The thickness of tissue between the urinary tract and the female genital tract is only a few millimeters. If you never studied human biology, you’d think that girls pee from the vagina! Urinary fistula refers to any  abnormal connection between the urinary tract and the female genital tract, whereby urine leaks from the latter continuously or intermittently without voluntary control. Vesico-vaginal fistula (VVF) is one of the subsets of urinary fistulae where the connection occurs between the bladder and the vagina. Other fistulae are named based on the point of connection with the exterior. For example, uretho-vagina fistula is when the urethra (the hollow pipe which empties urine out of the bladder) connects with the vagina. I will use VVF for the purpose of this article, to avoid verbosity. 
The commonest cause of VVF is obstetric. During labour, the head of the baby exerts pressure on the vagina as it pushes it’s way through. If the birth canal is roomy enough and the head is not too big or abnormally positioned, the delivery is smooth and quick. However, in case of prolonged obstructed labour, where there’s a problem with the “passage” or “passenger”or both, the pressure becomes too much and then, the tissue separating the vagina from the urinary tract is breached. Inflammation sets in and a fistulae is formed. Urine begins to leak uncontrollably. The woman becomes physically and emotionally devastated. The husband abandons her, the society stigmatizes her, and the vicious cycle continues… 
Once we understand the pathogenesis of VVF, we can see that prevention is the best option. The defect can be corrected surgically but failure rate is quite high. There are other, non-obstetric causes such as cancer, radiotherapy and surgical injury, but these are less common. Harmful cultural practices such as female genital cutting is also a recognized cause. The prevalence is very high in less privileged communities where young women undergo labour for several hours without access to interventions such as cesarean section. Teenage pregnancy is a particular risk factor in poor communities but older women, even with previous uneventful delivery, can also be affected. The problem is not in teenage pregnancy itself, but in the lack of access to quality maternity care- after all, teenage pregnancy is also rampant in the developed world… 
The advancement in maternity care in developed countries has helped to reduce the number of VVF’s to almost zero, but developing countries are still battling with this preventable condition. The WHO, UNFPA, and other international and local bodies are doing a great job in helping women living with VVF and educating communities on how to prevent it. There are many outreach programs, free surgery campaigns as well as NGO’s and individuals involved in the fight against the menace of VVF. In Nigeria, Professor Ojengbede and his team in UCH/Adeoyo is a very good example I can personally attest to. For more information, visit https://www.fistulafoundation.org. People living with VVF are usually withdrawn, if you know anyone of them, offer a helping hand and let them know that there’s hope out there.


Author: Khadijah Sanni-Tijani

Khadijah is a young Nigerian woman, a muslim, a wife, a mum, a doctor and a blogger. She was born and raised in Ibadan, Nigeria. She is currently practising in Saudi Arabia.

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