A fistula is simply a hole between an internal organ and the outside world that should not exist.  There are two primary causes of fistula in women in developing countries:  childbirth, causing obstetric fistula and sexual violence, causing traumatic fistula

Obstetric fistula the most devastating of all childbirth injuries

An obstetric fistula develops when blood supply to the tissues of the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die and a hole forms through which urine and/or feces pass uncontrollably. Women who develop fistulas are often abandoned by their husbands, rejected by their communities, and forced to live an isolated existence.

More than two million women live with fistula

Eradicated in western countries at the end of the 19th century when cesarean section became widely available, obstetric fistula continues to plague women throughout the developing world. It is estimated that there are 100,000 new fistula cases each year, but the international capacity to treat fistula remains at only 6,500 per year. The United Nations Population Fund (UNFPA) estimates the world's population of fistula sufferers at more than two million.

Nerve damage and psychological trauma

The WHO has called fistula “the single most dramatic aftermath of neglected childbirth”. In addition to complete incontinence, a fistula victim may develop nerve damage to the lower extremities after a multi-day labor in a squatting position. Fistula victims also suffer profound psychological trauma resulting from their utter loss of status and dignity.

Traumatic fistula -- when rape is used as a tool of war

The consequences of fistula are life altering when the injury goes unrepaired.  In Congo, rape is being used as a tool of war on a massive scale.  The result is often traumatic fistulas, that is holes in bladders, vagina and rectum that are caused by rape or attack using bayonets, wood, and even guns.  The Economist magazine recently estimated that 80% of the fistula cases in the Congo were the result of sexual violence.  For the women with the injury, they are still very much in need of treatment, and psychological counseling as well.  The Panzi Hospital in the Congo, founded by Congolese gynecologist Denis Mukwege is a pioneer in helping these victims of rape.