Obstetric Fistula Treatment

An obstetric fistula is an opening or connection that forms either between the rectum and the vagina, as would be seen in a rectovaginal fistula, or between the urinary tract and the vagina, as in the case of a vesicovaginal fistula. With both types of fistulas, the course of treatment varies depending on the size, location and severity of the condition. But most women suffering from either condition will first be treated for any associated infections; treatment then shifts to the closure of the abnormal opening.

Before Surgery

• The first aspect of care is to treat any infection or subsequent irritation that may be affecting the fistula, the vagina, the rectum or the urinary tract. For most women, this treatment includes some type of antibiotic that is taken prior to correcting the fistula. Once the infection or irritation is under control, the second step in the process can commence.

  In some obstetric fistula cases, an intravenous antibody is introduced to help heal the fistula. Infliximab is the most common. It works by altering the body's immune response that is causing the tissue of the fistula to inflame, hindering the healing process. From here, the fistula can then be better treated.

Surgery

• Once the infection and inflammation is treated, surgery is performed. The surgeries for either form of obstetric fistulas are similar in their processes. The area is first examined to determine how much damage has been sustained. Next, the fistula is removed and the area repaired. For some, surgery is performed through the vagina where the fistula (and any damaged tissue) is manually removed and the opening is stitched shut. For others, surgery is performed through an incision in the abdomen and a graft is used to repair the opening once the fistula is removed.

Follow-Up Care

• After surgery is completed, some women have a catheter or a colostomy to divert urine or feces away from the repaired tissue. This can ensure that the area doesn't become infected and has a chance to properly heal. Your diet will most likely change for the first few weeks after surgery, first restricting solid foods and then the amount of fiber in your diet, especially with rectovaginal fistulas.

  You'll also need to take special care of your genital area after surgery, regularly washing (without soap) and drying with soft tissue. Make sure to avoid any irritants, like vaginal sprays, soaps, douches and fragrant tampons.