If we were sitting at a table and I gave you a model of the stomach, model of the brain, and a drinking straw then I asked you to join the models together. What would you do? You would most likely put one end of the straw into the stomach and the other end of the straw into the brain hence you just created a fistula with the straw!

Fistula is an abnormal passageway or tube between two or more body parts that are not normally joined together.However fistulas can occur in the digestive, urinary and reproductive tracts, and in the circulatory system. Fistulas can be congenital meaning born with the condition, they may also be as a result of a disease, infection, surgery, or injury.

In our discussion today, let us discuss about the obstetric fistula which affects women especially after prolonged labor.

What are the causes of obstetric fistula?

An obstetric fistula occurs when a mother has a prolonged, obstructed labor. But it doesn’t have access to emergency medical care, such as a C-section. She often labors in excruciating pain for days. Tragically in some cases, the baby usually dies.

During her prolonged labor, the mother’s contractions continually push the baby’s head against her pelvis. Soft tissues caught between the baby’s head and her pelvic bone becomes compressed, restricting the normal flow of blood.

Without adequate blood supply, sections of tissue soon die, leaving holes—known as “fistulae” —between the mother’s vagina and her bladder or rectum. It is these holes that cause incontinence. If untreated, the woman will uncontrollably leak urine, stool, or sometimes both, for the rest of her life.

Lack of access to maternity care from a skilled health care provider can also be a cause of fistula.
Underlying social causes like poverty, early marriage and childbirth can also lead to fistula among other causes

Symptoms of obstetric fistula

  • Constant urine leaking from vagina
  • Irritation of the external genitalia
  • Frequent urinary tract infections
  • Leakage of gas and/or feces into the vagina
  • Vagina discharge
  • Nausea/vomiting
  • Diarrhea
  • Abdominal or pelvic pain
  • Absences of a normal menstrual periods
  • Painful sex

Role of a physiotherapist in treatment for fistula

There is a lot that physiotherapy has to offer for women who have experienced a fistula. When they realize they are leaking urine or faeces after childbirth, some stay in bed for weeks or months in the hope that it will stop. As a result, they can become very weak and develop contractures, particularly in the lower limb joints. In addition, some women develop foot drop, related to the obstructed labor itself or possibly due to prolonged squatting during labor with subsequent nerve damage in the leg.

Physiotherapy is the ideal treatment for this problem. In addition, the physiotherapists assess the women’s pelvic floor muscles (PFM) and advise them on appropriate exercises. Despite the fistula repair successfully closing the hole, unfortunately many women still have serious bladder problems so exercises and other specialist physiotherapy is extremely important.

Physiotherapy for women who have a fistula repair is important to enable them to regain as full and as active a life as possible after surgery. This includes improving bladder and bowel control and regaining mobility if they have general muscle weakness or have sustained injury to the nerves of their lower legs. If at all possible a physiotherapist with the relevant skills and experience in women’s health should be able work with these women.

Noora Wellbeing
Fistula foundation

Written By:
Grace Ndirangu
Physical Therapist, Chiropractic & Physiotherapy Health Centre

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