A fistula is a permanent abnormal hole or passageway between body parts (like a blood vessel or an organ) and another structure. Fistulas can develop at any age and in any body part. They usually result from injury or surgery, but infections and inflammation can also be the cause. Obstetric fistula, which results from obstructed labour during childbirth, can be life threatening.
Fistulas can form between two loops of intestine in people with diabetes and certain gastrointestinal diseases like inflammatory bowel disease (IDB), ulcerative colitis and Crohn’s disease.
The most common type is an obstetric fistula, which develops following a long, difficult or obstructive labour and affects the urinary and reproductive tract. It causes permanent incontinence (constant leakage of urine or faeces through the vagina). Fistulas occur almost entirely in developing Asian and African countries, where young pregnant girls live in poverty with little or no access to good medical facilities.
The Fistula Foundation estimates that more than two million young women live with untreated obstetric fistula in sub-Saharan Africa and Asia, with between 50 000 to 100 000 women worldwide affected each year. Despite being both preventable and treatable, only 60,280 women received fistula repair surgery between 2010 and 2013, according to the Global Fistula Map.
How they develop
Few remote areas in Africa have hospitals, obstetric care or trained midwives. If there are birth complications, a woman can be in labour for days.
Obstructed labour occurs when the baby’s head is too big, the uterus is not contracting properly or the mother’s pelvis is too small. When the baby’s head pushes against one area of the birth canal, it restricts blood supply to the delicate surrounding tissue, which eventually dies, leaving an abnormal hole (fistula).
A fistula then forms between the woman’s vagina and bladder (vesicovaginal fistula), or between the vagina and rectum (rectovaginal fistula), or both.
Depending on its location, it can cause varying levels of incontinence and other symptoms, e.g. recurrent vaginal/urinary tract infection, foul-smelling vaginal discharge, passing gas, pus or stool from the vagina, skin infections and pain during sexual intercourse. Not surprisingly, fistulas often cause physical discomfort, shame and emotional distress because women become social outcasts.
Young girls/women are at higher risk if they:
- Live in poor cultures where their ability to marry and bear children largely determine their social status;
- Are forced into marriage, early pregnancies or repeated childbearing;
- Don’t have access to good medical care during pregnancy/labour and give birth at home without access to skilled birth attendants.
Prevention and Treatment
Obstetric fistulas can usually be prevented by:
- Delaying the age of first pregnancy;
- Stopping harmful traditional practices;
- Timely emergency obstetric care if complications occur during labour.
The only cure or treatment for an existing fistula is if a skilled surgeon repairs it in a simple procedure. Between 80 to 90% of women with uncomplicated fistulas regain full control of bodily functions after surgery.