In God Is Our Health,In God Is Our Help
A fistula is an abnormal connection between two epithelial surfaces or cavities whiles an obstetrics fistula is an abnormal connection between the genital tract and the urinary system and/or lower gastrointestinal system that occurs as a consequence of child birth.
It can occur between the vagina and bladder giving rise to a vesicovaginal fistula(VVF) where there is uncontrollable leakage of urine from the vagina or between the vagina and rectum causing a rectovaginal fistula(RVF) with the patient or victim leaking fecal matter from the vagina.
Some victims have a combination of both leakage of urine and fecal matter from the vagina at the same time.
WHAT CAUSES OBSTETRICS FISTULA
An obstetric fistula will typically occur when a pregnant mother has a prolonged, obstructed labor, but does not have access to comprehensiveemergency obstetrics care such as C-section to relief the obstruction.
Obstructed labor accounts for 90% of obstetrics fistulas with genital tract trauma/injuries accounting for the remainder.
Prolonged compression of the bladder base between the fetal head and the pubic bone leads to Soft tissues been caught between the baby’s head and the mother’s pelvic bone, this will restrict the normal flow of blood, leading to infection, sloughing and formation of holes or abnormal connections between the vagina and bladder(VVF) and also between the vagina and rectum (RVF). Urine from the bladder will therefore leak out through the vagina (VVF) and fecal matter canalso leak from the vagina (RVF). Most commonly, prolonged obstructed labour will results in vesicovaginalfistulas (VVfs), but in very pronged obstructed labours, RVFs could also result in addition to VVF.
Incidence of combined fistula ranges from 5-10%.
It will typically take a few days (3-5) following delivery to develop fistula and manifest clinically. Tragically, her baby usually dies.
BURDEN OF THE PROBLEM
According to the world health organization (WHO), there are more than 2 million women living with obstetrics fistula conditions worldwide with majority of them living mainly in Asia and Sub Saharan-Africa
Each year between 50 000 to 100 000 women worldwide are affected by obstetric fistula.
In Ghana, it is estimated that more than 13, 000women suffer from obstetrics fistulas and there are about 1352 new cases recorded annually, an estimate incidence of 1.8 per 1000 deliveries.
Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems.
EFFECT OF FISTULA ON THE LIVES OF WOMEN
Several factors predispose to obstetrics injury and by extension fistula formation. They include socio-economic underdevelopment, poverty, ignorance, harmful traditional practices and difficulties with transportation and communication and poor health system and infrastructure.
All the above factors contribute to a pregnant women developing obstetrics fistula in the developing world/countries because they lead to delays in:
- Delays in realizing that there is a problem,
- Delays in taking decision to go to hospital,
- Delays in reaching the hospital and
- Delays in receiving killed scare at the facility.
African women are also predisposed to dystocia due to narrowed pelvic architecture. This is compounded by early child bearing before pelvic growth is complete as well as undernutrition which retards maturation.
Besides developing a fistula, these women also develop some other sequel of obstructed labour including: foot drop, paraplegia, boner damage, muscle damage, infertility, inability to have regular menses and poor reproductive outcomes.
The social consequences of obstetrics fistula are just devastating;the symptoms of urine and stool leakage make her to constantly smell of urine and fecal matter, creating a very embarrassing and shameful situation for these victims. Other social consequences include:
- Many women are ostracized by families and communities because the condition is considered as a curse, sexually transmitted disease and as a mark of infidelity
- Some are divorced and become single mothers
- Unable to socialize(go to church, mosque, social gatherings)
- Unemployment because they are unable to trade
Some women also develop psychological complications such as depression from the leakage, loss of the baby, divorce, isolation and social neglect. These lead to suicidal tendencies.
The social circumstances of these women make it difficult for them to seek health. The surgery or treatment forobstetrics fistula is purely surgical and most or all of these women are not able to take care of the charges for the surgeries and this prevent them from seeking care.
