A fistula is an abnormal hole between body cavities.

An obstetric fistula is a hole between a woman's birth passage and the bladder or rectum. This hole developes after many days of obstructed labor, when the pressure of the baby's head against the mother's pelvis cutts off blood supply to delicate tissues in the region.

The most common areas in the genital tract that may be connected abnormally are:
Vagina to bladder - Vesicovaginal Fistula (VVF)
Rectum to vagina - Rectovaginal Fistula (RVF)
Urethra to vagina - Urethrovaginal (UVF)
Urethra to vagina - Urethrovaginal (UVF)
Common causes of Fistula
i.
Obstructed labour due to pressure by the presenting part, causing necrosis. This accounts for 85% of cases in developing countries due to narrowed birth canal after undergoing Female Genital Mutilation (FGM)
ii.
Disease processes, such as carcinoma in advanced stages of the neighbouring organs
iii.
Congenital fistula
iv.
Radiation therapy for gynaecological conditions, which accounts for 15% of cases (usually many years after treatment)
v.
Congenital fistula that opens into the vagina as an accessory ectopic ureter
Sites where urinary fistula can occur
The dead tissue falls away and the woman is left with a hole between the vagina and bladder/rectum. This hole results in permanent leakage of urine and/or stool. Eradicated in western countries at the end of the 19th century when cesarean section became available, obstetric fistula continues to plague women throughout the developing world. It is estimated that there are 100,000 new fistula cases each year, but the international capacity to treat fistula remains at only 6,500 cases per year

In Kenya, it is estimated that ten percent of all women are living with this devastating condition, and 3,000 new cases occur each year. With only five doctors trained in fistula surgery in the country, only about 7% of these are able to access care and undergo surgical repair in a year.

An obstetric fistula can be closed with intra-vaginal surgery. If the surgery is performed by a skilled surgeon, a fistula patient has a good chance of returning to a normal life with full control of her bodily functions. Up to 98% success/cure rates have been recorded.

The World Health Organization has called fistula "the single most dramatic aftermath of neglected childbirth". In addition to incomplete incontinence a fistula victim may develop nerve damage to the lower extremities after multi-day labor in a squatting position. Fistula victims also suffer profound psychological trauma resulting from their utter loss of status and dignity. A majority of women who develop fistulae are abandoned by their husbands and ostracized by their communities because of their inability to have children and their foul smell.

Because of these most victims significantly minimize fluid intake making them dehydrated which in turn leads to nerve damage on the lower extremities making walking difficult thus after surgery a need for extensive physiotherapy for rehabilitating them. Many are forced to live an isolated existence. These medical issues coupled with social and economic problems greatly contribute to a general decline in health and well-being which can result in death and at some point some commit suicide.

If untreated, fistula can lead to multiple other conditions like kidney malfunction, urinary infections and culminate in death.

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Status of obstetric fistula (Double click on image to view)
Psychological effects of fistula
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