Urinary fistula
What is Urinary fistula?
Obstetric fistula (or vaginal fistula) is a medical condition in which a fistula (hole) develops between either the rectum and vagina (see rectovaginal fistula) or between the bladder and vagina (see vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available. The United Nations Population Fund (UNFPA) defines obstetric fistula as,
“A childbirth injury that has been largely neglected, despite the devastating impact it has on the lives of affected girls and women. It is usually caused by prolonged, obstructed labour, without timely medical intervention—typically an emergency Caesarean section. During unassisted, prolonged, obstructed labour, the sustained pressure of the baby’s head on the mother’s pelvic bone damages soft tissues, creating a hole—or fistula—between the vagina and the bladder and/or rectum. The pressure deprives blood flow to the tissue, leading to necrosis. Eventually, the dead tissue comes away, leaving a fistula, which causes a constant leaking of urine and/or faeces through the vagina.”
It is considered a disease of poverty because of its tendency to occur in women in poor countries who do not have health resources comparable to developed nations. An estimated 2 million women in sub-Saharan Africa, Asia, the Arab region, and Latin America and the Caribbean are living with this injury, and some 50,000 to 100,000 new cases develop each year.
In developed countries, the majority of women with OF suffer RVF (Rectovaginal Fistula). This is caused by episiotomy and forceps/vacuum extraction of the baby from the vagina. Over 80% of RVFs in the USA are obstetric, followed by Crohn's and radiation.
Fistula is almost entirely preventable. Its persistence is a sign that health systems are failing to meet women’s essential needs.