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What is Obstetric Fistula? Causes, Treatment, and Prevention
If you haven’t heard of obstetric fistula, you’re not alone.
In the United States, obstetric fistula has become extremely rare because most people can reach emergency obstetric care when labor becomes complicated. But in many parts of the world, timely care may still be too far away, unaffordable, or unavailable when it is needed most.
What Is a Fistula?
A fistula is an abnormal opening between two parts of the body. A female genital fistula is an opening in the genital tract that causes chronic, uncontrollable leakage of urine, feces, or both.
What Causes Fistula?
Female genital fistula can result from complications during childbirth, an unintended surgical injury, or severe physical trauma. Care should respond to the type of fistula and be delivered with compassion and confidentiality, while addressing common consequences such as trauma and stigma. Care should always be survivor-centered and responsive to each person’s physical and emotional needs.
Expand each section below to learn more about the primary types of fistula, what causes them, and how they can be prevented or treated.
Obstetric fistula is the most common type of female genital fistula. It is usually caused by prolonged, obstructed labor without timely medical care, such as a cesarean section.
During obstructed labor, the soft tissue of the pelvis is compressed between the baby’s head and the mother’s pelvic bone. The sustained pressure cuts off blood flow, and the tissue dies, creating a hole between the vagina and the bladder, the vagina and the rectum, or both.
This can cause continuous leakage of urine, feces, or both until the injury is successfully treated.
An estimated half a million women are living with obstetric fistulas worldwide, with many waiting years for care that could transform their lives. Yet, obstetric fistula is both preventable and treatable with access to safe and timely surgery.
Fistula can also occur unintentionally from an injury during surgery or other medical care. This is known as iatrogenic fistula.
The bladder, urinary tract, bowel, or reproductive organs may be injured during a cesarean section, hysterectomy, or another pelvic or abdominal surgery.
In countries where EngenderHealth has supported fistula services, iatrogenic injuries have accounted for a significant and, in some settings, growing share of patients seeking fistula treatment.
Strengthening surgical training, safety practices, supervision, and quality of care can help prevent these injuries.
Traumatic fistula can result from severe physical injury, including sexual violence.
It has been documented particularly in conflict and post-conflict settings, although reliable global estimates are not available. Inplaces where sexual violence has been used as a weapon of war, it can make up a significant share of fistula patients.
Survivors may also experience other injuries and health consequences, including sexually transmitted infections, unintended pregnancy, psychological trauma, and stigma.
Why Obstetric Fistula Is a Global Health and Rights Issue
Obstetric fistula is rare in the United States not because it is unavoidable elsewhere, but because access to timely, high-quality healthcare remains deeply unequal.
No one should experience a preventable childbirth injury simply because emergency care is too far away, a facility lacks appropriately trained staff, or treatment is unaffordable. The continued existence of obstetric fistula shows what happens when health systems do not provide people with the care they need during labor and childbirth.
The injury can affect a person’s health, mobility, relationships, livelihood, and ability to participate in community life. Left with chronic leaking, women with obstetric fistula are often abandoned or neglected by their husbands and families, unable to work, and ostracized by their communities.
Obstetric fistula is also closely associated with stillbirth. Many survivors are forced to grieve the loss of a pregnancy while managing a serious childbirth injury. As a result, women with fistula are often among the most impoverished and vulnerable members of society.
These outcomes are not inevitable. Preventing fistula means strengthening maternal healthcare, emergency referrals, transportation, surgical safety, and access to skilled providers. Treating it means ensuring that people can receive expert surgical care and comprehensive support without shame or financial hardship.
Can Obstetric Fistula Be Treated?
Yes. Most fistulas can be treated through reconstructive surgery performed by an appropriately trained and experienced surgical team. Treatment outcomes depend on factors including the location, size, complexity, and duration of the injury.
Recovery involves more than surgery. Comprehensive fistula care may also include counseling and mental health support, physiotherapy, treatment for related health conditions or disabilities, follow-up care, and support as people return home and resume their lives.
EngenderHealth’s Work to End Fistula
EngenderHealth has decades of experience preventing fistula, expanding access to surgical repair, and supporting recovery.
Our approach strengthens the full system of fistula care:
- Prevent fistula by training maternity teams to provide timely, high-quality obstetric care, including safe cesarean sections when needed.
- Expand treatment by preparing surgeons and hospitals to provide safe, high-quality fistula repairs.
- Reduce stigma by helping communities and individuals understand that fistula is a treatable injury, not a curse or source of shame.
- Support recovery through counseling, physiotherapy, follow-up care, and reintegration after surgery.
The tools, evidence, and lessons from our most recent fistula program are available through our MOMENTUM Safe Surgery resource collection.
Stories of Treatment, Recovery, and Hope
Behind every fistula repair is a person with their own experiences, relationships, goals, and hopes for the future. Explore stories of people who found treatment and the healthcare professionals and communities supporting their recovery.
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Help Expand Access to Fistula Care
No matter what caused the injury or how long someone has lived with it, every person affected by fistula deserves timely treatment, compassionate care, and the opportunity to recover with dignity.
Your support can help prevent fistula, expand access to surgical repair, reduce stigma, and support recovery and reintegration.