF) and to identify factors which might influence potential success or failure. METHODS: Data from Physiotherapy Department records of a series of 181 women referred for urethral plug assessment following successful repair of VVF were studied retrospectively. Outcome in terms of continence status with the plug was considered in relation to estimated bladder size, urethral length and diameter, and vaginal scarring. RESULTS: A total of 137 women (75.7 %) reported being dry whilst using a urethral plug and 18 (9.9 %) half dry. There were 26 women (14.4 %) who remained wet, 17 of whom had a new or wide urethra. A total of 101 women (55.8 %) had a smaller than normal estimated bladder size (linear measurement from urethral meatus to the deepest point of the bladder = <7.5 cm) and were more likely to remain wet although this was not found to be statistically significant. Adverse incidents included rupture of the urethral plug (two) and migration of a plug into the bladder, requiring cystoscopic removal (six) CONCLUSIONS: A urethral plug appears to be an effective means of restoring or improving continence in women with persistent urinary incontinence following successful repair of obstetric VVF although data on long-term outcome were not available for analysis. Success rates may be lower if women have a significantly reduced bladder capacity or a new or wide urethra.

How to make good children's nurses: children's view.

A consultation was held to seek children's views on how to make better children's nurses to influence a new curriculum. In one-to-one sessions, ten hospitalised children were asked to complete body outlines of 'good' and 'not so good' nurses. Based on this the children were asked about how good children's nurses could be made. They agreed that although children's nurses are special people with some innate characteristics, they also needed education to make them good at nursing children. The children were able to identify three areas of learning that could help to make a good children's nurse. The researchers categorised these as: attitudinal and professional persona; Cognitive and psychomotor learning; experiential learning. The consultation highlighted methodological issues in consulting children about curriculum development, as well as drawing our attention to how children are represented in the children's nursing curriculum. Child nurse lecturers should work in collaboration with clinical colleagues and, more importantly, children to develop teaching and learning in children's nursing.

Pregnancy after TVT-O: case report and literature review.

A 37-year-old woman previously treated with TVT-O developed recurrent symptoms of stress urinary incontinence during pregnancy. Symptoms started to develop later in the second trimester and progressed gradually to affect her quality of life at the end of pregnancy. In the event she had a very quick spontaneous vaginal delivery at 40 weeks' gestation. Postnatal physiotherapy successfully controlled the incontinence symptoms and urodynamic studies demonstrated no incontinence with a stable bladder and a normal flow rate. The patient remains well 2 years following delivery with no further treatment.