Hesperian Health Guides

Working Together to Stop Obstetric Fistula

HealthWiki > Working Together to Stop Obstetric Fistula

What is Obstetric Fistula?

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Share your knowledge to help others in the community

Obstetric fistula is a hole in a woman’s vagina that causes urine or feces to leak into her vagina, and from there, to leak out of her body. Fistula also causes pain, bad smell, and social rejection.

Fistula is often caused by too long labor when giving birth. When labor lasts an entire day, the baby can press too long on the wall of the vagina and make a hole between the vagina and the bladder causing urine to leak, or between the vagina and the rectum causing stool to leak. Usually the baby will die during birth and the woman will be left with leakage due to the fistula.

Fistula can be fixed with a surgery, done at many hospitals. Once the fistula has been fixed a woman can live a normal life. There are many ways to prevent fistula from happening.

Who Develops Obstetric Fistula?

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Less than 150 cm in height
Very young women and very short women, less than 150 cm in height, have a high risk of developing fistula. If they become pregnant, they should plan to give birth close to a hospital.

Fistula happens most often to girls under the age of 16, and to women who are short (less than 150 cm or 5 feet tall) with small, narrow hips. Fistula happens most often when women are having their first baby, but can also happen when women have had many babies (more than 6). But fistula can happen to any woman of any size or age if her labor is too long.

Labor is more likely to last too long and the baby is more likely to get stuck during delivery if:

  • the mother is young and her pelvis is not fully grown.
  • the mother did not get enough food when she was growing up and her growth was stunted (she is very short or small).
  • the mother’s pelvic bones are malformed or are very narrow.
  • the mother has diabetes.
  • the mother had difficulty delivering her last baby and this baby is larger.

If a mother has any of these characteristics, she should get medical advice and make an emergency plan in case there is a problem. She should probably plan to give birth close to a hospital.

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You have been in labor all day and this baby feels even bigger than your last. I think we should go to the hospital.

If a woman is in long labor (for more than 8 to 12 hours), she should go to a hospital immediately. Before a woman goes into labor, know where the closest medical help is located and make an emergency plan to get there in case there is a problem.

What Causes Fistula?

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Fistula is created when the head of the baby pushes down on the mother’s pelvis, stopping the flow of blood to the flesh inside the vagina. This pressure can kill the flesh and create a hole. If the fistula is between the vagina and the bladder, it causes urine to leak into the vagina and then out of the body. If the hole is between the vagina and the rectum, it causes leaking of feces. Sometimes fistulas are torn in both places and the woman leaks both urine and feces.

Fistula can also be caused by violent actions such as automobile accidents, rape, or torture.

Fistula can also be caused by yankan gishiri, a type of female genital cutting (FGC) done in Nigeria where the wall of a woman’s vagina is cut with a sharp razor or knife. It is mistakenly believed that these cuts will widen the birth canal and also fix other reproductive and sexual problems, especially for women who have long labors. But this cutting does not work. Instead, it makes scar tissue in the vagina which can tear when the woman gives birth and cause fistula. It can also cause infections.

Other kinds of genital cutting, which occur in many countries, are also harmful to women. When cutting is followed by a practice called infibulation, in which the remaining genitals are sewn partially closed, blocked births leading to fistula or death are common.

Female genital cutting does not improve a woman’s health or speed labor. These practices should be ended because they are bad for women’s health.

Myths about Fistula

There are many false beliefs about fistula.

Fistula is not punishment from the gods.
Fistula is not caused by a male baby if the mother does not love her husband.
Fistula is not caused by mistakes during delivery made by birth attendants, midwives, doctors, or nurses.
Fistula does not mean that a woman can no longer have children.

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Harm Caused by Fistula

The false beliefs about fistula can make women who have fistula targets of stigma, ridicule, hatred, and avoidance from the community. None of these behaviors will help women with fistula. Women with fistula should be helped by the community, because fistula can happen to any woman.

Women with fistula have a bad smell because of the leaking of urine or feces. People often avoid them because of the smell. Many women with fistula are victims of ridicule, bullying, hatred, and even violence.

Women with fistula often live outside of the community and feel rejected. This separation can cause sadness and depression. It can also cause impoverishment, since many women with fistula are divorced or abandoned because their husbands blame them for their condition.

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Men and women must learn that fistula is not a woman’s fault and that it can be fixed with surgery. Husbands should be kind when their wives have fistula, should encourage them to have surgery to fix it, and should take care of them during recovery.

What women with fistula need is medical care to repair the fistula and support during recovery so they can live a normal life.

How Fistula is Fixed

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Fistula can be fixed with a surgery that repairs and sews closed the hole in the vagina. During surgery, the woman is put under anaesthetic (put to sleep) so she does not feel any pain, and she wakes up after the surgery is finished.

Depending on how large the fistula is, more than one surgery may be necessary. The woman may need to stay in the hospital for 2 to 3 weeks so the doctors and nurses can make sure the fistula is healing.

Some programs hold educational classes or skills training workshops for women healing from fistula surgery. Women can learn reading, writing, and incomegenerating skills such as sewing, animal husbandry, and basket-weaving. This can help increase independence for women with fistula, especially if they have been divorced and left without income. This empowers women, helps them build bonds with other women with fistula, and allows them to better contribute to their community after they have recovered.

Many hospitals do fistula surgery for free, supported by sponsors and donors. Other hospitals ask patients to pay a fee.

What happens after the fistula operation?

After the fistula is fixed a woman can return to her normal life. In most cases, the surgery works and she will have no more leaking. Women who have had fistula repaired can usually have more children, but they must deliver them in a hospital. They will probably need a caesarean operation (C-section) to deliver the baby, because the repaired fistula has left behind scar tissue that could tear and cause another fistula.