What is Fistula?

Fistula is a childbirth injury caused by prolonged, obstructed labour without timely intervention, typically, a Caesarean section. During unassisted prolonged labour, the sustained pressure of the baby’s head on the mother’s pelvic bone, damages her soft tissues, creating a hole—or fistula—between the vagina and the bladder and/or rectum. The result is a constant leaking of urine and/or faeces through the vagina. Fistula is most common in poor communities in sub-Saharan Africa and Asia where access to obstetric care is limited. About two million women remain untreated in developing countries and between 50,000 and 100,000 new cases occur each year. Without treatment, fistula often leads to social, physical, emotional and economic decline.

Causes of Fistula

• Fistula occurs when emergency obstetric care is unavailable to women who develop complications during childbirth
• Violent rape
• Poverty, malnutrition, poor health services, early childbearing and gender discrimination are interlinked root causes of obstetric fistula.
• Childbearing before the pelvis is fully developed, as well as malnutrition and generally poor health conditions, are contributing physiological factors to obstructed labour.
• Women who have undergone FGM may also experience obstetric fistula.

Types of Fistula

Fistulas, or holes in organs, can occur for various reasons in different parts of the body.

There are two types of Fistula, namely:

• Vesicovaginal Fistula: This is a tissue damage between the bladder and vagina
• Rectovaginal Fistula: This is a tissue damage between the rectum and vagina

Medical Consequences of Fistula

If left untreated, fistula can lead to:

• Frequent ulcerations and infections
• Kidney diseases
• Dehydration as a result of some women’s minimal consumption of water to avoid leakages
• Damages to the nerves in the legs
• Early death, sometimes by suicide

How Can Fistula Be Prevented?

Prevention, rather than treatment, is the key to ending fistula. This is possibly through:

• Making family planning available to all those who desire it
• Skilled birth attendance and emergency obstetric care for women
• Preventing child marriage
• Regular antenatal visits to detect danger signs during pregnancy

Can Fistula Be Treated?

Yes, fistula is treatable. Reconstructive surgery can, in most cases, mend the injury. Two weeks or more of post-operative care, are needed to ensure a successful outcome. Counselling and support are also important to address emotional damage and facilitate social reintegration.

Sadly, most women living with fistula are either unaware that treatment is available or they cannot afford it. As with any surgery, fistula repair does carry some risk. Possible complications after a fistula surgery includes infection, urinary problems and breakdown of repair, most of which can be effectively managed. Only in rare cases do patients die.

UNFPA’s Interventions

Addressing social issues that contribute to the problem—such as child marriage, early pregnancy, Female Genital Mutilation, girls’ illiteracy, poverty and women's lack of power—are important factors to help prevent fistula from occurring in the first place. These interventions are part of UNFPA’s overall strategy to ensure safe motherhood.

In The Gambia, UNFPA works with its partners to provide fistula repair surgeries and rehabilitation for women suffering from the condition, while strengthening the Ministry of Health’s capacity, to integrate quality Fistula Case Management in the health care delivery system.