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About Obstetric Fistula

What is obstetric fistula?

Obstetric fistula is a complication of pregnancy that causes a hole to form between a woman’s vagina and her bladder (vesicovaginal fistula), or between her vagina and her rectum (rectovaginal fistula). The condition causes urine, feces or both to leak down through the vagina.

What causes fistula?

Obstetric fistula is caused by neglected prolonged labour. In the developed world, these prolonged labours typically result in caesarean sections. However, many less-developed countries lack access to emergency obstetric care, so caesarean section is not an option. For women in these countries, obstructed labours can last for days, threatening the mother’s life and often resulting in the death of the child. During this time, the significant pressure created by labour (by the presenting part, usually the head) can compress the tissues of the vagina, bladder, and rectum against the pelvic bone, restricting blood flow, and eventually causing these tissues to die. The result is obstetric fistula – a hole connecting vagina and rectum or vagina and bladder.

What is life like for women with fistula?

Women who live with an untreated fistula are often marginalized by their debilitating condition. The constant smell of leaking urine or feces can rob women of their ability to work or maintain meaningful social interaction and relationships. The stigma and shame associated with the condition can be devastating.

Who is at highest risk for fistula?

Small women, and women who give birth at a young age, are more likely to have an obstructed labour leading to fistula. Women who are malnourished or who are in general poor health are also at an increased risk.

How many women are living with an untreated fistula?

Because fistula is most common in less-developed countries, accurate data for fistula is limited. Worldwide estimates suggest that over 2 million women are currently living with an untreated obstetric fistula.

Where is fistula most common?

Fistula was once common in Canada and throughout the world. Because of advancements in obstetric medicine, obstetric fistula is most common today in the world’s least developed countries, particularly in rural or remote areas where access to care is limited. In particular, fistula is common in parts of Sub-Saharan Africa and less-developed countries in Asia. The problem is largely due to a lack of access to trained health professionals during birth.

Can fistula be treated?

Fistula can be treated through reconstructive surgery, and the procedure has a high success rate. Sadly, many women with fistula do not have access to this surgery.

How can we prevent obstetric fistula?

Prevention is the best way to address the issue of obstetric fistula. The most effective method of prevention is to ensure that women in less-developed countries have access to skilled attendants at time of birth, and access to emergency obstetric care. Access to family planning services can also play an important role in reducing fistula.

What are Canadians doing to help?

Through the International Women’s Health Program, Canadian health professionals are providing training in emergency obstetrical care to local health-care workers in less-developed countries. Since 1998, the program has offered training interventions in over 20 countries. The training focuses on preventing the most common causes of maternal and newborn death during labour, as well as complications such as fistula.

 

Last Updated June 12, 2009