Obstetric fistula

Obstetric fistula
Diagram of maternal and foetal sequelae of prolonged obstructed labour, highlighting areas that are at high risk of developing obstetric fistula(s).
Specialty	Urology, gynecology
Symptoms	Incontinence of urine or feces[1]
Complications	Depression, infertility, social isolation[1]
Usual onset	Childbirth[1]
Risk factors	Obstructed labor, poor access to medical care, malnutrition, teenage pregnancy[1][2]
Diagnostic method	Based on symptoms, supported methylene blue[3]
Prevention	Appropriate use of cesarean section[1]
Treatment	Surgery, urinary catheter, counseling[1][3]
Frequency	2 million (developing world), rare (developed world)[1]

Obstetric fistula is a medical condition in which a hole develops in the birth canal as a result of childbirth.^[1][2] This can be between the vagina and rectum, ureter, or bladder.^[1][4] It can result in incontinence of urine or feces.^[1] Complications may include depression, infertility, and social isolation.^[1]

Risk factors include obstructed labor, poor access to medical care, malnutrition, and teenage pregnancy.^[1][2] The underlying mechanism is poor blood flow to the affected area for a prolonged period of time.^[1] Diagnosis is generally based on symptoms and may be supported by use of methylene blue.^[3]

Obstetric fistulae are almost entirely preventable with appropriate use of cesarean section.^[1] Treatment is typically by surgery.^[1] If treated early, the use of a urinary catheter may help with healing.^[3] Counseling may also be useful.^[1] An estimated 2 million people in sub-Saharan Africa, Asia, the Arab region, and Latin America have the condition, with about 75,000 new cases developing a year.^[1] It occurs very rarely in the developed world and is considered a disease of poverty.^[5]