Overview – What is it?
Fistula or rather, obstetric fistula, is an abnormal opening between the genital tract and urinary tract or rectum that occurs during childbirth due to obstructed labour. It causes women to leak urine, faeces, or both, and can lead to depression and chronic medical problems, among other complications.
Obstetric fistula can be corrected through surgery and prevented through the avoidance of early marriage or pregnancy, and by having good obstetric care.
Causes – What causes it?
Obstetric fistula is caused by prolonged, obstructed labour which can last for 2 or more days. In obstructed labour, prolonged pressure is exerted by the foetus on the woman’s soft tissue against the pelvic bone. This cuts off blood supply, damaging the tissue separating the urinary tract or rectum from the vagina, leaving a hole that leaks urine, faeces, or both, from the vagina uncontrollably. The risk for a girl or woman to have to go through obstructed labour is increased by:
- Getting pregnant at an early age
- Lack of access to skilled obstetric and emergency care
- Untimely access to the right obstetric care
Symptoms – What do you feel?
A girl or woman who has fistula leaks urine, faeces, or both, through the vagina as a result of the hole left behind between the vagina and rectum after a woman goes through obstructed labour. Other symptoms of obstetric fistula include:
Diagnosis – How do you diagnose it?
- Medical History: The first step in diagnosing obstetric fistula is understanding the patient’s medical history; especially whether the patient has given birth or has got treatment for gynaecological cancer before. During the doctor’s consultation, the doctor will also be able to understand what symptoms the woman has; whether she is leaking urine constantly, whether the leaking started after childbirth, whether she had a prolonged labour, and any other information that can help in making the correct diagnosis.
- Pelvic examination: By examining the pelvis, the doctor can, at times, feel the hole.
Tests can also be done for proper diagnosis. These tests include:
- Cystoscopy: This is done by inserting a cystoscope into a woman’s vagina which enables the doctor to see through the ureter and the urinary bladder.
- Retrograde pyelogram: This involves carrying out an x-ray together with a dye which makes it easier to view whether there is a leakage in the ureter and the vagina.
- Dye test: This test involves filling the bladder with a dye solution, after which the patient is asked to cough, and the examiner observes whether there is any leakage in the vaginal area.
- Fistulogram/ Angiogram: This is an x-ray which enables the doctor to see through the internal organs and whether there are any fistulas in the rectum or bladder.
- Sigmoidoscopy: This involves using a flexible tube which is inserted into the rectum to check whether there is a fistula in between the rectum and vagina.
Treatment – How do you treat it?
- Surgery: Most fistula cases can be corrected through simple reconstructive surgery. However, in situations where the patient cannot afford the cost of reconstructive surgery, other treatments are available.
Other treatment options are:
- Urostomy: This involves surgically diverting the flow of urine from the kidneys and ureters, allowing for the urine to be collected in a bag. This way, the leakage is avoided.
- Catheterization: This procedure involves inserting a Foley catheter into a woman’s urethra where the urine is drained from the bladder into a bag that can be drained when full. This procedure is however, ideal when the fistula is detected early because there is more chance of the hole closing naturally, especially if it is small.
Prevention – How do you prevent it?
A great percentage of obstetric fistulas can be prevented by doing the following:
- Education: Educating the society is the first step to reducing or ending fistula cases in Africa. Educating the society on what fistula is, the importance of ensuring pregnant women get good medical care, and the importance of embracing women who have fistula, will go a long way in making more people aware of the need for proper obstetric care for pregnant women and making more women feel they can come out to talk about their condition and seek medical treatment without fear of isolation and judgement.
- Ensuring skilled obstetric care: All pregnant women should be able to access skilled birth attendance to ensure that they deliver safely and, in case of any complications such as obstructed pregnancy, they are able to get the emergency care they need, for instance, by having a Caesarean section.
- Timely obstetric care: Ensuring that a pregnant woman gets to hospital in time, especially in situations where she is experiencing complications, can, to a great extent, not only save her life and that of her baby, but also prevent childbirth complications like fistula. Health facilities should therefore be brought closer to people and good infrastructure be put in place, to allow for more accessibility to the health facilities.
- Ending early marriages: Girls who get married at an early age, most of whom are forced into it, are at a high risk of developing fistula. Ending early marriages and, in turn, delaying the first pregnancy, will help to reduce the number of fistula cases in Africa where the number of forced marriages is the highest.