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Fistula: It can be rectified

NAIROBI, September 1 – Vesico-Vaginal Fistula (VVF) is a health condition that commonly affects women causing them to pass urine and stool uncontrollably.

It mainly results from obstructed labour whereby the baby is either too big or probably the mother is too young.

In such instances, the unborn child presses tightly against the pelvis, cutting off blood flow to the vesico-vaginal wall.

“Eventually the tissues die and leave a hole. This is what we call VVF.  These women start to leak urine and stool through the holes involuntarily,” explains Dr Wakasiakha Khisa, a fistula surgeon at Kenyatta National Hospital (KNH).

However, the story of 62-year-old Sabina Wanjiku Waweru is, somewhat, different.

It all started in October last year, she says. At that time, Wanjiku was a troubled woman; she had domestic problems to the extent that she was considering moving out of her matrimonial home.

“But before I could make a decision, it was announced in church that my son who was in a seminary would be ordained priest in December. This was totally unexpected and I was shocked,” she narrates from her hospital bed at KNH where she is awaiting surgery.

“On December 10, I started passing urine and stool involuntarily and without feeling it. I think it was a result of the anxiety I was going through,” she goes on to say.

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By the time Wanjiku, who hails from Kandara in Murang’a, attended her son’s ordination she had already developed VVF.

“I was very uncomfortable. I didn’t want to sit near people because I thought they could smell it.”

“I would keep asking God where this devilish disease came from and pray that He takes it away,” says the mother of nine. 

In January, it dawned on her that the problem was not about to go away; she sought treatment at Thika District Hospital where she was taken through exercises on how to control her bladder again.

However, she says, this did not help.

Doctors prescribed medicine for her. “These worked for a while. I was able to control my stool a bit.”

Unfortunately, the problem recurred and it was not until May that she sought treatment at KNH.

“The doctor told me I could be cured. He asked me to come the following week for an operation.”

However, three weeks after the operation, Wanjiku started experiencing the same problem and that is when she was given a second appointment.

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She is now among more than 70 women with VVF who are admitted at KNH awaiting surgery.

The women are to benefit from an AMREF-sponsored medical camp on VVF that runs for two weeks.

In the first week, about 200 patients were attended to and 18 operations conducted.

“Majority of the cases are due to obstructed labour,” notes Dr Khisa.

Another case, he says, resulted from a damaged bladder during the removal of the uterus.

“We have a case where one is leaking directly from the kidney to the vagina bypassing the bladder, and this is as a result of surgery again. So we are saying that surgery in inexperienced hands is as dangerous and could cause VVF,” the surgeon warns.

He also warns that advanced cervical cancer could lead to VVF. The medic therefore stresses the need for women to go through regular Pap smear tests.

Also admitted to the hospital is a 13-year-old girl from Suba district who is also waiting surgery.

“I went to a local hospital for delivery in January, but the baby was too big. I was then taken to the district hospital to undergo a caesarian section and by that time the baby was dead,” she shyly explains.

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“From there my urine and stool just started leaking and I could not walk because my legs were weak.”

The standard five pupil was then taken to Nazareth hospital in Kiambu district where she was operated for stool.

“The doctors said they could not carry out both operations at the same time,” she explains.

Dr Khisa notes that most patients are from rural parts of the country including refugee camps.

Before the surgery, patients are first taken through physiotherapy to learn how to hold urine.

“We normally use the muscles that are responsible for holding all the vital organs in the abdomen. So once they learn how to squeeze, which is something they had forgotten, they are able to walk around without any leakage,” explains Fiona Kimonge a physiotherapist.

Kimonge further explains that patients must continue with the exercises even after discharge from hospital, to ensure the muscles are strengthened.

“Sometimes we find patients who had the problem for so long that they are unable to respond to the exercises. In such cases we have some machines that we use to help the muscles to contract,” Kimonge says.

She says after the surgery and with continuous exercise, it takes up to six months for a patient to heal fully.

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“The exercises help the patient to contract the openings- the urethra for the urine, the vaginal and anal muscles,” she says.

However, Dr Khisa says the problem can recur even after surgery.

“Some recur if the first operation has failed. There are also cases where, after surgery, a woman gets pregnant and then gets a fistula again and in most of these cases it is because the patient didn’t take our advice,” he says.
Presently, there are only eight fistula surgeons in the country, to handle close to 1,000 VVF cases reported annually.


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