Obstetric fistula is an underestimated problem that affects two million women and girls around the world. However it is usually found to get worse once left unattended due to poverty in developing countries. Fistula is a hole between the vagina and rectum or bladder caused by prolonged obstructed labour which produces contractions that push the baby’s head against the mother’s pelvic bone. It compresses the soft tissues between the baby’s head and the pelvic bone blocking supply of adequate blood flow.
The delicate tissues die due to lack of blood flow creating a hole between the mother's bladder and vagina or between the rectum and vagina or both. It causes incontinence in the woman which robs her of her dignity and results in social isolation.
The main cause is the lack of medical attention typically during a caesarean section to relieve the pressure during a prolonged obstructed labour. The lack of medical assistance causes the tissues in the mother's bladder or vagina to die due to lack of blood supply. It leaves the mother with a hole in her bladder or rectum through which she will leak urine, and sometimes feces, continuously, for the rest of her life.
After such an obstructed labour the baby dies in as many as 90 percent cases and the mother is left with chronic incontinence. Lack of obstetric care is the main cause of this problem however poverty, early marriage and malnutrition are some other common factors responsible for this condition. The World Health Organization considers fistula a sign of poor medical system in an area. The WHO called it 'the single most dramatic aftermath of neglected childbirth. Childbearing before the pelvis is fully developed is a common phenomenon in areas with gender discrimination and it increases the risk of fistula.
Fistula leaves women with urinary and fecal incontinence. If left untreated it can even lead to frequent infections and other diseases which may even cause early death. Since the patients are always concerned about incontinence they start eating and drinking less to minimize the leakage; this can, however, take a toll on an already poor health. It can also cause damage to the nerves in the legs which can disable some women from walking. WHO considers it to be one of the worst problems women have to live with in poor societies where proper medical attention is not available.
Fistula is a physical problem that can completely ruin the social life of a patient. Since the sufferers are women in poor and in male dominated societies they are bound to suffer socially as well. The patient is isolated socially and physically even by her own family. Besides physical effects that fistula has, it also brings about emotional isolation, ridicule and shame, infertility and abandonment. They can't work in public, climb stairs, board a bus, enter a place of worship or share a meal with family or others.
What is even more saddening is the fact that fistula is treatable as well as preventable but the lack of funds and access to medical care makes it a huge problem. A caesarian section during an obstructed labour can prevent the risk of fistula. Even if a woman develops fistula, it can be mended with a reconstructive surgery which only requires few weeks of post-operative care. However, since the problem has a huge social impact, proper counseling is also required to recover from the emotional damage.
In 1989, the WHO estimated that more than two million women remain untreated in developing countries and at least 50,000 to 100,000 new cases occur each year.
The social isolation of patients also reduces their chances of getting proper treatment for fistula. However, as a positive sign access to proper medical care has almost vanished fistula from the developed countries.
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