Fistula|Pariahs in their Society.

fstulaWhat is fistula?

Fistula is a tear in a woman’s bladder or rectum that causes her to constantly leak urine or faeces.

Two million women suffer from the condition with 50,000 to 100,000 new cases occurring every year worldwide.

The main causes are prolonged labour, botched Caesarean section and sexual assault.

Are their types of this disease?

There are two kinds of fistula.

Obstetric fistula which is an abnormal opening in the birth canal. It’s an injury that occurs during child birth, usually when a woman is in labour for too long or when the delivery is obstructed.

Traumatic fistula which is an abnormal opening in the birth canal between the bladder and rectum resulting in incontinence. It’s an injury caused by rape or sexual violence

Does it affect women in Kenya?

More than two million women in Kenya suffer from fistula complications. This situation is further aggravated by delayed treatment because of limited facilities.

Most victims suffer pain and stigma. The cases are high in parts of North Rift, Western and Nyanza region.

Who is mostly at risk of fistula?

Most fistulas occur among women living in poverty, in cultures where a woman’s status and self-esteem may depend almost entirely on her marriage and ability to bear children, notes UNFPA.

Are they factors that increase one chances of getting affected?

The risk of obstetric fistula often begins when young girls get pregnant early, before their bodies are able to safely sustain a pregnancy. The unease surrounding sex education in Kenyan schools is one of the reasons for early pregnancy due to a lack of accurate reproductive health knowledge,

Female Genital Mutilation: Infibulation, practiced in some communities, which involves the cutting and sewing up of a girl’s genitalia leaving a match-stick size hole for the passage of menstrual blood is especially harmful. This hole is then crudely cut open during childbirth, something which could end up severing the bladder.

Myths and misconceptions surrounding fistula

Fistula is sometimes linked to taboo conditions such as HIV/AIDS, abortion and infertility. Fistula survivors may be thought to be bewitched or cursed, or may be accused of being promiscuous. There is also a refusal by some women to give birth in hospitals due to the belief that they will receive injections that will cause infertility, or be forced to have unnecessary Caesarean births.

 Stigma

Women and girls with fistula are often abused, beaten, abandoned, and isolated. Without repair, fistula may cause a fetid odour, frequent pelvic and urinary infections, painful genital ulcerations, infertility and nerve damage to the legs.

Affected women may miss out on crucial information on treatment and support, due to a lack of social interaction.

Home therapies

Due to the stigma associated with leaking urine, women sometimes refuse to drink water, making the urine more concentrated and resulting in the burning of the vulva; some also develop kidney disorders. In some communities, women seek to control the seepage of urine by inserting hot rods in an attempt to “seal” the fistula, causing more damage.

Lack of reproductive health education coupled with widespread ignorance of the basic facts also contributes to misconceptions. Because even medical personnel have insufficient information this has hindered timely referrals for the patient’s.

   Is there treatment for fistula?

Treatment for fistula varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy.

Typically the first step in treating a fistula is an examination by a doctor to determine the extent and “path” that the fistula takes through the tissue.

In some cases the fistula is temporarily covered, for example a fistula caused by cleft palate is often treated with a palatal obturator to delay the need for surgery to a more appropriate age.

Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abscess).

Various surgical procedures are commonly used, most commonly fistulotomy, placement of a Seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from re infecting the channel).

Treatment involves filling the fistula with fibrin glue; also plugging it with plugs made of porcine small intestine submucosa have also been explored in recent years, with variable success. Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.

According to the UNFPA, only 7.5 per cent of women are able to access fistula treatment.

Cherangany Nursing Home, Kitale in Trans Nzoia County which partners with KMET offers these services for free. Patients are refunded their transport once they get to the facility and the corrective surgery done.

In Siaya county, on June 22 to June 25 there will be a free gynaelocology examination at Sagam Hospital. KMET is partnering with the hospital to reach out to patients seeking corrective fistula surgery.

By Don King and Ashiembi Pauline

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