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Vesico-vaginal fistula. What is an obstetric fistula?


 This article discusses vesico-vaginal fistulae: their causes, prevention, and treatment. A vesico-vaginal fistula is an obstetric complication consisting of a hole in the vaginal wall connecting to the bladder or rectum, often resulting from prolonged and obstructed labor. Most women with fistulae are poor, young, malnourished from birth, chronically anemic, susceptible to disease, and often physically stunted. Incontinence is an immediate effect of fistulae. Nerves in the pelvic region may also be damaged, leading to difficulty in walking. Women with fistulae may smell strongly of urine, and thus are often abandoned by their husbands and considered outcasts in the community. A small proportion of fistulae may heal if the woman is hospitalized and the bladder is drained continuously. Surgical repair is also possible. Obstetric fistulae can be prevented through nutritional improvement, access to family planning, presence of a skilled attendant during childbirth, delaying marriage and first birth, use of a partograph, and use of maternity waiting homes.
