Known to turn women into social outcasts, vaginal fistula is emerging as one of the conditions that brings out the harsh reality of lack of access to safe motherhood services or programmes in many parts of the country.
A significant proportion of those affected are poor women living in areas where lack of access to skilled birth attendants, maternity facilities, and detrimental cultural practices are rife.
Vaginal fistula is an abnormal opening between the vagina and another organ such as the bladder, urethra or rectum that results in constant leaking of urine or feaces from the vagina.
Affected women live in distress as they are treated as social outcasts by their families due to the foul smell they produce.
There are four types of vaginal fistula – vesicovaginal fistula, rectovaginal fistula, colovaginal fistula and enterovaginal fistula-, which are classified based on the part affected.
A vaginal fistula that opens into the urinary tract, for instance, is called a vesicovaginal fistula; the one that opens into the rectum is call rectovaginal fistula, and so on.
According to doctors, over 90 percent of the vaginal fistula cases are due to prolonged obstructed labour. Several days of pushing a baby that does not fit through the birth canal, can result in severe vaginal, bladder, or rectal damage, sometimes causing fistulas.
The remaining 10 percent is due to other factors that include trauma as a result of rape or from illegal abortion, or complication during surgery.
Cesarean -section and pelvic surgery are also responsible for many other vaginal fistula problems. Radiation caused by treatment of pelvic cancer can eventually lead to the development of the fistula as well.
In the case of prolonged obstructed labour, soft tissues – vaginal walls, urethra, bladder or rectum nerves – are burned and supply of blood in the affected area is cut-off if the pressure is not relieved on time.
The burned area then peels-off leaving a hole either from the bladder, urethra, or cervix to the vagina.
Constant leaking of urine, watery vaginal discharge, or stool leaking out from the vagina are some of the symptoms of vaginal fistula.
Besides causing infections, this discharge makes the woman to produce a foul smell all the time, forcing her to stay away from people. Women with pronounced scars caused by the fistula usually experience painful penetrative sex.
Treatment of vaginal fistula entails surgical repair of the area responsible for the urine or stool leakage. Surgeries take between 1 to 2 hours depending on the extend of the problem.
Gyneacologists who are highly specialized in fistula treatment are required to do the operation, since most of the conditions are complex. They usually screen to see if the tissue is healthy or not. If the latter is the case, the patient is given medicine to heal the wound before surgery is done.
Lack of skills among doctors, especially at the district or provincial hospitals, have sometimes witnessed tragic outcomes.
“Although those not specialized in this surgery can handle simple cases, we have had to undo what they did when they attempted to repair a complex case,” says Dr Khisa Wakasiaka, a consultant gynaecologist and specialist fistula surgeon at Kenyatta National Hospital.
Two weeks ago, a young girl from Webuye presented at the hospital after a doctor in the district did more damage than good when trying to repair her fistula.
Doctors at KNH now say she might not enjoy sex or deliver again after her uterus and birth canal were tampered with.
“The best thing to do is if you cannot handle it, do not attempt. Refer the patient to an expert,” says Yusuf Guled, the provincial gynaecologists at Garissa provincial hospital.
According to Dr Khisa, when surgery is done by an expert, the success rate is about 95 percent. After healing, patients regain their normal life and dignity in society.
Those who want to have babies can do so, but are advised to deliver through cesarean-section to prevent the problem from recurring. However, not all who have their fistula repaired enjoy afterwards.
In some cases, the surgery can result in shortening and thinning of the vaginal canal, making it difficult for the affected women to have sex.
“There are times we have seen women coming back after a successful surgery, complaining of inability to have sex,” says Dr Khisa.
But he is first to add that in some cases, the affected woman usually has a fistula whose repair will result in such complications.
When this happens, explains Dr Khisa, they have to do another surgery to create an opening that will enable the couple have sex. Currently, there are two women who are in need of this service. |
