What is Obstetric Fistula?
The obstetric fistula is also called as vaginal fistula. A fistula is medically referred as an abnormal opening from an organ which is connected by a passageway to another organ or to a neighboring anatomical structure. A fistula is also said an abnormality that arises from of an underlying condition and in different parts of the body.
In obstetric fistula however, it can either be rectovaginal fistula or an opening in the vagina connecting to the rectum while a vesicovaginal fistula is another form of passageway abnormally created from the urinary bladder to the vagina. This mostly happens during childbirth or labor where labor is prolonged and the pressure in the pelvic bones disintegrates.
According to statistics, about 50,000 until 100,000 women are affected with this condition in the whole world. What seem to be more alarming in the statistics is that this happens to impoverished women who have no direct access to a better medical facility when giving birth. This condition is not treated by medication or by home remedies but only through surgery. Studies showed that an estimated 2 million women or more who have this condition are mostly sub-Saharan African women and Asian women. Additionally, with the occurrence of this disease, it does not only affect them physically but women are also emotionally challenged because perception by the people around them that they are unhygienic.
Rectovaginal fistula is a type of obstetric fistula where there is a vessel connecting the vagina and the rectum. In a normal anatomy, the vagina and the rectum are not essentially connected as to continue in the normal process wherein the stool will only exit from the anus and the affected woman will have menstrual blood coming out from the vagina. If this condition exists, fecal incontinence can happen where the feces and the flatulence exits in the vaginal area. This will then lead to different infections and fecal parts will just exit in a “nonstop” fashion.
The other type of obstetric fistula is the vesicovaginal fistula. In this case, the fistula develops in between the vagina and the bladder. The bladder is connected to the ureter then to the urethra where urine is expelled. In this case, there is a connection from the bladder to the vagina. Because of this, urinary incontinence happens where urine involuntarily exits to the vaginal canal. The patient cannot hold-of their urine when they have VVF or vesicovaginal fistula.
Picture 1 : Recto-vaginal fistula
Image source : ADAM Inc
Picture 2 : Vesicovaginal fistula
Image source : ghananewsagency.org
Obstetric Fistula Symptoms
The symptoms experienced by the patient depend on which type of obstetric fistula they have.
- Vesicovaginal fistula: urinary frequency and/or urinary incontinence which usually happens at night.
- Rectovaginal fistula: fecal incontinence most likely to happen at night.
Causes Of Obstetric Fistula
There are various causes why the obstetric fistula happens. One of the direct causes is during long labors where the child is pressed or stuck in the vaginal canal. Because of this situation which happens for several hours, blood flow restriction occurs in the area that eventually will affect the tissues. Unoxygenated tissues cause necrosis and eventually leading to openings that connect to neighboring anatomical structures called fistula formation.
Other cause of the fistula is the trauma in the vagina in cases of sexual abuse. The lack of lubrication causes trauma on the vaginal walls where it can lead to necrosis and then the formation of the fistula. Gynecological cancer is also another probable cause of the fistula especially when the patient undergoes radiotherapy.
An indirect cause of having obstetric fistula is poverty. This cause or risk factor is backed up by studies where developing countries and first-world countries are compared when it comes to vaginal fistula incidence occurs. It is found out that developing countries suffer about 120-folds more than the 60-folds incidence in developed areas. Because of poverty, these women have no access to right nutrition during pregnancy and they have no access to a much better medical facility. The medical services they experience are only limited. Women’s lack of information in relation to their pregnancy is a crucial factor for consequences like obstetric fistula to happen.
Diagnosis of Obstetric Fistula
Once patient is admitted or decides to see a doctor, a thorough medical history is taken. This can help in the diagnosis of the problem especially when the woman gives birth and/or treated for gynecological cancer. Other diagnostic tests include:
- Cystoscpy. A cystoscope is a gadget inserted in the woman’s vagina see through the ureter and the urinary bladder.
- Dye test. Dye tests happen when doctors will fill your urinary bladder with a dye solution. Then the patient is asked to cough. Obstetric fistula occurs when there is leakage in the vaginal area.
- Fistulogram. This works like an x-ray where the doctors will see through the patient’s internal organs and see if there are fistulas either to the rectum or the bladders.
- Retrograde pyelogram. An x-ray is done to see if there is a leakage in the ureter and the vagina but first, the doctor injects a dye into the bladder via the ureter.
- Sigmoidoscopy. Sigmoidoscopy is done to check whether there is a fistula between the anus/rectum and the vagina.
Treatment for Obstetric Fistula
Patients should understand that treatment is best effective when consulting a doctor first. These processes help in addressing the problem carefully and correct the problem right away.
Fistulas are corrected surgically. Reconstructive surgery is often done to patient with obstetric fistula. This process gives 90% success ratings and complications like infections are prohibited. Additionally, the patient is also veered from being ridiculed as unhygienic. However problem arises when it comes to the expenses because in developing countries where women are less privileged, they cannot afford the total cost of the surgery.
This is another altenative which can be applicable to women who cannot avoid the reconstructive surgery. In this case, the patient will have a bag where urine collection is done. The bag should be worn everyday to make sure that leakage is avoided which can then produce foul-smell because of the ammonia from the urine. This is a good alternative for women who cannot afford surgical interventions.
A Foley cathether is inserted into the women’s urethra where it drains the urine from the bladder. There is a bag that collects the urine and can be drained when the catheter is full. This is ideal when the problem it detected early because there is a chance that the wound that makes the fistula will close naturally especially when the fistula is smaller.