When I hear Of Fistula, The Next Thing That Comes to Mind Is Pregnancy And Childbirth (Part II)

This is the second of a series on Fistula:

A fistula:

A fistula is a hole, or abnormal opening, in the birth canal, that results in chronic leakage of urine and/or feaces.

There are many resources one can use to get information on fistula condition. In a resource by Amie (2019), symptoms and types of fistula are listed.

Symptoms:

Symptoms of fistulas vary depending on their location and severity. However, some symptoms are common in most cases. People often feel very unwell and run a fever. They also feel pain or tenderness at the site of the fistula. Itching may develop, especially if the fistula involves skin. Fistulas often exude pus, which may have an unpleasant or foul smell.


Risk Factors: 

Certain conditions place a person at a higher risk of developing a fistula. Crohn's disease and diverticular disease are two conditions highly likely to cause fistulas. Around one in three people with Crohn's disease will get a fistula at some point. Certain cancer therapies, in particular, radiation therapy, can make fistulas more likely to form. An unusual cause of enterovaginal fistulas is obstructed labor when doctors delay intervention for too long. This is rare in the United States as women usually receive a high level of care during childbirth.

Sepsis: 

If left untreated, fistulas can become chronic. They can also cause sepsis, a potentially life-threatening condition that develops when the immune reacts to an infection. Symptoms of sepsis include a high-grade fever, a rash, and confusion. It can also result in a fast heart and breathing rate. Sepsis is a medical emergency and requires immediate hospital treatment.


Treatment with Enteral Diet:

Doctors may prescribe enteral diets to those with fistulas in the small or large intestines. When a person is on an enteral diet, they will consume only liquid food for a period. They may require a feeding tube. This type of diet ensures one receives all the nutrients they need without taking in any solid food, thus reducing the amount of stool passing through the intestines and rectum. With this treatment, the fistula has a chance to heal and may even close on its own.

Surgical Intervention:

If the fistula is large or does not respond to less invasive treatments, it will require surgical removal or repair. Where possible, surgeons will use laparoscopic methods, inserting cameras and tools through very small incisions. However, some fistulas require transabdominal surgery involving larger incisions in the abdominal wall. In some cases, a fistula may develop in a diseased part of the bowel. Doctors may resection the bowel and remove the diseased section, including the fistula. In this situation, the person may require a pouch after surgery. This will temporarily divert stool away from the resectioned area to give it time to properly heal.


Statistics: 

Preventing and managing obstetric fistula contribute to the Sustainable Development Goal 3 of improving maternal health.

According to fistualfoundation.org, there are over one million women suffering from obstetric fistula worldwide. Fistula is most prevalent in sub-Saharan Africa and Asia.

Fewer than 6 in 10 women in developing countries give birth with any trained professional, such as a midwife or a doctor. When complications arise, as they do in approximately 15% of all births, there is no one available to treat the woman, leading to disabling injuries like fistula, and even death.

The root causes of fistula are grinding poverty and the low status of women and girls. In developing countries, the poverty and malnutrition in children contributes to the condition of stunting, where the girl’s skeleton, and therefore pelvis as well, do not fully mature. This stunted condition can contribute to obstructed labor, and therefore fistula.

Obstetric fistula is both preventable and treatable. It can be prevented if laboring women are provided with adequate and timely emergency obstetric care when complications arise. Once a fistula has developed, however, the only cure is surgical treatment.


In the WHO (2019) report, each year between 50,000 to 100,000 women worldwide are affected by obstetric fistula. The development of obstetric fistula is directly linked to one of the major causes of maternal mortality: obstructed labour.

Women who experience obstetric fistula suffer constant incontinence, shame, social segregation and health problems. It is estimated that more than 2 million young women live with untreated obstetric fistula in Asia and sub-Saharan Africa.


Definitions:

The most common fistulas are listed. A fistula occurs when two organs or structures within the body form an abnormal connection. Fistulas can begin in various ways, but many start as an abscess. Abscesses are pus-filled pockets of tissue. Gradually, the abscess may fill with a bodily fluid such as urine. After a while, the abscess invades another structure in the body. This connects the two structures and forms a fistula. You can think of it as a tunnel that should not be there. Fistulas are most common in the abdomen but can occur anywhere in the body. 

Enterocutaneous fistulas connect the small intestine to the skin. They often result from surgical complications. 
Enteroenteric or enterocolic fistulas involve either the small or large intestine connecting to another structure in the body. 
Enterovaginal fistulas are fistulas involving the vagina. 
Enterovesicular fistulas enter the bladder and can cause the person to contract frequent urinary tract infections.

Remember, you too can contribute to preventing Fistula


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