Obstetric fistula is a destructive medical condition in which a hole develops in the birth canal (a muscular canal that goes from the uterus to the outside of the body, also called vagina) resulting from difficult childbirth. This can occur between the vagina and the rectum, ureter or bladder.
The resulting hole in the birth canal often results in chronic leakage of urine and/or faeces.
This condition arises as a result of a long or an obstructed labour, that lasts several days when the unborn baby cannot pass through the pelvis. The baby may be too big for the pelvis or is positioned wrongly or the pelvis may not be fully developed.
Basically, there are two fistulas that occur during pregnancy.
- Vesico-vaginal fistula,
- Recto-vaginal fistula
In vesico-vaginal fistula, an unwanted hole evolves from the vagina to the bladder, while a recto-vaginal fistula is a hole that evolves from the vagina to the rectum.
Both fistulas affect the proper functioning of the body of the girls and women that are affected, resulting in lifelong problems.
Causes of Obstetric Fistula
Pregnant teens or women with small statures due to malnourishment are at a higher risk of having birth complications because of smaller pelvic bones surrounding the birth canal.
The affected women are usually undernourished, uneducated and are given off into marriage and begin childbearing at an early age before their body is fully developed to cope with this. They are usually from rural, poor areas, with an early first pregnancy.
No access to medical facilities, obstetric care and emergency caesarean section delivery. The woman is tended to at home during labour without the benefit of trained personnel and is far from medical care that can provide surgical intervention.
- Lack of competent and skilled medical staff.
- Lack of medical supplies and equipments.
Majority of the affected women have no formal education and do not have access to precise information as regards health care, family planning, pregnancy and even childbearing.
Moreover, certain beliefs and traditions of most of women may stop them from sorting proper and necessary medical care, and for the few who are able to seek help have little to no financial ability to fund their medical care.
Symptoms
Constant leakage of urine and/or faeces as a result of obstetric fistula implies that the affected woman is constantly wet and dirty with a foul smell and is also constantly feeling dehydrated because of the loss of body fluid.
Complications such as infections, kidney disease, genital ulcerations, damage to vaginal tissues and painful sexual intercourse may also arise as a result of this.
Social and Psychological Impact
Asides from its medical consequences, this condition also has some social and psychological impact on the affected women.
These women might be isolated, stigmatized and discriminated due to the unpleasant smell that accompanies the constant leakage of urine and/or faeces. Some may be tagged unclean and unfit to partake in religious activities in their communities, while others may be rejected by their loved ones.
Treatment
The purpose of trying to fix this medical condition (Obstetric Fistula) is to surgically close the hole and to return normalcy to the affected woman’s sexual life and fertility. Also, important, is to ensure safe delivery in future and to reintegrate these ones back into the society.
Fistula repair is best carried out by experienced and efficient fistula surgeons. Surgical repair of a fistula has to be successful at the first attempt as the best surgical results are usually gotten with the first trial.
First and second trials are associated with lower success rates and higher complication risks.
Complications
There are many complications that may arise. Some of them include.
- Infections: wounds, urinary tract infections
- Vaginal narrowing
- Obstruction to bladder and kidney drainage
Recommendations
Obstetric fistula is a debilitating condition that no woman alive should have to suffer. Hence, sensitization programs should be organized to educate families on the dangers of early child marriage and the resultant effect on the girl child.
Both young and mature pregnant women should be educated on family planning, pregnancy, and childbirth. These sensitizations can take place right at medical centres.
Tending to pregnant women in labour at home by unqualified midwives should also be discouraged, as this is also a major cause of fistula, loss of life of both mother and child.
