Patients in Fistula unit.
NIGERIA 2017 © Maro Verli/MSF
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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 that are usually the result of obstructed labor. Fistulas affect more than two million women and girls worldwide.

Our health care teams work with pregnant patients 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.

Read more about fistulas in Because Tomorrow Needs Her

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

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

Doctors Without Borders/Médecins Sans Frontières (MSF) health care 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.

What Causes a Fistula?

Almost all fistulas are caused by obstructed labor. 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 labor for days.

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

During childbirth, the vaginal delivery of a baby may be impossible because the head of the child is too big for the pelvis of the mother. A delivery may also stall 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 die, adding yet more suffering for the mother.

While very rare, our surgeons have also witnessed a small number of fistula cases resulting from extreme sexual violence.

Symptoms of a Fistula

Due to 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 or ‘burns’ on the woman’s legs.

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

In most cases, women with fistulas develop psychological symptoms. Because of the physical symptoms, they are often ostracized by their community and abandoned by their husbands, who will take another “healthy” wife.

Due to the birthing complications, women in some cases suffer nerve damage, as well, causing paralysis in one or both of the woman’s legs, or leaving her with difficulties in flexing her feet—a condition called drop foot.

These problems can further isolate a woman and add to a long list of harmful repercussions to her physical and mental health.

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, women who have had a fistula repaired are able to have a healthy child in the future, if they receive 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, however, goes beyond the surgical aspect. Because of the stigma attached to fistulas, MSF teams also provide psychological and psychosocial care to help reintroduce fistula sufferers back into their communities.

Today, MSF treats obstetric fistulas in one permanent center in Jahun, Nigeria, and conducts short-term "fistula camps"; in 2014 MSF conducted camps in Democratic Republic of Congo and South Sudan.