Obstetric fistula is a health challenge peculiar to females in their reproductive ages caused mostly by trauma from prolonged obstructive labour, which leads to an opening in the birth canal between a woman’s urinary tract/genital tract and or her rectum. It can also be caused by complicated caesarian section or by instrument assisted deliveries.
In any of the cases, untreated obstetrics fistula results in urinary incontinence, and other embarrassing discharges, which cause physical, social and psychological challenges to the patients. This condition keeps women in isolation and leads to marital and social rejection for most of them who cannot afford the treatment.
A report from United Nations Population Fund indicates that over three million young women are presently living with untreated obstetric fistula in different parts of Asia and Africa. It is also reported that up from 50,000 to 100,000 cases occur worldwide yearly.
In Nigeria, the country’s programme manager of USAID fistula care project, Chief Iyeme Efem, revealed in an event last year that 12,000 new cases of fistula were recorded in Nigeria in 2017. He said that the welfare and wellbeing of women should not be dictated by backward cultural beliefs and myths.
According to medical practitioners, fistula can be caused by both gynecological and obstetrics factors. Dr. Sotari Igah of the obstetrics and gynecology department of the university in an interview said obstetrics factors are anything relating to delivery of a baby while the gynecological ones are caused by any other cause of the fistula not related to baby delivery.
“Fistula can occur through other factors, like injury from car accident and fracture of the pelvic bone,” the doctor said.
She added that it could also occur if a woman has cancer of the cervix or of the reproductive system or when she is receiving treatment like radiotherapy in that area.
According to Dr. Igah, female genital mutilation, which still takes place in some areas in Nigeria, is another factor that increases the incident of fistula. In the process of cutting some parts of the female genital organ to reduce heightened sexuality, mutilation can result in fistula.
On obstetrics factors, she said that prolonged labour and being attended to by unskilled birth attendants can lead to fistula as they use unorthodox methods in delivering babies. She said: “They usually do not react well to emergencies as they are not equipped to do so. Complicated caesarian section and instrumental delivery, like using the forceps or vacuum, can also lead to it.”
On the risk factors of obstetrics fistula, it has been confirmed that early marriage, which can lead to teenage and adolescent pregnancies can predispose young mothers to fistula as any immature pelvic can develop complications during delivery.
Speaking further on this Dr. Ijeoma Oppah, an obstetrician and gynecologist with the University of Port Harcourt Teaching Hospital added that the height of the mother and the weight of a baby could predispose one to have a fistula during delivery.
According to her, women that are short can develop complications, which can lead to this condition. Delay in the age of first pregnancy can also cause complications that can lead to this tragic childbirth accident.
Signs and symptoms
Speaking on signs to look out for, Oppah said dermatitis around the vulva might indicate the presence of leakage of urine through the vagina and should be presented on time.
She affirmed that educating the girl child and the woman is very important. “Young women of reproductive age must know that every pregnancy must be registered in an adequate health care facility because pregnancy is a very delicate process in females. Most primary health centres have workers that know what the red flags are and when to refer a patient to a tertiary health facility,”
The doctor advised that all first pregnancies should be monitored and special attention given to short women as height determines the size of the pelvic.
Another factor to be considered, according to her, is the size of the baby.
“When the baby is big and you don’t take that into consideration, the woman might go into obstructive labour and when it becomes prolonged, this can lead to a fistula. One way of preventing this is to retain a urinary catheter so as to allow the urine to drain properly and allow the bladder recover fully after a difficult prolonged obstructive labor process,” she said.
Oppah said another major way of reducing obstetric fistula is by performing reconstructive surgery on patients. She said adequate care was needed for patients of fistula before, during and after surgical procedure in other for them to live their normal lives again.
The doctor also advised that because of the constant leakage of urine by fistula patients, patients should take lots of water to replace the lost liquid as they prepare for the surgery to repair the fistula.
She said patients should endeavour to eat balanced and high protein diet to enable the wound to heal properly. “Doctors on this protocol are also advised to treat any ongoing infections, which may be caused by the fistula and this includes urinary tract or broad spectrum reproductive tract infections,” she said.
Oppah reiterated that patients must be fully treated and remain on catheter for three months or as long as required.
“Fistula is preventable and can be treated. Any where it persists, it shows that the health system available is not meeting the essential needs of the women or that the women are very poor and ignorant of required healthy practices during pregnancy,” the doctor said.
In another interview, a consultant with the department of obstetrics and gynecology, University of Port Harcourt Teaching Hospital, Dr. Nesto Inimgba, explained more on the causes of obstetrics fistula. According to him, poverty and lack of awareness are major factors. He said: “Women who are not registered for delivery go to maternity homes and labour for days and when the labour is not progressing, the head of the baby or whichever part that is coming first now gets obstructed in the woman’s pelvic bone; that is where the birth canal or the birth passage is. Once this obstruction occurs, it reduces the blood supply to the tissues and the tissue get rotten so to speak and after some days that area comes out and as a result a hole is formed between the bladder and the woman’s vagina.” Dr. Inigba also said that obstetrics fistula could be as a result of ignorance by the victim as they might be attended to by a non-skilled birth attendant.
According to him, going to maternity homes and some churches were skilled hands are not available to manage the delivery of babies, can lead to this. “Most people who patronise such do not go for antenatal care and are quite ignorant of the consequences of not going for antenatal classes, he said, while explaining that the condition was preventable and not a curse.
Inimgba called for proper equipping of health institutions to accommodate such cases, adding that people should raise public awareness on the issue. He further advised women to go for regular medical checkup to prevent health complications.
He said: “Fistula cases among our women in this country can be reduced or completely eliminated if new cases are prevented and old ones treated at minimal cost. The place of regular sustained enlightenment campaigns should not be underplayed too. Educate the women and half of the problem will be solved. Obstetric fistula is very prevalent in the northern part of Nigeria where teenage marriages are the norm. Most fistula centres in the North are free. There is also a free centre in Abakaliki, Ebonyi State. Fistula centres can be established and funded all over the country through private and government arrangements.”
The United Nations has been observing the International Day to End Obstetric Fistula since 2013. The day, May 23, has been set aside for it so as to raise awareness of this issue and mobilise support for it around the globe.