What is Fistula? Obstetric
fistula is the most devastating and serious of all
childbirth injuries. It happens because most mothers
in poor countries give birth without any medical
help. So many are young girls. Complications from
pregnancy and childbirth are among the leading
causes of death and disability for women of
reproductive age in these places.
was eradicated in the United States more than 100
years ago thanks to emergency cesarean section surgery.After enduring days of agonizing,
obstructed labor a woman's body is literally broken
by childbirth. During labor contractions, the baby's
head is constantly pushing against the mother’s
pelvic bone — causing tissue to die due to lack of
blood flow to this area. All of that pushing creates
a hole, or in medical terms a "fistula", between the
birth passage and an internal organ such as the
bladder or rectum. A woman cannot hold her urine,
and sometimes bowel content as well.Her baby is unlikely to survive.
If she survives, a
woman with fistula is likely to be rejected by her
husband because of her inability to bear more
children and her foul smell. She will be shunned by
her community and forced to live an isolated
existence. These women suffer profound psychological trauma resulting from their utter loss of status and
dignity, in addition to suffering constantly from
their physical internal injury.
Fistula is a abnormal medical condition which
results in the growth of un necessary passage ways
between different organs which need not have been
there in the first place. fistulas can develop
almost anywhere inside the body and between any two
organs. although in most cases it is not much of a
complication and can be easily treated using
medication and surgery. However precautions and
treatment not taken at the right time might lead to
problems like infection and even cancer at times.
Some of the Places Fistula might Develop include 1.
salivary gland 2.
rectal fistula 7.
intestinal fistula 8.
gall bladder fistula 9.
bile duct fistula buy adderall from online pharmacy
Types of Fistula:
Fistula are divided into three
broad categories according to the physical features
and type of connections shown by the fistula
1.blind(one open end ) 2.complete
(external and internal openings) 3.
incomplete (something that does not connect to any
internal organ) custom paper Fistula
is also classified according to the place of
existence of fistula. Here the name refers to the
place where the fistula can be found 1.vaginal
Fistula occurs in various places around the body so
there causes are also varied and cannot be
However some common causes of fistula include
1. diseases ( several inflammatory diseases like
crohns disease and ulcerative colitis.)
2. medical treatment( radiation therapy and
gallbladder surgery can cause fistula)
3. trauma caused by injury specially head injury and
In medicine, a fistula (pl. fistulas or fistulae) is
an abnormal connection or passageway between two
epithelium-lined organs or vessels that normally do
not connect. It is generally a disease condition,
but a fistula may be surgically created for
Without treatment, fistula often leads to social,
physical, emotional and economic decline. Although
some women with fistula display amazing courage and
resilience, many others succumb to illness and
The misery of fistula is relentless. In spite of
one's best efforts to stay clean, the smell of
leaking urine or faeces is hard to eliminate and
difficult to ignore. The dampness causes rashes and
infections. The cleaning up is constant, and pain or
discomfort may be continuous as well. The grief of
losing a child and becoming disabled exacerbates the
pain. The courage many women show in the face of
these challenges is extraordinary.
The injury leaves women with few opportunities to
earn a living, and many have to rely on others to
survive, or turn to begging or commercial sex. In
some communities they are not allowed to have
anything to do with food preparation and may be
excluded from prayer or other religious observances.
Although many women with fistula have supportive
families, the smell can drive even loving husbands
and friends away. For many women, the profound
social isolation is worse than the physical torment.
The pain and loneliness associated with fistula is
often compounded by a sense of shame and
humiliation. In some communities, the condition is
seen as a punishment or a curse for an assumed
wrongdoing, rather than as a medical condition.
Anal Fistula? A fistula in
ano is a tunnel like- pipe like track, developed in
the perennial region, usually having one or more
external openings around the anus leading to an
internal opening in the
mucosa of the anal canal or the rectum. Anal fistula
is termed "Bhagandara" in Ayurveda. In Ayurveda
fistulas, like other diseases have been classified
according to the vitiation of one per more of the
three doshas i.e. the vata, the Pitta & the kapha.
They have been classified also according to the
shape & site of the track of the fistula. Special
treatment for such different kinds of fistulas is
mention in detail. It is worth noting that the
complex & most challenging horse shoe fistula (
complex Ischio-rectal fistula) has been dealt with
in detail in Sushruta a classical Ayurveda text)
even as early as 300 ad.The Ksharsutra treatment was
probably first advised per this type of fistula
named Parikshepi Bhagandara by Sushurta. This
Ksharsootra treatment, with a little modification
has proved its worth even in modern times.Anal
fistula, a rare condition, is a chronically
inflamed, abnormal tunnel between the anal canal and
the outer skin of the anus. It often drains watery
pus, which can irritate the outer tissues and cause
itching and discomfort.
Symptoms of Fistula Symptoms
of anal fistula may include
A patient of fistula in ano often
suffers from a recurrent, small or large
boil/boils/abscess surrounding the anus, accompanied
with pain, discomfort & pus/blood discharge.
symptoms subside when the boil / abscess burst
spontaneously causing some more discharge for a
couple of days. The boil / abscess "heals up"
temporarily but almost always reappears after some
Itching, discharge of watery pus,
irritation of tissue around the anus, discomfort &
pain these are the main symptoms of the fistula in
Some of the most Common Symptoms of Anal Fistula
Throbbing pain ,itching and discomfort in the
regions in and around the anus.
Abscess releases watery puss or mucus which is
stained with blood.
Repeated bouts of fever
Loss of apetite
Several Diagnosis test need also be taken in order
to completely come to the conclusion that its
Causes of Fistula
fistula may form as a
result of: Injuries in childbirth.
Obstetric injuries are the most
common cause of rectovaginal fistulas. Such injuries
include tears in the perineum that extend to the
bowel or an infection or tear of an episiotomy — a
surgical incision to enlarge the perineum during
vaginal delivery. These may happen following a long,
difficult labor. Fistulas arising from childbirth
may also involve injury to your anal sphincter, the
rings of muscle at the end of the rectum that help
you hold in stool. Crohn's disease.
The second most common cause of
rectovaginal fistulas, Crohn's disease is a type of
inflammatory bowel disease in which the lining of
your digestive tract becomes inflamed. Most women
with Crohn's disease never develop a rectovaginal
fistula, but having Crohn's disease does increase
your risk of the condition. Surgery involving your
vagina, perineum, rectum or anus.
Prior surgery in your lower
pelvic region, such as removal of your uterus
(hysterectomy) in rare cases can lead to
development of a fistula. Cancer or radiation
treatment in your pelvic area.
A cancerous tumor in your rectum,
cervix, vagina, uterus or anal canal can lead to
development of a rectovaginal fistula. Radiation
therapy for cancers in these areas can also put you
at risk of developing a fistula. A fistula caused by
radiation usually forms within two years following
the treatment. Before the fistula forms, you may
experience pain in your anus or rectum, bloody
diarrhea, or bright red blood in your stool. If you
spot these warning signs, your doctor will first
rule out a return of cancer as the cause. Other causes. Less commonly, a rectovaginal
fistula may be caused by infections in your anus or
rectum; infections of small, bulging pouches in your
digestive tract (diverticulitis); or vaginal trauma.
Risk Factors for Fistula Risk
Factors of Fistula Include the following:
bowel disease such as Crohn's disease may cause both
anal fistula and perirectal abscesses. An anal or
rectal abscess may also be caused from diabetes
immunosuppression, pregnancy and ulcerative colitis.
• Complications such as Crohn's disease, trauma,
radiation therapy or chemotherapy may develop the
• Life style may also contribute in the development
of fistula such as inactivity, stress diet, and
• Behaviors such as sex, smoking, alcohol, drugs may
develop the fistula.
• Obesity, cholesterol, diabetes, hypertension may
develop the fistula.
• Diseases such as HIV, heart problems0, cancer,
autoimmune, immunocompromise may cause the fistula.
• Infections caused by animals, birds, insects,
water, travel may develop the fistula.
• Factors such as environment, occupation, sunlight,
radiation, chemicals may cause the fistula.
• Some of the medications, contraceptives, steroids
may cause the fistula.
• Pregnancy, childbirth, menopause may cause the
Complications of Fistula
Complications of the Fistula include the following:
• Blockage of the urinary catheter, infection,
anuria and most of this can be managed effectively
but in rare cases a patient dies.
• Women with fistula tend to be malnourished and may
be more susceptible to disease.
• Pancreatic Fistula (PF): This fistula is regarded
as a serious complication both in terms of frequency
• Peoples with untreated pulmonary arteriovenous
fistulas will develop a paradoxical embolism here a
blood clot travels from the lungs to the arms, legs,
or brain (if it travels to the brain, it can produce
This is the most serious complication of large
arteriovenous fistulas. Since your blood flows more
quickly through an arteriovenous fistula than it
would if your blood flowed through a normal course
of arteries, capillaries and veins, your blood
pressure drops and your heart pumps harder to
compensate for the drop in blood pressure. Over
time, the increased intensity of your heart's
pumping can weaken your heart muscle, leading to
heart failure. Blood clots.
An arteriovenous fistula in your legs can cause
blood clots to form, potentially leading to deep
vein thrombosis, a painful and potentially
life-threatening condition if the clot travels to
your lungs (pulmonary embolism). Depending on where
your fistula is, it can lead to a stroke. Leg pain.
An arteriovenous fistula in your leg can also cause
you to develop pain in your legs (claudication), or
can worsen pain you already have.
Prevention of Fistula Prevention
comes in the form of access to obstetrical care,
support from trained health care professionals
throughout pregnancy, providing access to family
planning, promoting the practice of spacing between
births, and supporting women in education and
postponing early marriage. Fistula prevention also
involves many strategies to educate local
communities about the cultural, social, and
physiological factors that condition and contribute
to the risk for fistula.
One of these strategies
involve organizing community-level awareness
campaigns to educate women about prevention methods
such as proper hygiene and care during pregnancy and labour. Prevention of prolonged
obstructed labour and fistula should preferably
begin as early as possible in each female’s life.
For example, improved nutrition and outreach
programs to raise awareness about the nutritional
needs of female children to prevent malnutrition as
well as improve the physical maturity of young
mothers, are important fistula prevention
It is also important to ensure access to
timely and safe delivery during childbirth; measures
include availability and provision of emergency
obstetric care as well as quick and safe caesarean
sections for women in obstructed labour. Midwives
located in the local communities where fistula is
prevalent can also contribute to promoting health
practices that help prevent future development of
obstetric fistulas. Promoting education for girls is
also a key factor to preventing fistula in the long
term. There are currently several organizations that
have developed effective fistula prevention
strategies. One of them is the Tanzanian Midwives
Association, which works to prevent fistula by
improving clinical health care for women and
delaying early marriages and childbearing years, as
well as help the local communities advocate the
rights of females.
Treatment of Fistula
fistulas are serious complications and as compared
to other kind of fistulas and they never heal by
themselves. The most popular method of treatment of
fistula is Herbal Treatment. Once treated the fistula should heal and
produce no long-term problems, provided there is no
underlying cause. An anal fissure is a superficial linear tear in the
anoderm most commonly caused by passage of a large,
hard stool. This tear is distal to the dentate line.
Anal fissures are among the most common anorectic
disorders in the pediatric population; however,
adults also are affected. The 4 categories of
fistulas, based on the relationship of fistula to
sphincter muscles, intersphincteric,
transsphincteric, suprasphincteric, extrasphincteric.
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