THE STIGMA OF VESICO-VAGINAL FISTULA (VVF) by Dr. Alex Nnadozie

A typical VVF patient in our society is commonly poor, neglected, unhappy and untidy. She is too poor to afford frequent change of urine-soaked clothes, or frequent change of diapers as may be required. She is neglected by family and friends because she always smells of ammonia (from the urine), therefore a source of embarrassment to family and friends. She loses self-esteem and is not very far from depression. She is commonly found in the company of others like her – the only place she can share her agony and be listened to. A typical VVF patient in our society is a dehumanized suicidal young girl.

VVF is a preventable, disturbing condition that affects women of child-bearing age. It is particularly characterized by urinary incontinence (inability to control urine outflow from the body). In the female anatomy, the urinary bladder is just in front of the uterus and vagina. The vagina is the channel that leads from the end of the uterus to the ‘external environment’. VVF, therefore, is an abnormal connection of the urinary bladder to the vagina behind it.

The urinary bladder, which collects urine from the kidneys and stores till it is full, has a sphincter at the exit point which ensures that urine does not leak out until one deliberately voids in the appropriate place. That is not the case in VVF; the abnormal connection is almost always above the level of the sphincter, therefore the leakage of urine from the bladder to the vagina is uncontrolled. The vagina in itself has no sphincter, hence the continual wetting of the sufferer with urine.

CAUSES OF VVF

In developed countries the most known common cause of VVF is injury to the Urinary bladder during surgeries like Hysterectomy (surgical removal of the uterus). Due to the closeness of the three structures: the uterus, the urinary bladder and the vagina, in trying to remove the uterus and spare the other two, such complications have been known to occur.

In developing countries on the other hand, the commonest cause of VVF is prolonged obstructed labour. To offer some explanation… Experts have defined time limits for the painful but beautiful process of labour and delivery beyond which a woman should not be allowed to continue without adequate intervention. The head of a (cephalic presenting) baby is usually applied to the lower end of the uterus, extending the pressure to the other two organs as discussed above. If labour fails to progress within the acceptable time, the pressure may have been sustained long enough to prevent blood supply to the little area under pressure. The tissues there die for lack of blood and fall off, creating the unfriendly fistula between the two friendly structures.

This condition is commonly found in low socio-economically handicapped parts of the society where labour is poorly supervised due to lack of qualified doctors and midwives. Doctors and midwives are trained to know when to intervene if labour does not go as planned. For those that

have been through the prolonged process already, the experts know what to do to prevent VVF from ultimately setting in.

Researchers have described early marriage among “under age” girls as a factor that commonly leads to VVF; however, a pregnant teenage girl whose pregnancy, labour, and delivery are well supervised by experts is unlikely to suffer from VVF. Therefore, the age is not the cause, but the poor infrastructure and lack of personnel in communities where the pregnant teenager dwells. However, make no mistake about it, a female pelvis that is not well developed is more likely to have a prolonged labour than a more mature pelvis.

PREVENTION

The single best method of preventing any health condition is HEALTH EDUCATION. Teach people in the language they can understand. If they watch television, show it on television; if they listen to radio, broadcast it as frequently as possible. Teach it in schools and in the communities. Make use of posters and billboards. If all these are done to save one young lady that could have killed herself, then, they are not too much after all.

Encourage pregnant women to attend Antenatal services. There they will be taught all what to expect in every pregnancy. They will be taught that no two pregnancies are the same; that a stitch in time saves nine. Big babies are identified at antenatal visits and plans for the mode of delivery are made on time. Women with inadequate pelvises are identified and managed appropriately.

Women should be discouraged from home deliveries.

Let the girl child go to school, get educated and develop herself. An educated girl will know how to prevent VVF. She will know early enough where to find help if she has it or if anyone around her does. She will even join the next group to be discussed in the next paragraph to solve the problem of VVF.

THE GOOD NEWS

There are a lot of fistula surgeons in many fistula centers in the country. Because of the capital-intensive nature of these surgeries, a lot of NGOs are giving funding for the treatment and rehabilitation of VVF patients.

The centers for these treatments and the organizations that offer support all have their contacts on the internet. Help is just a click away.

CONCLUSION

VVF is an ugly and dehumanizing condition that affects women of child bearing age; but the good news is that it is as treatable as it is preventable. Do not stigmatize the patients; their conditions are known, therefore, their cure is near.

Bring someone out of depression today – save them from VVF.

We hope you found this article useful, please remember to register for the walk here and support women living with this condition through your donations.

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