What To Know About VVF (1)

Dr. Habib Sadauki is Country Project Manager, EngenderHealth and Fistula Care Plus. He presents the ABC of VVF in this interaction with PAUL ADUNWOKE
VVF, Anal Fistula and Risk Factor
Vesico Vaginal Fistula (VVF), and faeces Recto-Vaginal Fistula (RVF), is an abnormal hole between the bladder and rectum, the vagina characterised by continuous and uncontrollable leakage of urine following childbirth. Prolonged obstructed labour without timely intervention is by far the most common cause of this abnormal hole, constituting an estimated 95 per cent of all VVF, and RVF cases. During unrelieved obstructed labour, the soft tissues of the pelvis are compressed between the baby’s head and the mother’s pelvic bones.

The lack of blood flow causes tissues to die, creating a hole between the mother’s vagina and bladder, VVF or between the vagina and the rectum, RVF or both, resulting in continuous leakage of urine or faeces respectively. Other causes include harmful traditional practices such as Female genital cutting and trauma to the pelvis or certain cancers affecting the pelvic organs. In some cases the fistula is caused as a result of surgical operations, such as Caesarian Section, when it is called iatrogenic fistula.

Fistula is a problem that can be prevented by timely and skilled maternity care. With appropriate resources, awareness, knowledge and strong health systems for prevention, treatment and reintegration, fistula can become a rare event for the future generations.

The Prolonged Obstructed Labour results from many causes, which include small maternal pelvis or the baby is too big, uterine contractions not strong enough to push the baby out, deformed uterine walls due to fibroids, abnormal lie of the baby in the womb and multiple pregnancy. When the pelvis is small, regardless of the age for marriage of the mother, it will obstruct in labour and if there is no early intervention she will develop fistula. A major cause of small pelvis in our environment is malnutrition suffered in early childhood, which leaves the mother stunted in growth. In some cases the pelvis is deformed by rickets.