Obstetric fistula (or vaginal fistula) is a severe medical condition in which a hole develops between the rectum and the vagina (rectovaginal fistula) or between the bladder and vagina (vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available. With this problem, a woman uncontrollably passes out urine and sometimes stool.
Photo: woman with vagina fistula
The resulting disorders typically include incontinences, severe infections and ulcerations of the vaginal tract, and often paralysis caused by nerve damage. Sufferers from this disorder are usually subject to severe social stigma due to odor, perceptions of being unclean, and a mistaken assumption of venereal disease and in some cases, the inability to have children.
It develops when a woman’s pelvis is torn by the baby during the delivery while pushing and mainly due to a small pelvis. It sometimes develops when a prolonged labor presses the unborn child so tightly in the birth canal that blood flow is cut off to the surrounding tissues which eventually rots away. The injury can also be caused by female genital cutting, poorly performed abortions, or pelvic fractures. It can be due to obstructed labor, episiotomy, forceps; vacuum extraction, sexual abuse and rape, lack of education, early marriage and early childbirth are also contributing causes.
“Women with vaginal fistula are stigmatized and despised by the society and most times they don’t have jobs. This puts them in a bad situation when they are abandoned and when they’re not able to work for themselves” says an Obstetrician at Rwanda Military Hospital.
Treatment is available through reconstructive surgery. The surgery for uncomplicated cases has a rate of 90% success, and success rates for more complicated cases are estimated to be 60% successful. The cost for this procedure is estimated to be about 270.000Rwf which is too much for many Rwandan women.
Successful surgery enables women to have normal lives and have more children, but it is recommended to have a cesarean section during delivery to prevent the fistula from recurring. Post operative care is vitally important to prevent infection.
The largest challenge that stands between women and fistula treatment is lack of information because most women have no idea that treatment is available. Due to the fact that this is a condition of shame and embarrassment, most women hide themselves and their condition and suffer in silence with no relief.
Women should undergo proper antenatal care while pregnant, frequent monitoring during labor and be sure to deliver from a health facility so as to reduce the risk of vaginal fistula and to seek treatment when they get it as Dr. Gable Tekle an obstetrician advised.