A mother of three, left incontinent at the age of 25 after being seriously injured in a road accident in Oman, has expressed her gratitude to doctors in Abu Dhabi for giving her a new lease of life.
Iman, who asked that her full name not be disclosed, said she had “lost hope” after years of her condition going undiagnosed following the accident in 2011.
The pioneering surgery, undertaken in 2023, uncovered multiple vesicovaginal fistulas – abnormal openings between the bladder and vagina – that had gone undiagnosed.
Iman, a UAE resident who is now 39, was treated in Oman before being transferred back to the UAE, where she underwent several operations to repair multiple pelvic fractures.
Metal plates and screws were inserted into her pelvis only to be removed after she developed severe sepsis. Although she survived the crash, a new ordeal soon began.
“I started leaking urine all the time,” Iman said. “I was diagnosed with overactive bladder, urinary incontinence and repeated infections. I was given medication over and over again, but nothing worked.”
For years, she sought treatment to identify the underlying cause.
“By 2018, I had lost hope,” she said. “I had three children and I was still young. I felt as though my life had stopped, but my family encouraged me to keep searching.”
Eventually, relatives advised her to seek further treatment in Abu Dhabi, where she was initially referred to Dr Amin El Helw, consultant orthopaedic surgeon at Sheikh Shakhbout Medical City (SSMC).
Recognising the complexity of her symptoms, he referred her to Dr Manal Elredy, consultant obstetrician, gynaecologist and urogynaecologist at the hospital.
“Iman’s condition was complex and hard to diagnose. During the accident, her pelvis fractured and a piece of bone became displaced into the vagina, effectively blocking it,” said Dr Elredy.
The operation that followed showed why previous examinations had failed.
“Because the bone was blocking the vagina, we could not properly assess the area until it was removed,” Dr Elredy said. “That was when we diagnosed multiple vesicovaginal fistulas.”
Dr Elredy explained that the abnormal opening caused by a vesicovaginal fistula can “cause urine to leak continuously, day and night, without stopping. It does not respond to medication. Surgery is the only effective treatment.”
She said the case illustrates why persistent urinary incontinence should always be investigated, particularly when symptoms begin after major trauma.
“About a third of women under the age of 45 experience some form of urinary incontinence, while the figure rises to about 50 per cent after the age of 45,” said Dr Elredy.
“The common causes include pregnancy, childbirth, chronic constipation, weakness of the pelvic floor and heavy lifting.
“There are also women who have never been pregnant who develop urinary incontinence because of connective tissue disorders or congenital weakness of the pelvic floor.
“Roughly two-thirds of patients require surgery, while about one-third can be managed with medication,” said Dr Elredy.
“In Iman’s case, the problem was not an overactive bladder. She had been treated medically because the fistula had never been diagnosed.”
Looking back on the years of suffering before her diagnosis, Iman said: “I tried everything, but nothing changed. I felt my life had stopped.”
