In November 2012 MSF conducted a fistula surgery camp for women requiring a fistula repair operation. This is a surgical operation that requires highly specialised surgical skills, and expert surgeon Dr Volker Herzog spent 3 weeks in the MSF Gogrial proje

An obstetric fistula is a hole between the vagina and the bladder or rectum, through which urine or stool leaks continuously. They are devastating injuries resulting from complicated childbirths, affecting more than two million women worldwide.

Fact: 

A fistula is a hole between the vagina and the bladder or rectum

They are usually caused by complicated births

They cause damaging psychosocial problems

MSF has three permanent centres in Chad, Burundi and Nigeria to treat fistulas

An obstetric fistula is a hole between the vagina and the bladder or rectum, through which urine or stool leaks continuously. They are devastating injuries resulting from complicated childbirths, affecting more than two million women worldwide.

Our healthcare teams work with pregnant women to prevent the occurrence of obstetric fistulas, while at the same time treating those with the condition and providing psychological support to fistula sufferers to help rebuild their lives.

In 2010, MSF surgical teams repaired fistulas for about 1,000 women.

While any woman can be susceptible to fistulas, most cases are found in African countries. It is largely a hidden problem, affecting young women who give birth at home in poor, remote areas with limited or no access to maternal healthcare.

If a woman survives a complicated birth, and suffers a fistula as a result, her family and community will often shun her. Because of this social exclusion, it is even less likely that the sufferer will receive care.

Our healthcare teams work with pregnant women to prevent the occurrence of obstetric fistulas, while at the same time treating those with the condition and providing psychological support to fistula sufferers to help rebuild their lives.

In 2010, MSF surgical teams repaired fistulas for about 1,000 women.

What causes a fistula?

Almost all fistulas are caused by obstructed labour. In remote African regions, where there are few hospitals or midwives and obstetric care is scarce, complicated childbirth can result in a woman being in labour for days.

Without access to emergency caesarean sections, these complications can be fatal. However, if the woman survives the labour, permanent injuries to the birth canal often result.

During childbirth, the delivery of a baby may stop because the head of the child is too big or the pelvis of the mother is too small. A delivery may also stop because the uterus is not contracting properly.

As the baby’s head presses against one part of the birth canal, the surrounding tissue eventually dies and creates a hole, or a fistula —— an abnormal connection between the vagina and the bladder, the vagina and rectum, or both.

This hole will never heal naturally and, more often than not, the baby will be stillborn, adding yet more suffering for the mother.

Our surgeons have also encountered fistula cases resulting from sexual violence.

Symptoms of a fistula

Because of the abnormal opening to the bladder or rectum, a woman suffering from a fistula will constantly leak urine or feces through her vagina. The leaked fluids cause an unpleasant smell and can cause ulcers on the woman’s legs.

Women often reduce their fluid intake to try and reduce the flow of urine, which can result in kidney disease and bladder stones.

In some cases women suffer nerve damage related to the fistula, causing paralysis in one or both legs, or difficulties in flexing the feet — a condition called drop foot.

In most cases, women with fistulas develop psychological problems. Because of the physical symptoms, they are often ostracized by their communities and abandoned by their husbands, who will take new, “healthy” wives. This can lead to fistula sufferers becoming —isolated and malnourished.

Treating a fistula

With good obstetric care, fistulas are preventable; in developed countries, fistulas have all but disappeared.

In some cases, a simple repair may take only 45 minutes to complete, but many cases are more complex and require several operations by highly skilled surgeons. Only a few institutions in Africa teach these specialized surgical skills.

After the operation, the patient will need a bladder catheter for a couple of weeks and will be taught pelvic floor exercises to strengthen her muscles.

Thankfully, a woman who has had a fistula repaired can have a healthy child in the future, if she receives appropriate antenatal care.

Training local midwives to help mothers give birth safely is vital. They can spot whether a mother is having difficulty giving birth and can arrange help before it is too late.

Total treatment goes beyond surgery. Because of the stigma attached to fistulas, MSF teams also provide psychological and psychosocial aftercare to help reintroduce fistula sufferers back into their communities.

Today, MSF treats obstetric fistulas in three permanent centres in Burundi, Chad and Nigeria.

The number of patients treated by MSF teams has been steadily rising: from approximately 100 repairs in 2006, to between 400 and 500 repairs in 2009, and then about 1,000 in 2010.

 

In 2010, MSF surgical teams repaired fistulas for about 1,000 women.

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