Obstetric fistula

Vesico-vaginal fistula (VVF) is a hole that develops between the vagina and the bladder, and recto-vaginal fistula (RVF) is a hole that develops between the vagina and the rectum.

Causes

VVF and RVF are both the result of lengthy obstructed labour without the alternative of a caesarean section. The constant pressure of the baby’s head against the mother’s pelvic bone causes the tissues to disintegrate between the vagina and the bladder and/or between the vagina and the rectum.

Consequences of fistula

The baby almost always dies as a result of the long labour and the mother is left leaking urine and/or faeces uncontrollably from the vagina. In addition, fistula can lead to ulceration of the genital area. It may also cause a condition known as “foot drop”, which makes it difficult or impossible for women to walk due to extreme nerve damage to the lower limbs.

Beyond these physical consequences, fistula often takes a severe social toll, resulting in divorce or abandonment and varying degrees of social isolation. It is not uncommon for women with fistula to live in isolation.

Can fistula be cured?

Fistula can be cured; repair surgery can yield success rates of over 90%. The biggest challenge faced by many women with fistula is reaching a health facility that has a surgeon trained in fistula repair. Countries with a high rate of fistula tend to have shortages of trained health care providers and health facilities overall and typically have only a few doctors (if any) trained in fistula repair.

Role of socio-economic factors

Various socio-economic factors can increase a woman’s risk of fistula. The condition is most likely to affect those women who have very a low income (or have minimal control over their finances) and who lack access to preventive and emergency obstetric care. Women who cannot easily travel to hospital facilities, either because of long distances, high costs of transportation or lack of decision-making power in the family, are at an increased risk. Malnutrition and early childbearing are also associated with higher fistula incidence, because it is more difficult for a woman with a small pelvis to deliver her babies normally.

How can fistula be prevented?

Obstetric fistula is preventable and can largely be avoided by:

• • Delaying the age of first pregnancy

• • Termination of harmful traditional practices

• • Timely access to obstetric care.

 

Sources

http://www.who.int