What is Fistula? 

A fistula is simply a hole between an internal organ and the outside world that should not exist. There are  two primary casuses of fitula in women in developing countries: childbirth, causing obstetric fistulas and sexual violence, causing a traumatic fistula. 

Obstetric fistula  the most devastating  of all childbirth injuries. 

An obstetric fistula develops when blood supply to the tissues of  the vagina and the bladder (and/or rectum) is cut off during prolonged obstructed labor. The tissues die and a hole forms through which urine and/or feces pass uncontrollably. Women who develop fistulas are often abandoned by their husbands, rejected by their communities, and forced to live an isolated existence. 

More than two million women live with fistulas. 

Eradicated in western countries at  the end of the 19th century when cesarean section became widely available, obstetric fistula continues to plague women throughout the developing world. It is estimated that there are 100,000 new fistula cases each year, but the international capacity to treat fistula remains at only 6,500 per year. The United Nations Population Fund (UNFPA) estimates the world's population of fistula sufferers at more than two million. 

Nerve damage  and psychological trauma 

The WHO has called fistula “the single most dramatic aftermath of neglected childbirth”. In addition to complete incontinence, a fistula victim may develop nerve damage to  the lower extremities after a multi-day labor in a squatting position. Fistula victims  also suffer profound psychological trauma resulting from their utter loss of status and dignity. 

Traumatic fistulas -- when rape is used  as a tool of war 

The consequences of fistulas are life altering when the injury goes un-repaired.  In Congo, rape is being used as a tool of war on a massive scale.  The result is  an often a traumatic fistula, that is holes in bladders, vagina  and rectum that are caused by rape or attack using bayonets, wood, and even guns. 

The Economist magazine recently estimated that 80% of the fistula cases in the Congo were the result of sexual violence.  For the women with the injury, they are still very much in need of treatment, and psychological counseling as well.  The Panzi Hospital in the Congo, founded by Congolese gynecologist Denis Mukwege is a pioneer in helping these victims of rape.