International Day to End Obstetric Fistula (23rd May, 2018)

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Online Free Medical Dictionary define fistula as a permanent abnormal passageway between two organs in the body or between an organ and the exterior of the body. It can arise in any part of the body, but they are most common in the digestive tract, develop between blood vessels and in the urinary, reproductive, and lymphatic systems. May occur at any age or can be present at birth (congenital). Some are life-threatening; others cause discomfort, while still others are benign and go undetected or cause few symptoms.

Diabetics, individuals with problems with immune systems (AIDS, cancer) and individuals with certain gastrointestinal diseases (Crohn's disease, inflammatory bowel disease) are at increased risk of developing fistulas.

There for types of fistula;

  • Blind fistulas are open on one end only.
  • Complete fistulas have one internal opening and one opening on the skin.
  • Horseshoe fistulas are complex fistulas with more than one opening on the exterior of the body.
  • Incomplete fistulas are tubes of skin that are open on the outside but closed on the inside and do not connect to any internal structure.

Fistula diseases can occur in the event of:

  • Abdominal surgery (hysterectomy or C-section)
  • Pelvic, cervical, or colon cancer
  • Radiation treatment
  • Bowel disease like Crohn’s or diverticulitis
  • Infection (including after an episiotomy -- a tear during child birth
  • Traumatic injury, such as from a car accident

Some fistulas may heal on their own; others would need the following correction procedures in order to heal

  • Sew a special patch over the fistula
  • Take tissue from your body to close the fistula
  • Fold a flap of healthy tissue over the fistula
  • Fix the muscles of your anus if they are damaged
  • Non -invasive treatment that include the following two procedures;
  1. Fibrin glue.  A specific medicinal adhesive used to seal fistulas.
  2. Plug. This is usually a collagen matrix used to fill the fistula.
  • Surgical treatment, through either of  these two procedure
  1. Transabdominal surgery. The fistula is accessed through an abdominal wall incision.
  2. Laparoscopic surgery. This is a minimally invasive surgery that involves a tiny incision and the use of cameras and small tools to repair the fistula.
  • Replenishing of   fluids
  • correcting of  blood serum electrolytes
  • normalizing an acid and base imbalance
  • reducing the fluid output from fistula
  • controlling infection and guarding against sepsis
  • protecting  skin and providing ongoing wound care

However, fistulas that do not heal can be managed by a Catheters. Which is used to drain fistulas, catheters are usually used on small fistulas to manage infection. Symptoms listed below may be an indication that one is suffering from fistula. It is important to take note that these symptoms may vary depending on the type of fistula,

  • Constant urine leakage from the vagina
  • Irritation in the external female genital organs
  • Frequent urinary tract infections (UTIs)
  • Leakage of gas and/or feces into the vagina
  • Fluid drainage from the vagina
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain

Fistula is common in Kenya too, it is said that 10% of men who visit Kenyatta National Hospital have fistula and six million women suffer from it. This is brought about because of the following reasons;

  • Forced early marriage
  • Female Genital Mutilation
  • Socio- economic factors e.g. lack of fistula surgeon in some hospitals
  • Poverty
  • Illiteracy
  • Inaccessibility health facilities

In order to declare Kenya fistula free there is need to;

  • Carry out frequent awareness of the disease
  • Involve provincial administrators, religious leaders and NGOs  in the campaign
  • Jail perpetrators of  FGM
  • Develop and implement fistula strategy  in accordance with WHO
  • Provide adequate health facilities to treat and prevent fistula
  • Expand community midwifery to cover the entire country
  • Devolve health centers
  • Train more fistula surgeons

Compiled by Grace Sitienei – University of Nairobi Library