Since womanhood has existed, Vesicovaginal Fistula (VVF) has been part of that existence. Notably, it is one of the serious health issues facing Nigerian women, although it is not talked about just like many women-specific health issues.
Simply put, VVF is an abnormal fistulous tract that extends between the bladder (or vesico) and the vagina, that allows a continuous involuntary discharge of urine into the vaginal vault. However, this definition oversimplifies the pain and trauma that comes with this health issue.
More explicitly explained, a woman’s anatomy consists of the vagina and bladder, amongst other organs. Usually, the vagina and bladder are separate and there is no space inside the vagina unless it is stretched open —for example, during an examination, sexual intercourse, or childbirth.
The stretching that occurs during childbirth is always more severe and results in a hole (also known as fistula). This hole develops over many days of obstructed labour when the pressure of the baby’s head against the mother’s pelvis cuts off blood supply to delicate tissues in the region. The dead tissues fall away and the woman is left with a hole between her vagina and her bladder and sometimes between her vagina and rectum (rectovaginal fistula, RVF). This hole ultimately results in the permanent inability of the body to control the evacuation of urine and/or faeces.
When this happens, the medical condition is termed Vesicovaginal Fistula (VVF) or Rectovaginal Fistula (RVF), depending on the organ affected. Sadly, a majority of women who develop fistulas are abandoned by their husbands and ostracized by their communities because of their foul smell.
Since fistula mainly results from obstructed labour during childbirth, it could occur to any woman, whether in developed or developing countries. In fact, it is estimated that 5% of all pregnant women worldwide will experience obstructed labour. However, the prevalence of emergency obstetric care which is readily available in developed countries makes it less likely to happen. In many developing countries, on the other hand, where there are few hospitals, few doctors, and poor transportation systems, obstructed labour often results in the death of the mother. When she survives, there is a great likelihood her child will die and she will develop a fistula.
According to the United Nations Population Fund, some 50,000-100,000 women sustain an obstetric fistula while giving birth every year. It is the most devastating of all pregnancy-related disabilities and Nigeria accounts for 40% of fistula cases worldwide.
Approximately 80-95% of the causes of Obstetric fistula occurs when a young woman, usually between the ages of 11-15 experiences prolonged obstructed labour and has no access to a Caesarean section. The obstruction can occur because the woman’s pelvis is too small (in such cases, it may have been as a result of early marriage or through accidental pregnancy), the baby’s head is too big, or the baby is badly positioned. She can be in labour for five days or more without medical help.
To create the passage for the baby, an unskilled birth attendant may simply cut the vagina, and if the mother survives, she is left with extensive tissue damage to her birth canal, and by extension, the hole that enables urine and faeces to leak into the vagina.
HOW CAN IT BE TREATED?
There are hundreds of thousands of such cases throughout Nigeria, especially in regions that are known for conducting early marriages. Patients with uncomplicated fistula can undergo a simple surgery to repair the hole in the bladder or rectum. Approximately 80-95% of vaginal fistula can be closed surgically.
PREVENTION IS BETTER THAN CURE!
It is worth mentioning that childbirth-related health issues are most times dependent on the age of the mother. If a woman is older or very young, she is more prone to such issues than, for example, a 20-something-year-old woman. As such and specifically for this health issue, the best way to avoid fistula would be to delay the age of first pregnancy. This may, nevertheless, be difficult in cultures where a woman’s status and self-esteem may depend almost entirely on her marriage and ability to bear children.
In conclusion and very importantly, there is the need to lessen the influence of religion on the reproductive health decision making and behaviour of women in Nigeria. This is because many women in rural areas believe VVF occurs as a result of their “sins” or simply do not go to hospitals with the belief that they will be miraculously healed. In reality, VVF can be avoided through timely access to quality obstetric care before or during childbirth, NOT through prayers. Women should always visit the clinics for antenatal check-ups when available.3