When Julienne Nyirandinabo delivered her third child by C-section in 2018, she never imagined the operation would lead to a life-altering medical condition.

The 40-year-old resident of Nyabikenke in Bumbogo Sector, Gasabo District, developed a vesicocutaneous fistula after the surgery, causing urine to leak through her surgical wound. Doctors inserted a catheter to help her pass urine.

After being discharged, Nyirandinabo began experiencing severe pain within days. Her husband rushed her to the University Teaching Hospital of Kigali (CHUK), from where she was referred back to Kibagabaga Hospital, where she had given birth.

ALSO READ: The toll of fistula: American doctors working to stem the tide in Rwanda

Her condition worsened as urine continued leaking through the wound, which became infected and started discharging pus.

At the time, few specialists in Rwanda could treat her condition. She was eventually informed that a team of experts from the United States would handle her case. She spent six months confined to a hospital bed waiting for their arrival.

The prolonged illness took a heavy toll on her physical and mental health. Her weight dropped from nearly 90 kilograms to 30 kilograms, and she struggled with depression. Seeing other women facing similar challenges, however, helped her come to terms with her situation.

Throughout the ordeal, she relied on support from her husband, nurses, and well-wishers who provided food and other necessities.

"My husband was a great support. He would do labour work, earn some money, buy food, cook and bring it to me. My children sometimes missed school. It was not easy for him to provide for the family and handle all the household responsibilities alone. I didn’t even know about fistula until I got it,” said the mother of four.

ALSO READ: Local medics, IOWD on why they embraced fistula fight

In October 2018, specialists from the International Organization for Women and Development (IOWD), a U.S.-based nonprofit that partners with Rwandan medical professionals to provide free specialised surgeries to underserved women, arrived in Rwanda and prepared her for surgery.

Doctors told her the fistula could be repaired through surgery, although full recovery would take about two months. She underwent the procedure, with treatment fully covered by Community-Based Health Insurance (Mutuelle de Santé).

Nyirandinabo remained in hospital for 15 days as she recovered. Once the catheter was removed, she was able to urinate normally again.

"After the operation, the happiest moment of my life was being able to urinate normally. I danced and thanked God. It felt amazing to feel normal again.”

By the time she was discharged, her weight had increased to 48 kilograms. Two months later, the wound had completely healed.

In 2021, she gave birth to her fourth child, a baby girl, through another C-section at Kibagabaga Hospital without complications.

Before developing the fistula, Nyirandinabo earned a living through casual labour, including washing clothes and doing other small jobs. In 2022, the organisation that operated on her gifted her a sewing machine.

Having trained in tailoring in 2015, she began making uniforms, caps for health workers, and other garments for members of her community.

Owning a sewing machine had long been her dream, but it was previously beyond her means.

Through savings from her tailoring business and other side jobs, she and her husband purchased a house and land in 2025. They no longer rent, and their children are now in school.

Nyirandinabo encourages women experiencing urinary leakage after childbirth to seek medical care promptly.

She says she has spoken to women with similar symptoms and urges them not to delay treatment.

Although she has fully recovered, she can no longer lift heavy loads or perform strenuous physical labour.

What causes fistula?

Immaculée Kantengwa, a midwife at Kibagabaga Level Two Teaching Hospital, said obstetric fistula is a serious childbirth injury with far-reaching consequences for women.

It is an abnormal opening between the birth canal and the bladder or rectum, usually caused by prolonged obstructed labour without timely access to emergency obstetric care, such as a C-section.

"Since May 2022, the Fistula Programme at Kibagabaga Hospital has examined 1,319 patients and performed 549 surgeries. In Rwanda, the main causes include early marriage leading to adolescent pregnancy before the pelvis is fully developed, malnutrition, long distances to health facilities, and delays in seeking skilled birth attendance,” she said.

Common symptoms include continuous leakage of urine or faeces through the vagina following difficult labour, chronic infections, skin irritation, and foul-smelling discharge.

When to seek medical attention

"Women should seek immediate medical help if they experience leakage after childbirth. Anyone who has undergone labour lasting more than 24 hours should have a follow-up check-up, even if no symptoms are initially present,” Kantengwa advised.

She noted that fistula can have severe physical, emotional, and social consequences. Chronic incontinence can lead to recurrent infections, kidney problems, and infertility. Many women also experience depression, low self-esteem, and social isolation due to stigma associated with the condition.

In some cases, women are abandoned by partners or excluded from community activities, limiting their ability to work and participate in public life.

Treatment and prevention

Corrective surgery remains the primary treatment for obstetric fistula and is highly effective. In Rwanda, fistula care is integrated into the national maternal health strategy.

"Hospitals such as CHUK and selected district hospitals provide these surgeries. The government, in partnership with the United Nations Population Fund (UNFPA) and NGOs such as Rwanda Women’s Network, also organises fistula camps where specialised surgeons offer free or subsidised repairs to women in rural areas,” Kantengwa said.

While access to treatment has improved, she noted that distance remains a major barrier for women living in remote areas.

Preventing fistula requires addressing delays in seeking, reaching, and receiving quality care. Pregnant women are encouraged to attend all antenatal care visits, plan for facility-based deliveries, and avoid home births without skilled assistance.

Health workers also play a crucial role in detecting obstructed labour early and ensuring timely referrals for C-sections.

"Families and communities should be educated about the dangers of early pregnancy, support pregnant women in reaching health facilities, and help combat the stigma surrounding fistula so that women feel comfortable seeking care immediately,” Kantengwa said.