What is an Obstetric Fistula?

An obstetric fistula is a complication of childbirth which occurs when prolonged labor leads to tissue death which creates an opening between the bladder and the vagina or the rectum and the vagina. In some cases, obstetric fistula can become fatal, and in others, it can be very debilitating. There are a number of steps which can be taken to prevent fistula, and the condition is also fully treatable in cases where it could not be prevented.

The process through which a fistula forms starts with a prolonged obstructed labor. As the baby fails to progress, pressure is placed on the walls of the vagina. If the pressure is not relieved, tissues can become ischemic, meaning that they are deprived of oxygen. The oxygen deprivation eventually leads to tissue death. Because the bladder and rectum are both very close to the vagina, the tissue death can inadvertently create an opening where one should not be.

A woman with an obstetric fistula will experience incontinence as the contents of the bladder or the rectum leak out through the vagina. She can also experience repeated infections and inflammation and may also be subject to nerve damage. If the obstetric fistula is not treated, she can develop kidney failure and a severe infection which may lead to death. In addition to being associated with physical complications, fistulas are also emotionally traumatic. Women with fistulas can experience distress because of their incontinence and may be shunned by people who believe that they are unclean.

The treatment for a fistula is surgery to close the opening, which is successful in a very high percentage of cases. Women are also given antibiotics and antiinflammatory drugs to manage the inflammation and infection. In some instances surgery cannot repair the fistula, and a woman may need to be given a urustomy or colostomy to provide a new outlet for drainage of urine or feces.

Historically, obstetric fistula was a not uncommon complication of childbirth, and women of every social class all over the world could be at risk of developing fistulas. Today, the incidence of fistula is primarily limited to nations in the developing world. There are a number of reasons for this, ranging from the fact that women in the developing world tend to have children at younger ages, which increases the risk of fistula, to the issue of poor medical care in many developing countries. Women who do not have access to good prenatal care and the supervision of an experienced obstetrician, midwife, or nurse during childbirth can be at risk of developing an obstetric fistula.

Several charitable organizations work in developing nations to provide prevention services which are designed to reduce the incidence of fistula. In addition, many of these organizations also perform surgery free of charge to repair obstetric fistulas in women who could not otherwise access treatment.