Fistula

Hello guys? I hope you enjoyed our previous episode on female genital mutilation/cutting. If you haven’t seen the update, its available on my website. Click here. It’s a very interesting read. If you did not receive the email notification, you might want to check your spam emails because sometimes some emails can hide there.

Let’s continue on our women’s health journey and hopefully educate each other or remind you of some facts you might have forgotten.

On today’s episode two of season one, we look at:

Fistula

By definition this is an abnormal opening or passage between two organs or between an organ and the surface of the body. This can be anywhere in the body, such as esophagus and trachea, but today we will concentrate on the female genitalia fistulas, since our series is on women’s health.

There are many causes of fistulas: The list is very long but for the purpose of today’ discussion we will only mention a few. Which are:

• Congenital malformations (born with it)

• Obstetric trauma (injury while giving birth)

•  Foreign bodies in vagina i.e., sex toys

• Surgery

• Extension of malignant disease (cancers)

• Sexual assault

• Accident

• Old age

There are a lot of medical terminology to describe the exact region where the fistula is, such as; Vaginal-perineal, Tubo-intestinal, Utero-intestinal, Vaginal-intestinal, Recto-vaginal, Vesico-colic, Utero-colic, Vesico—uterine, Vesico-vaginal, Utero-rectal, and Perineo-intestinal, to bore you with a few. You don’t need to know all these but just understand that it is a complex condition affecting girls and women.

Alright so lets look at obstetric fistula. Obstetrics is a branch of medicine that specializes in the care of women during pregnancy and childbirth and in the diagnosis and treatment of diseases of the female reproductive organs.

Obstetric fistulas are commonly as a result of child birth, though there are other causative etiologies as I mentioned earlier but it is mostly caused by injury to the pelvic tissue caused by prolonged and unrelieved obstructed labour that may last several hours or days.

So how does it happen? Well, I will explain medically and try to simplify it. During obstructed labour, prolonged pressure of the fetal presenting part, commonly the head, severs blood supply to the soft tissue on the bladder resulting in ischemic necrosis. The necrotic tissue on the bladder or rectum soon sloughs off resulting in urine or stool incontinence.

This simple means that, the pressure from the baby trying to get out, can damage some blood vessels which supply blood to the tissues around the vagina, the bladder, or the rectum. Once those tissues stop receiving blood, they will die and start falling off. They can leave an opening that connects the vagina with the rectum or with the bladder or any other organs around. This means that, faeces or urine can enter the vagina and cause a lot of problems, like infections and foul smells.

In the unfortunate event, the baby, or the mother can die during birth, but when they survive, the baby will have life long delabitating complications and the mother will also have complications such as those which have already been mentioned above.  

The sad part is that, this can be preventable but as I said in the beginning of the season that, we will put emphasis on women in rural areas, which often than not, have to give birth at home because clinics are too far, or they don’t operate 24 hours in that specific area, or there are cultures or traditions that dictate how she should give birth.

Let me tell you a story about this one woman from a rural area. She was so excited about being pregnant and she couldn’t wait to have her baby as she had recently gotten married and the pressure to have children in rural settings is much stronger that it is in urban setting. (Story for another day). She was so proud that she was going to be a mother. When the labour pains started, she was home, and it was the middle of the night. She had rehearsed many times and she has been told stories from those that have done it before, on what she needed to do when the time came. So she got up and crouched on the floor and waited for the baby to come out, but it didn’t come, no matter how hard she pushed. The pain just kept getting worse and at some point, she fell down. The morning came and the whole day passed by, and baby still refused to come out.  After so many hours of pushing and pushing, she stopped feeling the baby’s kicks.  The next morning, she eventually gave birth to a dead baby boy. She was so exhausted after the experience; she fell asleep for a long time and when she woke up the bed was wet and there was blood and a foul smell.

we can both agree that this was not a pleasant experience for any human being to go through.  We can imagine that she had serious injuries and bleeding on her private part. Many of the underlying social causes that contribute to the realities of these woman are.

• · Poverty

• · Uneducated

• · Relatively poor health

• · Poor nutrition

• · Stunted growth (short and small bodied women)

• · Early marriages and childbirth (younger girls having children)

• · Limited access to maternal health care

• · Harmful traditional practices

The heart breaking fact is that, just below a hundred thousand women are affected each year per rural setting of most African countries. These are just estimated figures. WHO estimate the figure to be at least two million worldwide per year. So its really bad, especially because we are in 2023, and we have the technology and the means to avoid and or prevent these from happening.  

Recent research actually shows that 83% of the cases are in rural areas but about 56% also occurs in urban areas.  The most affected age group at 32% is mostly teenagers (14 to 19 years old). The issue of teenage pregnancy is a thorn for all societies around the world.

Ok, now so what are the clinical consequences of an obstetric fistula? The woman would suffer from offensive smells, especially if the abnormal communication is between the vagina and the rectum. They will suffer from leaking urine, which could be mistaken for bladder incontinence (this is weakening of bladder sphincters to hold urine) but in this case, the damage to the walls, internally is what is causing the communication between these two organs. The woman will suffer from persistent infections as you may already imagine, and genital sores would be a reality for her. In some cases, the woman can suffer from foot drops (this is the inability to lift the front part of her feet)

Why am I telling you all this? Mumm? Ill tell you why. It is because I would like for you, after reading this article, to be an advocate to speak out against, teen pregnancy, teen marriages, and advocate for more clinic facilities for women in rural areas. Advocate for women to attend their antenatal care during pregnancy.

The psychosocial effects on women are dire. They loose interest in life, isolate themselves, feel rejected, misery, depression and eventually loss of ability to earn income.

The good news is that fistulas can be repaired surgically, but only after three months post-delivery. There are many reasons, for this and one being the fact that, the woman’s hormonal balances need to restore to non-pregnant state. But before then, the woman needs to learn how to manage until then. Sanitary care, antibiotics for the infections. At the end of it all, the fistula will be closed, and the woman will be continent and able to resume daily activities and active life.

In conclusion

It wouldn’t be me if I didn’t say in conclusion... But yes, I want to stress the importance of Raising awareness for prevention and treatment.

• · Advocacy

• · Community education

• · Community workers and clinicians

• · Medical school

If we could get to a world where we have waiting homes for pregnant women, closer to health care facilities. I am imagining a world of safer motherhood facilities like improved access to family planning in rural regions. A place where we have enough skilled and willing birth attendants (Midwifery). A world where there is improved communication, teaching and transport.

Thank you reading. See you on the next installment.

Referrence

https://www.crtv.cm/2023/05/obstetric-fistula-unfpa-and-stakeholders-multiply-efforts-to-end-disease/