A vesicovaginal fistula is an abnormal opening between the urinary bladder and the vagina that results in urine leaking out uncontrollably through the vagina.
Many girls aged 11-15 in Nigeria become mothers either after early marriage to older men or through accidental pregnancy as a result of sexual intercourse with peers. Their small pelvis sizes cause most of these young girls to experience obstructed labor. Unskilled birth attendants simply cut through the vagina to create a passage for the baby, which results in vesicovaginal fistula (VVF), the leakage of urine and faeces through the vagina.
Also, VVF can be caused by rape or prolonged sexual abuse, as in the case of Ochanya Ogbanje.
This post aims to enlighten you on this condition, including its symptoms, causes, and treatment.
Causes
Most cases of vesicovaginal fistula occur following childbirth. Causes of vesicovaginal fistula include the following:
1. Obstructed Labor During Childbirth
Prolonged, obstructed labour is the leading cause of vesicovaginal fistula everywhere around the world. Obstructed labor occurs when the uterus contracts normally during childbirth, but the baby does not pass through the birth canal.
Sometimes, when the delivery is prolonged, the fetus is brought out with the help of an instrument called a forceps. The use of forceps for delivery can cause trauma to the pelvic tissues.
It could occur in conditions like a big baby, an abnormally positioned baby, or a small maternal pelvis or birth canal. Very young mothers are physically immature to have babies and often suffer from obstructed labor.
2. Cancer
Advanced cancer of the cervix, vagina, or bladder may produce a vesicovaginal fistula by direct spread to the surrounding organs. In addition, radiation used for the treatment of cancer of the cervix might result in the development of a fistula. However, it usually takes a long time (1-2 years) to develop such a type of fistula.
3. Surgery
Abdominal operations include a C-section, surgical removal of the uterus (hysterectomy), or operations on the urinary tract or lower gastrointestinal tract. A fall on a pointed object or the use of a stick for criminal abortion also causes VVF.
4. Rape
Rape is a painful and traumatic process, especially when it involves multiple men with a younger child. Most teenage girls who are raped experience VVF.
Symptoms
- Continuous leakage of urine occurs through the vagina during the day as well as the night (true incontinence), which is the characteristic feature.
- In a large fistula, there is no urge to empty the bladder because the urine seldom stays in the bladder.
- Leakage of urine following a difficult surgery occurs on the first postoperative day itself or once the catheter is removed; however, a fistula following obstructed labour may take three to five days to develop. Fistulas after radiation could develop several months or years following the treatment. This happened commonly after radiation for cervical cancer.
- The vaginal skin appears red or inflamed and excoriated.
- The smell of urine may be noted.
Treatment
Catheter
Once the diagnosis is made, and if the fistula is small and the patient leaks urine occasionally, a catheter is introduced into the bladder and is kept there for 6-8 weeks. This minor procedure could result in the spontaneous closure of the fistula tract.
Surgery
The ideal time for surgery of VVF due to obstructed labour is after three months following delivery. By this time, the general condition of the woman improves, and the local tissues are likely to be free from infection. The repair is done through either the vagina or the abdomen, or through a combined approach, depending upon the choice and expertise of the surgeon. Laparoscopic surgery is also sometimes used.
Electrocoagulation
The fistula tract is being treated with electrocoagulation with a negligible coagulation current delivered through a small electrode introduced either through the vagina or the urethra, which has been utilized effectively in a few patients with fistulas under three millimeters in diameter.
