After fistula repair, the nurse must advise the patient on discharge that
A. Abstinence for 3 month
B. Ensure that next delivery is by caesarean
C. Do pelvic floor exercises to strengthen the muscles
D. Both (A) and (B)
Correct Answer: D. Both (A) and (B)
Explanation
Here is the standard post–fistula repair discharge advice that a nurse should give to the patient. These points apply mainly to vesicovaginal fistula (VVF) and rectovaginal fistula (RVF) repairs:
Discharge Advice After Fistula Repair
1. Maintain Strict Genital Hygiene
- Keep the perineal area clean and dry.
- Wash with clean water after urination or defecation.
- Pat dry—do not rub.
- Change pads frequently if there is any discharge.
2. Avoid Sexual Intercourse
- No sexual intercourse for at least 3 months (or until follow-up approval by the surgeon).
This allows the repaired tissue to heal properly and prevents breakdown of the repair.
3. Avoid Heavy Lifting and Strenuous Activity
- Do not lift heavy objects.
- Avoid activities that increase abdominal pressure (vigorous exercise, running).
- These activities can strain pelvic tissues and compromise healing.
4. Maintain Good Nutrition and Hydration
- Drink plenty of fluids to keep urine dilute (reduces irritation).
- Eat a balanced diet rich in protein, iron, and vitamins to promote tissue healing.
- Prevent constipation through high-fiber foods.
5. Prevent Constipation
- Take prescribed stool softeners.
- Eat fruits, vegetables, and whole grains.
- Avoid straining during bowel movements.
6. Continue Prescribed Medications
- Antibiotics (if prescribed).
- Analgesics for pain.
- Stool softeners.
7. Pelvic Rest
- No vaginal douching.
- No insertion of tampons or anything vaginally.
8. Follow-up Visits
- Attend all scheduled follow-up appointments to assess healing and bladder function.
9. Bladder Care (if catheter is present)
- Keep Foley catheter clean.
- Avoid pulling or bending the catheter.
- Watch for blockage, foul odor, fever, or pain.
10. Warning Signs to Report Immediately
- Fever
- Lower abdominal or pelvic pain
- Leakage of urine through the vagina
- Foul-smelling vaginal discharge
- Bleeding
- Difficulty urinating
Other Options Details
Here is a clear and simple description of all the options:
A. Abstinence for 3 months
This means avoiding sexual intercourse for about 3 months.
It is usually advised after conditions like vesicovaginal fistula repair, pelvic surgeries, or childbirth to allow proper healing of tissues and prevent reopening of the wound.
B. Ensure that next delivery is by Caesarean
This means the woman should deliver her next baby by C-section instead of normal vaginal delivery.
This is often recommended when a woman has had previous obstetric fistula, severe pelvic injury, or other complications where vaginal delivery may worsen or recreate the problem.
C. Do pelvic floor exercises to strengthen the muscles
Pelvic floor (Kegel) exercises help strengthen the muscles that support the bladder, uterus, and bowel.
They are useful in:
- Urinary incontinence
- Mild pelvic organ prolapse
- Post-childbirth muscle weakness
But they may not fix structural problems like fistulas.
D. Both (A) and (B)
This option means following abstinence for 3 months + ensuring the next delivery is Caesarean.
These two recommendations are commonly given after fistula repair to ensure complete tissue healing and avoid recurrence.
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Writer: Vandita Singh, Lucknow (GS India Nursing Group