In the first of our Clinical Conversations series, Dr Yeshineh Demerew, Medical Director and Surgeon of Hamlin Fistula Ethiopia, answers the most common questions about obstetric fistula.
What is obstetric fistula?
A fistula is an abnormal communication between two or more organs in our body that don't normally connect, and usually takes the form of a hole or tunnel.
An obstetric fistula is related to childbirth, and is usually the result of a prolonged and obstructed labor where the pregnant woman has no access to a trained birth assistant, such as a midwife.
The most common form of obstetric fistula is a hole between the birth canal and the bladder and/or rectum, which leaves women unable to control their bladder or bowel movements, and results in both physical and emotional pain.
How do you diagnose obstetric fistula?
Most cases can be diagnosed very easily during a pelvic examination, where you can detect the hole.
In difficult cases you can do the so-called dye test. You can put dye into the patient's bladder and then see it coming out from the female genital tract. Or you can put dye into the gastrointestinal tract, and then see it coming through the vagina.
How can obstetric fistula be prevented?
This is a common question in regards to obstetric fistula. The most important tool we have to prevent childbirth injuries is through the proper and timely management of labor. This is the most important thing.
Where there is a delivery facility with capability, you can manage an obstructed labour with a caesarean section. The labor might be prolonged, but it might not become obstructed because of early intervention with a caesarean delivery.
We also need to find these patients as early as possible, within the first days or weeks after delivery. We can put a catheter inside the bladder. If there is a dead tissue, it can be surgically removed. We can also provide rehabilitation measures, such as nutritional iron, and antibiotic treatment.
About 15% of all obstetric fistula can be treated this way, and the hole will close spontaneously, usually within four or five weeks.
For the other cases, surgical intervention is needed.
What are the symptoms?
Most women who suffer an obstetric fistula will usually have had a prolonged labor – often more than 24 hours, frequently 2 or 3 days, but sometimes as many as 7 days. days, In the process, the baby dies in the utero because of shortage of oxygen supply to the fetus.
Following the birth, they start to leak either urine or stools or both. These are the most important symptoms but in very severe cases they may have other symptoms as well. Like an inability to walk because of the compression on the pelvic nerves that supply the lower limbs, and ulcerations around the genital area.
When there is a continuous leakage of urine, people tend to reduce their water intake which causes a concentration of waste materials in the urine, so skin irritation in another symptom leading to scratching.
This is the first in our Clinical Conversations series, where we interview our staff on a range of reproductive health topics. You can also find the interview recordings on our YouTube channel.
