Obstetric fistula

Overview
Obstetric fistula (or vaginal fistula) is a severe medical condition in which a fistula (hole) develops between either the rectum and vagina (see rectovaginal fistula) or between the bladder and vagina (see vesicovaginal fistula) after severe or failed childbirth, when adequate medical care is not available.

Causes
The fistula usually develops when a prolonged labor presses the unborn child so tightly in the birth canal that blood flow is cut off to the surrounding tissues, which necrotise and eventually rot away. More rarely, the injury can be caused by female circumcision, poorly performed abortions, or pelvic fractures.

Presentation
The resulting disorders typically include incontinence, severe infections and ulcerations of the vaginal tract, and often paralysis caused by nerve damage. Sufferers from this disorder are usually also subject to severe social stigma due to odor, perceptions of uncleanliness, a mistaken assumption of venereal disease and, in some cases, the inability to have children.

Risk factors
Primary risk factors are early and/or closely-spaced pregnancies and lack of access to emergency obstetric care; a 1993 study in Nigeria found that 55 percent of the victims were under 19 years of age, and 94 percent gave birth at home or in poorly equipped local clinics. When available at all, cesarean sections and other medical interventions are usually not performed until after tissue damage has already been done.

Incidence/prevalence
According to the World Health Organization (WHO), an estimated 50,000 to 100,000 women develop obstetric fistulas each year and over two million women currently live with fistula injuries.