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28 July 2011

Fistula: A hidden affliction

Obstetric fistula or childbirth fistula—once common throughout the world—has today become a rarity in developed countries. It is, however, still a common problem in many African and Asian countries where emergency health services are insufficient in tackling complications arising during labour and delivery. This condition is an indicator of poverty, malnutrition and poor health services. Because of the stigma attached to the condition, it remains a relatively hidden problem that not many people are aware of. Most of these fistulas are neglected and go unrecognised and unreported.

One type of fistula, the genito-urinary fistula, is an abnormal communication between the genital (uterus, cervix, vagina) and the urinary (ureter, bladder, urethra) systems causing continuous leaking of urine. Among these, the vesico-vaginal fistula (VVF), located between the bladder and the vagina, is the most common. Worldwide, the majority of the genito-urinary fistulas occur due to childbirth trauma, predominant in impoverished countries. In developed countries, on the other hand, the most common causes of this fistula are surgery, radiation and malignancies.

Fistulas occur as a result of complication of childbirth where obstructed labour is neglected and medical services are not easily available. The prolonged pressure of the baby’s head on the labouring mother’s bladder, rectum and vagina with the bony pelvis, compromises the blood supply which ultimately leads to a hole or a fistula formation. Usually in such cases the baby is born dead. As a consequence of this, there is a constant uncontrollable dribbling of urine which can have a devastating effect on the life of the woman. Due to the stench, often these females are abandoned by their husbands, friends and families and they become an outcast in society. If this problem is left untreated, it can lead to ulceration, infection and kidney disease.

Most fistulas can be cured by surgery. These women need to know that fistulas can be repaired and help is out there. More than this they need to know that it can be prevented by timely intervention in prolonged obstructed labour. Avoidance of early pregnancy, antenatal checkups, the attendance of skilled birth attendants and easy accessibility to health facilities during labour can also prevent obstetric fistula.

A global Campaign to End Fistula was launched in the year 2003 by United Nations Population Fund (UNFPA) and partners aiming to eliminate obstetric fistula by 2015 through prevention, treatment and rehabilitation. This drive is part of the efforts to achieve the United Nations Millennium Development Goal 5, which is to improve maternal health.

Patan Hospital, located in the heart of Lalitpur, is one of the pioneers in fistula surgery in Nepal and has become a referral center for fistula patients. In the last one year, two fistula camps have already been conducted in the hospital sponsored by UNFPA, in association with Women Rehabilitation Center (WOREC), curing many women and training many medical personnel.

Childbirth fistula is a sad story of “love, labor, loss and lifelong leaking”. But we can rewrite the story by making available preventive emergency obstetric care, treating by operative procedure and rehabilitation, thereby preventing tragic ends.

Dr. Singh is an Associate Professor of Obstetrics & Gynecology at the Patan Academy of Health Science.

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