Management of stress urinary incontinence using vaginal incontinence pessaries in rural Kilimanjaro, Tanzania.

Abstract

The effect of incontinence pessaries for urine incontinence (UI) has previously been described in studies from high-income countries, where they have been documented to reduce urinary leakage significantly. However, there is a profound literature gap in these data in low- and middle-income countries. This study, therefore, aims to describe the acceptance, impact and complications of pessary treatment among Tanzanian women diagnosed with stress UI. Women who reported stress UI underwent a stress test, and if positive they were offered an incontinence pessary. Swahili versions of the Urinary Distress Inventory-6 (UDI-6) and the Urinary Impact Questionnaire (UIQ) were administered at 3- and 12-18-month follow-ups in addition to questions regarding pessary acceptance and pelvic examination for complications. A total of 48 women were fitted with an incontinence pessary. The frequency and amount of leakage were reduced significantly at 3- and 12-18-month follow-up. Additionally, a significant reduction in the overall UDI-6 score from 29.2 to 25.0 and overall UIQ score from 52.1 to 25.0 was observed from baseline to 3-month follow-up. Thirty-seven per cent of the women reported vaginal discharge at 12-18months while signs of infection were found in 11.5%. In all, 32/48 (67%) wanted to continue the pessary treatment at 12-18-month follow-up. In the setting studied, pessaries for stress UI can be successfully fitted in most women with considerable acceptance and satisfaction rates and minimal complications.