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What is a Fistula?

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Vaginal Fistula

 Is a medical condition where a fistula (hole) develops between the rectum and vagina or between the bladder and vagina?

This can occur after a prolonged or severe child birth and where adequate medical birthing care is unavailable.

Fistulas of this nature generally occur with women in underdeveloped countries where poverty prevails and where medical help is unavailable or cannot be afforded.

Symptoms of a fistula  may include any or all of  below:

  •      Foul smelling vaginal discharge
  •      Chronic urinary tract infections
  •      Painful intercourse
  •      Pain and irritation in the vaginal area
  •      Bowel and or  bladder Incontinence
  •      Flatulence
  •      Still born babies
  •      Vaginal Ulcers/Abscesses
  •      Nerve damage to lower limbs

Causes

The fistula usually develops as a result of a long labour which may stretch into 3-4 days and a cesarean delivery is not possible.

Because the baby is literally forced into the mothers birth canal very tightly the blood supply to the vagina and rectum and bladder may be cut off and this causes these organs because of no blood to die and ultimately rot away

They can be caused by

Risk factors

Impoverished countries not only have low incomes but also lack adequate infrastructure, trained medical professionals and resources to lessen the incidence of vaginal fistula among its women.

Because women in poverty stricken countries are generally malnourished they are smaller in stature and consequently struggle with a having any baby and many do not have the physical strength or stamina to sustain such trauma in a prolonged child birth. Additionally many young girls aged 12-15, marry and becoming pregnant all these factors combine in underdeveloped countries giving them the highest mortality rates for childbirth in the world for both mother and child.



Consequences

Where a fistula (hole) develops between the rectum and vagina or between the bladder and vagina there is the constant leaking of urine, faeces, and blood .

The acidic nature of this material causes severe burn wounds on legs from the continuous dripping. Nerve damage can result from the leaking causing the victim to struggle with walking and possibly lose the ability to walk.

Women limit their intake of water and liquid to avoid the leaking causing the skin burn ,but this can cause urinary tract infections, kidney failure and dehydration leading to death.

75% of women who suffer a fistula cannot have babies following.


Treatment

The largest challenge that stands between women and fistula treatment is information. Most women have no idea treatment is available.

Women with the condition are often ostracised suffering shame and embarrassment and end up suffering their condition for years and suffer in silence.

Fortunately treatment is available through reconstructive surgery.

For primary fistula repair, there is about a 90% success rate.

Successful surgery enables women to live normal lives however post-operative care is vital to prevent infection.

It is generally seen that most women who undergo surgery have a very good success rate, but about 20% of all patients experience some degree of incontinence from light to extreme.

Incontinence is an issue that can remain with severe cases of fistula.

Bladder function may be disturbed in several ways through the trauma experienced. The bladder size can range from normal to severely reduced and as a result incontinence can vary from exhibiting minimal muscle tone to chronic retention to overflowand to detrusor muscle instability( the detrusor muscle is the muscle surrounding the bladder).

Following surgery a catheter is worn and poor control for a time is common, however after catheter removal generally improves continence rapidly.

There are 4 categories of incontinence severity following removal of the catheter:

1. Wet when coughing or effort often improves with time and pelvic floor strengthening.

2. Wet on walking, dry on sitting and lying, but can empty well. Often improves with pelvic floor strengthening.

3. Wet on walking, sitting or lying, able to empty to a degree. May not improve with time, but intensive pelvic strengthening exercising for 6 months may marginally improve things. Often adhesions may slow this up. If no improvement after 6 months probably require operation for stress incontinence.

4. Wet all the time, not emptying. Rarely improves with time, but again intense pelvic floor exercising may improve. Problem may be the size of the bladder or urethra dysfunction which could be the cause. If no improvement in 6 months with intensive pelvic floor exercising surgery may be required.