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Because this is a condition of shame and embarrassment, most women hide themselves and their condition and suffer in silence. In addition, after receiving initial treatment, health education is important to prevent fistulae in subsequent pregnancies. [16] Another challenge is the lack of trained professionals to provide surgery for fistula ...
If the fistula cannot be repaired, the clinician may create a permanent diversion of urine or urostomy. [6] Risks associated with the repair of the fistula are also associated with most other surgical procedures and include the risk of adhesions, disorders of wound healing, infection, ileus, and immobilization. There is a recurrence rate of 5% ...
To have a successful recovery from the surgery, it must be successful on the first attempt. [9] Sims's operations on African-American enslaved women showcase the dangerous nature of the procedure. [7] There still have not been clear instructions on how to properly recover from the procedure other than taking prescribed antibiotics. [9]
Rectovaginal fistulas are often the result of trauma during childbirth (in which case it is known as obstetric fistula), with increased risk associated with significant lacerations or interventions are used such as episiotomy or operative (forceps/vacuum extraction) deliveries [2] or in situations where there is inadequate health care, such as in some developing countries.
First- and second-degree tears rarely cause long-term problems. Among women who experience a third- or fourth-degree tear, 60–80% are asymptomatic after 12 months. [24] Faecal incontinence, faecal urgency, chronic perineal pain, pain with sex, and fistula formation occur in a minority of women, but may be permanent. [25]
In some types of fistulae, a seton may be tied with more tension and tightened periodically. In this case, the seton loop will slowly cut through tissue inside the loop while scarring behind the loop, essentially "pulling out" the fistula without surgery. This is the Kshar-Sutra method mentioned by Sushruta in ancient Indian surgical practice.
Fistulas can form after long-term pessary use, [10] hysterectomies, malignant disease and pelvic irradiation, [4] [11] [1] pelvic surgery, cancer or a pelvic fracture. [4] [12] Fistulas are sometimes found after a cesarean section. [8] Providers can also inadvertently cause a fistula when performing obstetric or gynecological surgery.
Surgery can be carried out through the vagina, bladder or peritoneum and can be done via laparoscopic or robotic surgery. [8] Watchful waiting is the treatment of choice in case of small fistulas. The bladder is catheterised for a period of 4 to 8 weeks in order to allow spontaneous closure of the vesicouterine fistula.