Obstetric Fistula: Symptoms & Treatment

Instructor: Megan Gilbert

Megan has a master's degree in nursing and is a board certified Women's Health Nurse Practitioner. Her area of clinical focus is the impact of infectious disease on pregnancy. She has experience teaching college allied health classes. She is also a certified EMT and holds a certificate of added qualification in electronic fetal monitoring.

Obstetrical fistula is a life changing childbirth injury. This lesson covers the common symptoms, as well as the treatment options available to women suffering with this condition.

A Routine Annual Exam

A young woman, recently immigrated to the United States from an under-developed nation sits on your exam table. She's shifting awkwardly in the unfamiliar gown and is doing her best to answer your questions through an interpreter. You continue through your routine questions and ask her, ''Do you have any difficulty making it to the bathroom in time when you need to urinate or have a bowel movement?''

She begins to cry and explains that several years ago she was pregnant with a baby and was in labor for several days. Eventually the child died during the long delivery, but since that time she has been unable to control her urine. You suspect that after suffering a prolonged labor the woman now has an obstetrical fistula.

An obstetrical fistula is a hole or connection that occurs between the vagina and the bladder or between the vagina and rectum. This is most often caused during a prolonged labor when the fetus' head applies continuous pressure to the pelvic bones resulting in soft tissue damage to the muscles in the pelvis.

What complaints would you expect from this woman with an obstetrical fistula? And how can you help this woman end her suffering?
african woman

Common Symptoms

The complete urinary incontinence that she is describing is a common symptom, as is bowel incontinence. However, women will often report several different symptoms.

Common symptoms include the following:

  • Constant urine leaking from vagina
  • Irritation of the external genitalia
  • Frequent urinary tract infections
  • Leakage of gas and/or feces into the vagina
  • Vagina discharge
  • Nausea/vomiting
  • Diarrhea
  • Abdominal or pelvic pain
  • Amenorrhea (or the absence of a normal menstrual period)
  • Dyspareunia (painful sex)

Upon further questioning about medication usage, she tells you that she suffers from frequent urinary tract infections, but that she is able to treat them at home using antibiotics available without a prescription in her home country.

What can you offer her to help relieve her symptoms and allow her to return to her pre-fistula life?

Treatment

During the exam you find a small hole connecting the vagina to the bladder. You smile at her as you leave the room for her to get dressed - and reassure her that you'll be able to help her.

There are several treatment options available, but you'll need to pick the right one for this patient.

The main goal for surgery is to close the hole connecting her bladder and her vagina. This allows her to become continent again, and for her to resume a normal life.

Immediate management

If she had access to treatment immediately following her birth injury, she would have been a good candidate for a catheter to be placed into the bladder which allows it to remain empty. This takes pressure off of the hole, and prevents liquid from flowing through it while it repairs itself. Doing this often allows it to heal on its own. Unfortunately, this patient is no longer a candidate for this option as the hole has healed open.

Non-invasive treatment options

There are some non-invasive treatment options available. These have less risk than traditional surgery, including less risk of infection and a faster healing time. But they work best for small holes.

You have two options in this group, either fibrin glue, which is medical grade glue that can be used to seal the connection. Or, you could use a plug, which is a matrix made from collagen used to seal the connection.

Invasive treatment options

Surgical correction is often needed. This can be accomplished with intra-vaginal surgery, where the surgery is preformed via the vagina.

Sometimes the surgery is done as a laparoscopic surgery, where a small incision is made and the surgeon is able to use camera-guided equipment to close the holes.

For larger repairs, the surgery may need to be done intra-abdominally, where a large incision is made across the abdomen and the organs are repaired through the central incision.

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