FAQ Topic: Obstetric Fistula

What is a fistula?

A fistula is a hole. 

An obstetric fistula is a hole between a woman’s vagina and one or more of her internal organs. This hole develops over many days of obstructed labor, when a mother is unable to access emergency maternal care. Contrary to a common misconception, this injury is not due to the ripping of tissue, rather it is due to the pressure of the baby’s head being pushed against the mother’s pelvic bone by uterine contractions during labor. This pressure can cut off the supply of oxygenated blood. Deprived of oxygen, the tissue becomes “necrotic” or dead. When this dead tissue falls away, it leaves behind holes in the vagina, bladder and sometimes the rectum. These holes result in permanent incontinence of urine and/or feces. A majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their foul smell.

Traumatic fistula is the result of sexual violence. The injury can occur through rape or women being butchered from the inside with bayonets, wood or even rifles. The aim of sexual violence is to destroy the women and the community within which the sufferer lives. Once committed, the survivor, her husband, children and extended family become traumatized and humiliated. Panzi Hospital in Congo is a pioneer in treating victims of traumatic fistula, and Fistula Foundation is proud to support their work. Learn more about their work on our DRC country page

An iatrogenic fistula is caused unintentionally by a healthcare provider. For example, the bladder may be accidentally cut during a C-section or hysterectomy, resulting in a hole through which urine leaks. Iatrogenic fistulas are becoming more common in places where women deliver in a health facility but where the health workers do not have the skill to provide high quality care. These cases currently comprise 11% of fistula we treat and underscore why supporting training and well-equipped facilities are so essential. Learn more about our investment areas

The Institute for Health Metrics and Evaluation (IHME) compares the burden of different health conditions through a relative-weight metric. A weight of 0 means perfect health, and a weight of 1 means death. The IHME rates Vesico-vaginal fistula (incontinence of urine) at 0.342, putting it on par with complete hearing loss and drug-resistant tuberculosis. It rates recto-vaginal fistula (incontinence of feces) at 0.501—on par with terminal cancer.

Can obstetric fistula be cured?

Yes. An obstetric fistula can be closed with corrective surgery. If the operation is performed by a skilled surgeon, a woman with fistula  can very often return to a normal life, with her continence and hope restored.

Launched in 2012 by Fistula Foundation, Direct Relief and UNFPA, the Global Fistula Map is the single most comprehensive source for understanding worldwide availability of treatment for women living with fistula. The map relies on self-reported data from treatment partners, but counts only 60,280 surgeries completed between 2012 and 2015 – about 20,000 per year.

What are the root causes of fistula?

An obstetric fistula occurs when a mother has a prolonged, obstructed labor, but cannot access emergency medical care, such as a C-section. It is a symptom of deep, intractable poverty and the low status of women and girls.

In poor countries, many children are malnourished, which can stunt their growth. If a young mother’s pelvis is not fully mature, she is at an increased risk of experiencing an obstructed labor—and with it, devastating childbirth injuries like obstetric fistula. The practice of early marriage and young pregnancy can additionally compound this risk. Child marriage remains a worldwide issue, affecting millions of girls around the globe.

Another key cause of fistula is a critical lack of doctors and medical facilities. In poor, rural regions of Africa and Asia, fewer than 6 out of 10 women give birth with a medical professional present.

Does obstetric fistula occur in wealthy countries?

Even though obstructed labor occurs in approximately 5% of all child births worldwide, obstetric fistula has largely been eradicated in wealthy countries, thanks to the advent of the Cesarean section in the early 1900s. 

Today, fistula persists in low-income countries where women have limited access to emergency obstetric care. It continues to destroy women’s lives at an alarming rate in poor, rural regions of Africa and Asia, where  fewer than 6 out of 10 women give birth with a medical professional present. Learn about where we work

Where is fistula prevalent?

Women are susceptible to developing fistulas in low-income countries with poor access to emergency maternal care. Today fistula remains prevalent in poor, rural regions of sub-Saharan Africa and parts of Asia. With the advent of the C-section in the early 1900s, the condition was largely eliminated in wealthy countries such as the United States. 

To learn more about the regions where Fistula Foundation works, please see our Country Directory

How many women does this problem affect?

A peer-reviewed analysis, published in December 2013 by a team at the London School of Hygiene and Tropical Medicine, estimates there are over one million women suffering with obstetric fistula. Because many women with fistula sustained their injury as young women — many still in their early twenties or even late teens — they are likely to live with their condition for decades if it is left untreated. Yet surveys done for the Global Fistula Map estimate that fewer than 20,000 surgeries are performed per year.

Can obstetric fistula be prevented?

Any woman with obstructed labor who has access to competent emergency obstetric care, including a Cesarean section, will not develop a fistula.

I heard that fistulas are a result of female genital cutting. Is this true?

While harmful traditional practices such as female genital cutting (FGC) are rightly of concern to the international medical community, they are not major contributors to the development of an obstetric fistula. Some patients have been victims of FGC, but their fistulas are almost always caused by an obstructed labor resulting from a too-small pelvis or a malpresentation of the baby. FGC does not “cause” a fistula.

FGC can, however, make treatment of an obstetric fistula more complicated, because the scar tissue resulting from FGC can make fistula repair surgery more difficult.

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