There are many women living with fistula who are not yet treated because of a lack of awareness of the availability of treatment.
Childbirth is usually a period of great joy to the mother and family. However, at times complications arise in this supposedly normal process. Complications occur in about 15-20 % of the deliveries hence the need to deliver under skilled birth attendant.
The complications which can occur include childbirth injuries of which some are quite severe. Examples of childbirth injuries that may occur to the birth canal during delivery include perineal tears, injuries to pelvic muscles, urine, and stool incontinence. Unrepaired perineal tears and injuries to the pelvic floor muscles may cause laxity and this may become a source of great misery on love life.
Urine and stool incontinence usually arise because of a childbirth injury called obstetric fistula. Secondly, it is preventable and thirdly it can be successfully treated in most cases.
Obstetric fistula is a very devastating childbirth injury that develops because of prolonged and neglected labor which becomes obstructed. If the cesarean section is not accessible there is the destruction of vaginal tissue making a hole (fistula) to develops between the bladder and birth canal.
Consequently, urine leaks continuously through the hole without any break. When the same damage occurs between the rectum and the birth canal feces leak continuously from the rectum to the birth canal.
Labor is said to be prolonged if it takes more than 24 hours. The majority of the patients with fistula often report having labored for 3-5 days at home under the assistance of relatives or traditional birth attendants. In most of the cases (95%) the babies are born dead. While the causation of the fistula is clear as stated above many fistula victims attribute this condition to witchcraft while others wrongly blame the caesarian section done to save their lives.
The story which follows after this injury is terrible. First, the baby is dead, secondly, urine leaks continuously without control day and night. The victims are wet all the time and stink like urinals. Since these women are usually poor, they use old clothes or pieces of old mattresses as diapers. They stop going to public places like markets and churches because they smell. It becomes difficult to engage in any meaningful economic activities because of the stigma associated with leakage. In a number of cases, they get separated, divorced, domestic violence or some husbands marry another wife. They become social outcasts and as a result of the stress they end up with depression, life becomes horrible and some commit suicide. This is one of the worst childbirth injuries a woman can have.
There are many women in Africa living with obstetric fistula. In most places where I have visited to perform repairs the number of fistula victims has been overwhelming. In Africa, we estimate there are about 30 million women living with fistula. It’s also estimated that 500 000 new fistulae develop yearly in Africa largely because most women in Africa deliver at home or go to the hospital too late after failed home delivery. These women lack awareness about the availability of treatment and some have lived with fistula for a very long time.
The good news is that fistula can be treated. Cure can be achieved in most cases. However, there are a number of challenges when it comes to treatment. Some of the challenges include lack of awareness, a handful of Surgeons who repair fistula, and high cost of repair.
Can Fistula be prevented?
Obstetric fistula is a hundred percent preventable. Obstetric fistula is rare in the developed countries due to the wide availability of cesarean section. The presence of Obstetric fistula is an indicator that maternal health services and the general health of the population are wanting.
The current government policy in many African countries on free maternity services if well implemented will go a long way to prevent obstetric fistula and generally improve maternal health. However, this alone is not sufficient. Poverty is the main underlying risk factor. Poverty eradication as been elusive since independence. Industrialization, economic development, and education of women hold the key to eradication of obstetric fistula in Africa's health in general. Implementation of vision 2030 will improve maternally