Vesicovaginal Fistula

A vesicovaginal fistula is an abnormal opening between the bladder and the vagina, most often resulting from prolonged, obstructed labour without timely access to emergency care. It causes continuous, uncontrollable leakage of urine and has a significant impact on a woman’s health and social life, but is treatable with surgery.

• Continuous, uncontrollable leakage of urine from the vagina
• Constant wetness, which can lead to skin irritation and infection
• Urine odour, which can be socially distressing and lead to isolation
• Symptoms typically begin days after a prolonged, obstructed labour, once tissue that was damaged by prolonged pressure breaks down

• Most commonly results from prolonged, obstructed labour, during which the baby's head presses against the mother's pelvic tissues for an extended period, cutting off blood supply and causing tissue death that later breaks down to form a fistula.
• Risk is greatly increased by lack of access to timely emergency obstetric care, including emergency caesarean delivery, during obstructed labour.
• Less commonly, can result from pelvic surgery, cancer, or radiation treatment affecting the pelvic area.

• Suspected based on a history of continuous urine leakage following a prolonged or obstructed labour.
• Examination, including specific tests using dye instilled into the bladder, can help confirm the fistula and its exact location.
• Assessment for associated injuries, such as nerve damage causing foot drop, which can also occur after prolonged obstructed labour, is part of a thorough evaluation.

Surgical repair is the definitive treatment and is successful in restoring normal bladder function for the majority of women, particularly when performed at a specialised fistula treatment centre.

Timing of surgery depends on the specific circumstances, and some fistulas identified very soon after delivery may be managed initially with prolonged bladder catheterisation to allow a chance of spontaneous healing before surgery is considered.

Comprehensive care includes not only surgical repair but also psychological and social support, given the significant impact of this condition on a woman's dignity, relationships, and community standing.

Rehabilitation after successful repair, including pelvic floor support and follow-up care, helps ensure the best long-term outcome.

• Ensure skilled birth attendance and access to emergency obstetric care, including timely caesarean delivery, for every labour — this is the most effective way to prevent obstetric fistula.
• Support community education about the danger signs of prolonged labour, to encourage timely transfer to a facility that can provide emergency care.
• Reduce delays in seeking and reaching care during labour, including addressing transport and financial barriers where possible.
• Seek referral to a specialised fistula treatment centre for surgical repair and comprehensive support if a fistula develops.