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VVF: Plug up that leaky problem

| January 3, 2013 More

Many women face the inability to control their bowels and bladders due to prolonged, unattended and obstructed labour during childbirth. Sometimes, these women also suffer from neurological damage that affects their ability to walk. But experts say many hospitals currently offer free surgical operations to treat this dreadful ailment, reports Sade Oguntola.

Many women in Nigeria cherish the joy of childbirth, but it is also the beginning of life as an outcast for some that end up leaking urine or feaces.

Helen Labaki (not real name), a 43-year-old Nigerian resident in Cotonou, is just one of the thousands of women that live with the constant and humiliating smell of urine. Rejected and separated from her husband after a child birth that left her unable to control the passage of urine, the stigma she faced made her to relocate from Nigeria to Cotonou, far from the people that knew her.

Although her baby was born dead, Helen uses clothes as pad to prevent urine soaking her clothes while she goes around selling food on the streets of Cotonou.

“I wear pads made with clothes because of the urine problem. The pad is changed regularly, but coping with the smell of urine is not easy,” Helen recounted on her bed at the University College Hospital (UCH), Ibadan, Oyo State.

This was few days after she had a surgical operation to correct the 20 year-old problem on the bills of the United States Agency for International Development (USAID) Fistula Care Project.
An initial attempt to correct Helen leaking urine failed because she also had double urethra, a congenital abnormality. Urine was passing directly from one of the urethra into her vagina. The urethra is the tube through which urine passes from the urinary bladder to the genitals. In females, the urethra emerges above the vaginal opening.

For 30-year-old A’isha Shittu, a mother of one, it was an experience she never bargained for in her life. Her plight started two years ago when she was to give birth to her second child that died.

She said, “During the labour at the government hospital in Oyo town, I was asked to push. But after a long time of pushing in the labour room, blood started to gush out from my private part.

From then, whenever my tummy is touched, it pains me seriously.”

According to her, rather than her menses coming out through the vagina, she passes it out with her urine.

Her husband and family members, according to her, have however been supportive. Even while at UCH, Ibadan, where she accessed the USAID free-VVF treatment, her mother was seen around waiting to attend to her needs.

 Mrs Bamke Ali, a young mother of two experienced the condition last October after she had a normal delivery of a baby girl. She found that urine trickled into her underpants. The uncontrollable leakage of urine, she linked with the birth of her second child.

Although her first child was through a caesarean operation, the uncontrollable leakage of urine after her second child which she delivered by herself was suspected to have occurred as a result of an injury she sustained on the scar from the previous caesarean operation.

But the case of Mary Anuh, a 21-year old spinster from Enugu State, is slightly different. Not only does she have challenges in the way she passes urine, she is also not menstruating like other ladies of her age group.

For Mary, a prolonged nightmare of stomach ache led to her seeking medical care. She stated: “It was after the pain became unbearable that the medical doctor asked that I have an ultra sound scan done. Based on the result of the scan, they said that I would require a surgical operation.”

According to Mary, while one surgical operation would help to reconstruct the urethra to ensure proper passage of urine, the other surgical operation would help to reconstruct her vagina to ensure free flow of menses.

Unfortunately, about 800, 000 women are caught in the web of Vesico-Vaginal Fistula (VVF) in Nigeria. About 90 per cent of these cases are however caused by prolonged, unattended and obstructed labour.

The remaining cases occur from poorly performed abortions, harmful traditional practice, such as the radical forms of female genital cutting(such as the Gishiri cut and infibulations), among others. Infibulation is the stitching up of the vagina.

Experts say there are two types of obstetric fistula. These are Vesico-Vaginal Fistula (VVF) and Recto-Vaginal Fistula (RVF). They say VVF occurs when blood supply to the tissues of the vagina and the bladder are restricted during prolonged, obstructed labour leading to the death of the tissues between these organs forming holes through which urine can pass uncontrollably.

Recto-Vaginal Fistula (RVF) occurs in a similar way to VVF when the holes form between the tissues of the vagina and the rectum and lead to uncontrollable leakage of faeces.

VVF is not a life-threatening condition but it has profound psychological effects on the victims which results from their utter loss of status and dignity because of uncontrollable passage of urine and/or faeces through the vagina all the time.

Several women who are not up to childbearing age, but forced into marriage and others who could not access hospital care on time are tied down with this condition in Nigeria.

Paradoxically, Professor Dosu Ojengbede, a consultant obstetrician and genealogist, who is involved in the USAID VVF treatment at the UCH, Ibadan, said that the profile of women with VVF has now been extended to include those that are educated and access paid health care services.

According to him, “we are now seeing more cases of VVF that come from complications of caesarean operation. You have the educated and uneducated women, the young and the old, women who have delivered a baby before and those who have not delivered before now developing VVF.”

Unlike in the past where people presume that VVF was a problem in the northern part of Nigeria, he said VVF is a silent epidemic ravaging women in the southern states of Nigeria.
“Over a million Nigerian women now have VVF with many in the South-West, occurring as a complication of caesarean operation and unassisted delivery,” he stated.

The expert declared that as long as maternity healthcare services, particularly during labour, were not efficient and of the highest quality, Nigeria would continue to have VVF cases, considering that over 99 per cent of all VVF cases occur as a result of childbirth complication.

Professor Ojengbede, stressing that there was surgical repair for women that leaked urine or faeces uncontrollably, expressed concern that many women with VVF were still hidden in the communities for different reasons such as cost of treatment and dearth of knowledge on where to seek help.

He said: “Women should not assume that there is no help. It is when they get to the hospital that they will now be able to know what can be done for them or where they can be referred to for assistance, rather than resign to fate.”

Under the (USAID) Fistula Care Project, women that leak urine and faeces can get free treatment in many hospitals such as Ningi General Hospital, Ningi, Bauchi State and UCH, Ibadan.
According to Professor Ojengbede, “The UCH, Ibadan, has designated numbers they can call to book an appointment to see experts on VVF. Through the Centre for Population and Reproductive Health, they can access support from the fistula care project which is a USAID funded project.”

Although most women suffering from fistula can be treated with surgery, Dr Adeola Abdul-Salam, a UCH-VVF team member, stated that after the surgical operation, such women can still have children and live normal lives without the fear of a re-occurrence provided they conform with the instructions they are given.

“After a VVF surgery, we expect that, within the first three months, such women should abstain from sex or any attempt to get pregnant.  This is because we want the area of fistula to heal properly and be sure that the area does not open up again.”

Ensuring they abstain from sex for at least three months, she stated, would not be difficult because at times, the women, before the surgery, might have been deserted by their husbands.
 In addition, they are not supposed to douche or insert anything into the vagina as part of measures to prevent the re-occurrence of the problem.

Dr Abdul-Salam said where couples are involved, such are jointed counselled on the need to abstain from sex for at least three months, depending on the cause of the VVF.

Such women, she said, are expected to plan their subsequent pregnancies and book early for antenatal care at the hospital, preferably where they could access skilled birth attendants.

Although many people think of leaking urine and faeces that can be repaired surgically, she said, variants of VVF include such cases as women that sometimes  cannot control passage of watery stool during sex.

Category: Bauchi State News

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