The fight against fistula

Women who were screened and treated in 2016 at a hospital camp at Ruhengeli Hospital in Musanze for surgical repair of obstetric fistula, a devastating childbirth-related condition. /Courtesy-Jhpiego

Fistula is a distressing disease that affects women. There are different types of fistula and the most common of all is obstetric fistula. Obstetricians say that this commonly occurs among women who live in low-resource countries, who give birth without access to medical help. If a woman’s labour becomes congested, she could remain in severe pain for days before her baby is finally removed. Her baby likely dies and she is often left with an obstetric fistula, a small hole created by constant pressure from the foetus, which reduces her incontinent.

Michel Baingi Mulebu, a Kigali-based general doctor, states that fistula is the abnormal communication of two internal organs or internal organ with exterior by an orifice; the main cause could be delivery, surgery, cancer, and infection.

Mulebu says that types of fistula include ano-vaginal, bladder-vaginal, arterio-venous, pulmanory, and intestinal. Signs and symptoms are presence of stool, or urine on the orifice or organs, pruritus, infection uro-genital and dyspareunia.

Mulebu explains that the complications are infection, mental disease, and necroses.

Dr Iba Mayele, an obstetrician gynaecologist at Clinic Galien, Kimironko, says fistula is the tunnel that connects the gland to that opening. Most of the time an abscess causes a fistula, it is rare but it can also come from conditions like tuberculosis, sexually transmitted diseases, or an ongoing illness that affect the bowels.

Mayele says that anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus. It is usually the result of an infection near the anus causing a collection of pus or swelling in the nearby tissue.

Caritas Musanabera suffered with fistula for eight years before she received help. There are no statistics on the number of people suffering from fistula because many of them conceal their illness and shy away from the public. /File photo

He adds that symptoms include pain, redness swelling around the anus, bleeding, painful bowel movements or urination, fever, and a foul-smelling liquid oozing from a hole near the anus. There is no medication to fix the condition, so surgery is the solution.

Mayele adds that a vaginal fistula is an abnormal opening that connects your vagina to your bladder, ureter, urethra, rectum, large intestine, and small intestines. Most often, that culprit is tissue damage that can result from any of the following abdominal surgery (hysterectomy or C-section), pelvic, cervical, or colon cancer.

He explains that vaginal fistula can be upsetting and embarrassing because it leaks and can cause a bad smell, and its complications include vaginal or urinary tract infections that keep bringing back hygiene problems, stool or gas that leaks through the vagina, irritated or inflamed skin around the vagina or anus, radiation treatment, bowels diseases like Crohn’s or diverticulitis, infection including after an episiotomie, traumatic injury such as from a car accident.

Mayele notes that for treatment, a catheter is inserted into the bladder to drain the pee and give the fistula time to heal by itself, or a special glue or plug made of natural proteins is used to seal or fill the fistula, but still, many people need surgery.

Mulebu states that treatment of fistula could be controlling infections, mental-socio caring, and having proper nutrition. The risk is delivery if the patient pushes enough without the uterine contraction or pushing a big baby.

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