Obstetric fistula
Obstetric fistula is a medical condition characterized by an abnormal opening that develops between a woman's vagina and either her rectum or bladder, primarily due to complications during childbirth. This condition arises when prolonged labor or inadequate medical care leads to significant pressure on the pelvic area, often resulting in tissue damage and the formation of a fistula. Although it can occur in developed nations, obstetric fistula predominantly affects women in low-resource settings, particularly in parts of Africa, Asia, Latin America, and some Arab countries, where access to adequate maternal healthcare is limited.
Symptoms include severe pain, urinary tract infections, and leakage of urine or fecal matter, which can result in social stigma and psychological distress. The risk factors contributing to obstetric fistula include early marriage, poverty, malnutrition, and insufficient education. Prevention strategies focus on delaying pregnancies and improving access to obstetric care. Treatment typically involves surgical repair, with a high success rate, but many women face barriers to receiving such care. Initiatives by organizations like the United Nations aim to raise awareness and improve the resources available for prevention and treatment of obstetric fistula, highlighting the need for better maternal health services globally.
Subject Terms
Obstetric fistula
An obstetric fistula is a condition in which a hole develops between a woman's rectum and vagina or her bladder and vagina. This is caused most often by complications during childbirth due to insufficient medical care. The hole forms when pressure is applied to the woman's pelvic bone, usually by the baby's skull. This pressure deprives the pelvic area of blood flow, deadening the surrounding tissue. The dead tissue then falls away and creates a hole either between the rectum and vagina or the bladder and vagina. Although the condition does occur in developed countries, obstetric fistula most commonly occurs in poor countries that lack adequate medical treatment for pregnant women. More than two million women have sustained this type of injury throughout Africa, Asia, Latin America, and some Arab countries. Concern about the prevalence of this condition in developing countries led the United Nations to declare May 23 the International Day to End Obstetric Fistula in 2013.
Causes and Symptoms
A number of signs and symptoms can indicate the presence of an obstetric fistula in women during labor. Common symptoms include intense vaginal pain, excessive flatulence, frequent urinary tract infections, and vaginal discharge. Vaginal ulcers and lower limb paralysis can also occur. Some women also suffer abscesses on the fistula and in some cases they lose the ability to menstruate. Stillborn birth occurs in 85 to 100 percent of pregnancies that suffer an obstetric fistula. This is mainly a result of prolonged labor, a primary cause of fistulas.
Following labor, women may experience a number of chronic symptoms caused by the fistula. Leakage of fecal matter, blood, and urine is common. The acid in these substances can burn the woman's skin. If infections or ulcers are not treated, a woman can develop kidney disease and go into kidney failure. Few women can conceive another child after suffering a fistula. Women also experience social and psychological consequences due to their condition. Depending on the severity and persistence of symptoms, women may find themselves shunned from their communities and unable to find work. Many of the symptoms have unpleasant smells, creating a source of embarrassment. The humiliation paired with the discomfort of the symptoms often produces psychological effects such as depression or anxiety.
The main cause of obstetric fistula is tissue damage that occurs during childbirth. When pelvic tissue remains damaged and untreated for a length of time, it breaks down and develops into a hole. Obstetric fistulas are not common in developed countries but can result from a deep tear in the perineum or an infected episiotomy, which is a vaginal incision made during labor to aid in childbirth. Obstetric fistulas are very common in developing countries where pregnancy occurs at a very young age. The small size of the female's vagina complicates childbirth. The baby has difficulty fitting through the birth canal, and labor often lasts for days. During this time, the baby's body creates pressure in the pelvic region that can cut off the blood supply to the surrounding tissue. Without oxygen, the tissue begins to die and eventually breaks down, dissolving into a hole.
In developing countries, the leading risk factor of obstetric fistula is lack of proper medical care for pregnant women. Emergency procedures such as caesarean sections are typically unavailable to pregnant women in developing countries, mainly due to poorly equipped medical clinics and the prevalence of home births. Underlying risk factors include poverty, malnutrition, and lack of education. Social factors and customs such as limited women's rights and early marriage also put females at greater risk of developing childbirth issues such as obstetric fistulas.
Prevention and Treatment
Obstetric fistula can be prevented in a number of ways. The primary way is to delay the age of a woman's first pregnancy. In sub-Saharan Africa, girls commonly get married between the ages of nine and fifteen. At this age, the body has had little time to develop into maturity, leading to difficulties during childbirth. Postponing pregnancy allows the female's body to grow and make the necessary room for conceiving a baby. Other prevention methods suggest eliminating traditions such as home births and early marriages all together. Obstetric fistula is also preventable with timely access to obstetric care and treatment.
Obstetric fistula treatment depends on the location and size of the hole. Surgery is the most common remedy for fistulas. Doctors may prescribe antibiotics and anti-inflammatory medications prior to surgery to eliminate infection and heal the pelvic tissue surrounding the fistula. Some women must wait three to six months before having surgery to ensure the tissue is healthy. At times, this process will let the fistula heal on its own and the woman can avoid surgery entirely. If the fistula does not heal, the surgeon will sew together the healthy tissue to close the opening.
A number of surgical methods can be employed to close and heal the opening. Some surgeons sew a plug or patch of biological tissue into the fistula. Others graft tissue from a separate part of the body onto the fistula. Doctors may also need to repair the anal sphincter muscles if the fistula damaged them. A colostomy, a procedure that diverts a piece of the colon to an artificial opening in the abdomen to bypass the infected area, may be necessary in cases of severe infection.
An estimated 80 to 95 percent of vaginal fistulas can be repaired with surgery, but due to high costs and unavailability of nearby medical centers, many women in developing countries do not get the treatment needed to heal. The United Nations and the World Health Organization have initiated efforts to bring awareness to the prevalence of obstetric fistulas in developing countries and have taken measures to help prevent this problem. Since 2003, the United Nations Population Fund has financed thousands of surgical fistula treatments and continued these efforts through a number of partner agencies.
Bibliography
"International Day to End Obstetric Fistula." Partnership for Maternal, Newborn & Child Health. World Health Organization. Web. 20 Feb. 2016. http://www.who.int/pmnch/media/events/2013/fistuladay/en/
"International Day to End Obstetric Fistula." United Nations. United Nations. Web. 20 Feb. 2016. http://www.un.org/en/events/endfistuladay/background.shtml
"Rectovaginal Fistula." Mayo Clinic. Mayo Foundation for Medical Education and Research. Web. 20 Feb. 2016. http://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/basics/definition/con-20034033
"Vaginal Fistula—Topic Overview." WebMD. WebMD, LLC. Web. 20 Feb. 2016. http://www.webmd.com/women/tc/vaginal-fistula-topic-overview
"What Is Fistula?" Fistula Foundation. Fistula Foundation. Web. 20 Feb. 2016. https://www.fistulafoundation.org/what-is-fistula/
Winsor, Morgan. "What Is Obstetric Fistula? 10 Facts About Female Condition Prevalent in Sub-Saharan Africa, Asia." International Business Times. IBT Media Inc. 22 May 2015. Web. 20 Feb. 2016. http://www.ibtimes.com/what-obstetric-fistula-10-facts-about-female-condition-prevalent-sub-saharan-africa-1935322