SESSION 4

CARE AND MANAGEMENT OF

COMPLICATION DURING
POSTNATAL PERIOD
OF MOTHER AFTER
ONE HOUR OF BIRTH TILL 6
WEEKS(Cont)
(Incontinence of faeces & Urine)
 OBJECTIVE
At the end of the session, students will be able to;
1. Review anatomy & physiology of the female excretory
system.
2. Causes of incontinence faeces and urine in the post-natal
period.
3. Identify the Sign and Symptoms of incontinence.
4. Manage the condition during post-natal clinical posting.
OBSTETRIC FISTULA
 Obstetric fistula is a medical condition that occurs primarily
in women during childbirth.
 It is characterized by an abnormal opening between the
rectum and vagina (rectovaginal fistula) or between the
bladder and vagina (vesicovaginal fistula).
 This condition usually results from prolonged and
obstructed labor, which puts prolonged pressure on the soft
tissues, causing tissue damage and subsequent formation of
a fistula.
CAUSES:
 Prolonged obstructed labor is the primary cause.

 Insufficient medical assistance during childbirth, especially

in resource-limited settings, increases the risk.

 Women with obstetric fistula often experience continuous
urinary or fecal incontinence, leading to social isolation and
stigma. Additionally, they may suffer from skin infections
and ulcerations.
 URINE & STOOL INCONTINENCE IN
PUERPERIUM
During the puerperium period common urinary issues:
 Urinary Incontinence: Weakened pelvic floor muscles from
pregnancy and childbirth may lead to involuntary urine
leakage.
 Urinary Retention: Some women may experience difficulty
emptying the bladder completely, often due to trauma during
childbirth.
 Complicated birth, prolonged labour may increase risk of
urinary infections, which may lead to cystitis and in some
 Stress & urge incontinence due to utero-vaginal prolapse,
cystocele, rectocele and dyspareunia are associated with
pelvic floor damage.
 Anaesthesia such as an epidural or spinal anaesthetic can
have an effect on the neurological sensors that control urine
release and flow, which may cause acute retention.
 Urine retention may prevent the uterus from effective
contraction, which leads to increased vaginal blood loss.
SIGN AND SYMPTOM
 Abdominal tenderness.
 Urine dribbles out soon following the operative delivery.
 Blood stained urine following cesarean section or
hysterectomy is suggestive of bladder injury.
 Poor output, dysuria or offensive urine.
 Frequency, urgency, painful voiding.
 Raised temperature or general flu-like symptoms, might
indicate a urinary tract infection.
INV: URINE RE & CS.
Rx/MANAGEMENT

 Antibiotics accordingly.
 If Traumatic fistula: Immediate local repair is
recommended.
 In some cases, there may be spontaneous closure of the
fistula. If it fails, repair is to be done after 3 months.
 Sloughing fistula occur when dead tissue or debris is
expelled from the fistula. Repair should not be attempted.
 Pelvic floor exercises - Kegels.
 Encourage to pass urine following delivery.
 If the woman still can’t pass urine, catheterization
should be done. Continuous drainage is kept until the
bladder tone is regained.
 Ensure adequate bladder emptying to prevent cystitis &
other infections.
 Maintain adequate hydration.
 Avoid bladder irritants like caffeine.
At PNC VISIT:
 Enquire about bladder habits.
 Assess for hydration status.
 Pelvic floor exercise if she can.
 Maintain bladder record, (intake & output)
 Social & psychological support.
Bowel Problems
 It is estimated that about 44% of women will suffer from
constipation and 20–25% of women will suffer from
haemorrhoids following birth.
 Can have short or long term, social, psychological & physical
consequences for a woman.
 Mostly associated with primiparity, instrumental birth and

severe perineal injury.

 Can be caused by a neurological or muscular dysfunction or

both.
 Incidence may be very high because it is too embarrassing for

woman to talk on this issues, therefore they choose to remain

in silent.
Sign and symptom
 Flatus & bowel incontinence.
 Constipation.
 Hemorrhoids.
 Passive leakage.
 Urgency.
 Rx/MANAGEMENT
 Access timely and skilled obstetric care, especially in areas with
limited resources, is crucial to preventing obstetric fistula.
 Ask woman whether she has taken any laxatives in the previous
24 hours and explore what food was eaten.
 Adequate prenatal care and appropriate medical interventions
during childbirth.
 Surgical intervention is the primary treatment for obstetric fistula.
Reconstructive surgery aims to close the abnormal opening and
restore normal function.
 Post-surgery - psychosocial support is essential.
 Determine the nature of the incontinence and distinguish it
from an episode of diarrhoea.
 Dietary assessment - Fiber intake.
 Check hydration status
 Provide pain killers if it is due to perinea injuries & trauma
 Reassurance.

 If bleeding piles/haemorrhoids, Refer to a higher center.

THANK YOU