Obstetric fistula is an abnormal opening between the birth canal and the bladder and/or rectum, usually caused by prolonged, obstructed labour without timely access to caesarean section. The result is continuous leakage of urine, faeces or both. UNFPA estimates that hundreds of thousands of women and girls live with fistula, most in sub-Saharan Africa and South Asia. Many are abandoned by partners, excluded from their communities, and live in poverty and shame. Fistula is almost entirely preventable, and most cases can be surgically repaired.
How fistula happens
During prolonged obstructed labour, the baby’s head presses on the soft tissues of the pelvis for hours or days, cutting off blood supply. The tissue dies and breaks down, leaving a hole. The baby often dies. Risk factors include very young maternal age, small pelvis, malnutrition, lack of skilled birth attendants, delays in reaching care, and lack of emergency obstetric services. Fistulas can also result from surgical injury or sexual violence.
Prevention: the nurse and midwife’s role
- Skilled birth attendance and use of the partograph or WHO Labour Care Guide to detect prolonged labour early. See labour monitoring.
- Timely referral for caesarean section when labour isn’t progressing.
- Antenatal education on birth preparedness and danger signs.
- Delaying first pregnancy and ending child marriage.
- Family planning access.
- Bladder catheterisation after prolonged obstructed labour: an indwelling catheter for a period (often 10–14 days, per protocol) may allow small fresh fistulas to heal without surgery, and protects the bladder.
Recognising fistula
- Constant leakage of urine or faeces from the vagina after childbirth.
- Skin irritation, infections, odour.
- Women may hide symptoms out of shame; ask sensitively after difficult births.
Treatment
- Surgical repair by trained fistula surgeons has high success rates for simple cases. Many countries have dedicated fistula centres and periodic free repair campaigns supported by governments and partners.
- Nursing care around surgery: catheter care (keeping it draining freely is crucial to healing), fluid intake, monitoring for infection, pressure area care, nutrition.
- Rehabilitation: pelvic floor physiotherapy, counselling, literacy and livelihood programmes to support reintegration.
Dignity and compassion
Women with fistula have often been treated with disgust and rejection, even in health facilities. Nurses can restore dignity simply by treating them with respect, providing privacy and supplies, and helping them access repair. Talk to communities to reduce stigma: fistula is a medical injury, not a curse or a punishment.
Related: Perineal care · Urinary catheter care
Based on UNFPA Campaign to End Fistula resources and WHO guidance on obstetric fistula. Educational content.