OBSTETRICAL FISTULA

Vesico-vaginal fistula is a major health problem in the developing world, especially in sub-Saharan Africa and South Asia, a problem that is now quite rare in Western countries. The majority of these fistula are a result of obstructed labor during delivery, but trauma, sexual abuse, coital injury in child brides and female genital cutting practices also contribute to the phenomenon. Obstetrical fistulas form when there is a discrepancy between the size of the fetus and the space available in the pelvis (cephalopelvic disproportion). The fetus is stuck in the birth canal often for as long as 3 to 5 days and the vaginal, vesical and/or rectal tissues are compressed by the fetus head and the pubic bone leading to the death of these tissues. The fetus eventually dies and the woman is left with a fistula (a hole) between the bladder and the vagina (or the rectum) and incontinence of urine or feces.

in addition to discomfort from the continuous dripping of urine (or feces), these women are often rejected by their husband, their family and their community. They cannot use transportation, walk for long periods of time, stand outside with friends, cook, participate in social and religious events or go to the mosque ot church. Since most of these women are left without children, they feel that they cannot fulfill their role either as a woman, a wife or a mother. It is estimated that there are about 2 millions cases  of obstetrical fistula worldwide. Lack of access to obstetrical care is the main risk factor for  fistula.

Djénéba’s Story

Djénéba’s suffered excision at the age of six. The wounds to her genital organs eventually healed, but left her with scar tissue at the entrance to the vagina, which lost its elasticity. Djéneba thus lost her ability to give birth naturally.

At 13, Djénéba underwent arranged marriage to a man twice her age. She suffered multiple traumas as a result of penetration that ruptured her genital scars.

Djénéba’s first baby was stillborn. The mother’s perineum resisted the movement of the baby’s head and the prolonged pressure caused a large fistula to form between the bladder and the vagina. As a result, Djénéba has become incontinent and the escaping urine leaves her with a persistent, unpleasant odour.

Djénéba was rejected by her community. A tiny hut was built for her at the edge of the forest, far from the other villagers.  She is treated as a witch and children throw stones when she attempts to enter the village.

It is women such as Djénéba that the FWHM helps.

To learn more about fistulas in Africa:

• Narcisi L, Tieniber A, Andriani L, McKinney T. The Fistula Crisis in Sub-Saharan Africa: An Ongoing Struggle in Education and Awareness. Urologic Nursing. 2010;30(6):341-6.
• Wall LL. Obstetric vesicovaginal fistula as an international public-health problem. The Lancet. 2006;368:1201-9.
• Semere L, Nour NM. Obstetric Fistula: Living With Incontinence and Shame. Rev Obstet Gynecol. 2008;1(4):193-7.
• Sombie I, Kambou T, Conombo SG, Sankara O, Ouedraogo L, Zoungrana T, et al. Bilan rétrospectif des fistules urogénitales obstétricales de 2001 à 2003 au Burkina Faso. Med Trop. 2007;67:48-52.
• Alio A, Merrell L, Roxburgh K, Clayton H, Marty P, Bomboka L, et al. The psychosocial impact of vesico-vaginal fistula in Niger. Arch Gynecol Obstet. 2011;284:371-8.
• Yeakey MP, Chipeta E, Rijken Y, Taulo F, Tsui AO. Experiences with fistula repair surgery among women and families in Malawi. Global Public Health. 2011;6(2):153-67.