Obstetric fistulas are a medical condition where a hole forms between a woman’s uterus and bladder or rectum. These holes cause urine and feces to leak out of a woman’s uterus [1][2]. These fistulas occur for several different reasons and result in the death of the uterus tissue. Fistulas are common in women between the ages of fourteen and twenty and are a growing problem in underdeveloped countries. This is because there is not any proper equipment, not many trained doctors and no community awareness about this condition. Worldwide, about 50,000-100,000 women suffer from obstetric fistulas [3]. Women with obstetric fistulas have experienced newborn death or a stillbirth at the time of birth. If fistulas are not treated properly, both the mother and the child may die [4].
Causes
editObstetric fistulas are known as one of the forgotten diseases in underdeveloped countries because they are usually happen in poor areas [1].There are four main causes of fistulas: obstructed labor, malnutrition, genital mutilation, and social causes.
Obstructed Labor
editOne of the most common causes of obstetric fistulas is birthing that takes a long time. The baby becomes stuck in the mother’s birthing vessel for many days and a caesarean section cannot be done [1][4]. The baby’s head gets stuck inside the back of the woman’s uterus and causes the blood coming into that area to stop. This causes the tissue to die and a fistula to form [1]. Obstructed labor is a major cause of death for the mother and makes up about 8% of all deaths during births [3][5].
Malnutrition
editWomen can get obstetric fistulas if their bodies are not fit for giving birth. Narrow hips and pelvises are the results of not getting proper nutrition [1]. The formation of the fistulas happens during the second stage of the birthing process when the woman's body cannot bear giving birth [4][6]. Because there is no proper nutrition in underdeveloped countries, growth of many women can be stopped early. These women have the most difficulty having children [4][6].
Genital Mutilation
editObstetric fistulas are also caused by female genital mutilation. Female genital mutilation (FGM) is purposely injuring the genital area of women without cause [7]. Every year, millions of girls over the age of ten undergo FGM. In several countries, FGM depicts the discrimination against women. Also, there are several cultural, religious and social reasons behind FGM. This includes preparedness for adulthood, cultural ideas of femininity, and the authority of religious leaders [7].
Social Causes
editEarly marriage and pregnancy, poor health choices, no proper healthcare, and male dominance are all indirect reasons for fistulas [8][9]. Most of the women who have fistulas are those that are poor, young, and uneducated [9].
Risk Factors
editWomen are more likely to suffer from obstetric fistulas when they live too far from medical facilities, live in poor regions, and do not know enough about fistulas [4]. Some things that add to the problem of obstetric fistulas are the place of birth, the help of trained people during the birth, care before and after the birth, the mother’s age, and no emergency care available [4][6][8]. The longer a birth lasts, the more likely a fistula forms [6]. Knowing what causes obstetric fistulas is important to stop them before they form.
Treatment
editRepair
editThe surgery that is needed to fix fistulas has been found to work 82% of the time [4]. The United Nations Population Fund (UNFPA) found several issues that stop women with fistulas from being treated in poor countries. Age, height, weight, the time birthing took, or the age of the first pregnancy did not whether or not the surgery worked [4]. However, the surgery cannot always be checked because the equipment available is not good enough, the travel time is too long between medical buildings and homes, or the cost is too high [4][6].
Post-Operative Care
editAfter the surgery to fix the fistula is done, the patient must be very careful and take care of their body. There must be a drain from the bladder for fourteen days after the surgery. If the rectal area is involved, only light food can be eaten so that the digestive system can rest. Several medicines, including morphine or codeine, may be used if there is any pain following the surgery [2].
Geographical Differences
edit
Africa and Asia
editThe number of obstetric fistulas is much higher in Africa and Asia because there are not enough resources [8]. Obstetric fistulas are known as a disease of poverty [10]. According to the World Health Organization (WHO), there are approximately 2 million young women in sub-Sahara Africa and Asia who are living with untreated obstetric fistulas [3].
United States and Europe
editObstetric fistulas are present in the United States and Europe, but since the late 19th century and early 20th century, the number of women that suffer from fistulas has lowered greatly [11]. The number of women has lowered because of safe childbirth practices and the use of caesarean sections to relieve obstructed labor [11].
Social Issues
editOne of the biggest issues that comes with having an obstetric fistula is how people treat a woman. People keep away from woman that have fistulas. Married women end up being divorced by their husbands and their families stop talking to them [1]. The worth of a woman is only as great as her ability to be a good mother and wife, so husbands take fistulas as a bad sign for the rest of the marriage [9][12]. Even though fistulas are not fatal, there are several other issues that come along with it. A side effect of a fistula is leaking urine or feces [1][5]. Women with fistulas in Africa are put down by name calling, including chepsikiror, which means smelling of urine, and chepchekey, which means something that leaks [12]. Some women have surgeries that do not go well, and these women are seen as cursed or unclean [12]. Because of all this emotional pain, efforts have been made to help these women.
Efforts in Prevention
editNurses in African countries such as Mozambique, Malawi, and Tanzania, are being trained to perform C-sections [8]. In Ethiopia, health workers are being trained to identify fistulas so they can treat them quicker [8]. Tanzania has come up with a system to help women with fistulas be a part of the community. Sudan and Nigeria have radio programs and community activities so people can understand that the condition is treatable [8]. The UNFPA and the Fistula Foundation have mapped over 175 health facilities that will provide repairs of fistulas in 40 different countries across Asia, Africa, and the Middle East [13].
References
edit- ^ a b c d e f g Wall LL. Obstetric fistula is a "neglected tropical disease". PLoS Negl Trop Dis. 2012;6(8):e1769. http://www.plosntds.org/article/info%3Adoi%2F10.1371%2Fjournal.pntd.0001769
- ^ a b Walley RL, Kelly J, Matthews KM, Pilkington B. “Obstetric fistulae.” Gynaecological Practice. 2004:73-81
- ^ a b c World Health Organization. “Obstetric Fistula.” March 2010. http://www.who.int/features/factfiles/obstetric_fistula/en/
- ^ a b c d e f g h i Hawkins L, Spitzer RF, Christoffersen-deb A, Leah J, Mabeya H. Characteristics and surgical success of patients presenting for repair of obstetric fistula in western Kenya. Int J Gynaecol Obstet. 2013;120(2):178-82.
- ^ a b Wall LL. Preventing obstetric fistulas in low-resource countries: insights from a Haddon matrix. Obstet Gynecol Surv. 2012;67(2):111-21.
- ^ a b c d e Tebeu PM, Fomulu JN, Khaddaj S, De bernis L, Delvaux T, Rochat CH. Risk factors for obstetric fistula: a clinical review. Int Urogynecol J. 2012;23(4):387-94.
- ^ a b World Health Organization. “Female genital mutilation.” Fact sheet N241. 2013. http://www.who.int/mediacentre/factsheets/fs241/en/
- ^ a b c d e f Hardee K, Gay J, Blanc AK. Maternal morbidity: neglected dimension of safe motherhood in the developing world. Glob Public Health. 2012;7(6):603-17.
- ^ a b c Roush K, Kurth A, Hutchinson MK, Van devanter N. Obstetric fistula: what about gender power?. Health Care Women Int. 2012;33(9):787-98.
- ^ Browning, Andrew. "Obstetric Fistula In Ilorin, Nigeria." Plos Medicine 1.1 (2004): 022-024. Academic Search Complete. Web. 25 Oct. 2012.
- ^ a b The Fistula Foundation. “What is Fistula? Fast Facts & FAQs.” 2012. http://www.fistulafoundation.org/whatisfistula/faqs.html
- ^ a b c Khisa AM, Nyamongo IK. Still living with fistula: an exploratory study of the experience of women with obstetric fistula following corrective surgery in West Pokot, Kenya. Reprod Health Matters. 2012;20(40):59-66.
- ^ Direct Relief. “Obstetric Fistula Repair and Prevention.” 2012. http://www.directrelief.org/focus/maternal-and-child-health/obstetric-fistula/