Vesicovaginal fistula (urine leaking from the vagina)Vesicovaginal fistula (vagina se peshab ka rissna)

Vesicovaginal fistula kya hai

Vesicovaginal fistula (VVF) bladder aur vagina ke darmiyan ghair-mamooli suraakh hai. Peshab bladder mein rukne aur toilet jane tak rukne ke bajaye musalsal vagina mein aur jism se bahar rissta hai. Fistula wali auratein din raat peshab ka rissna rok ya control nahi sakti.

Yeh tibbi masla hai jis ka ilaaj ho sakta hai. Zyada tar auraton mein suraakh ko operation se band kiya ja sakta hai, aur bohat si khushk ho jati hain. Yeh guide auraton aur un ke ghar walon ke liye hai. Yeh batati hai ke fistula kyun banta hai, kaise jaancha jata hai, kaise marammat hoti hai, aur sahara kahan mil sakta hai.

Agar aap ka peshab musalsal rissta hai aur aap ko kaha gaya hai ke bardasht karein, to meherbani karke maahir ko dikhayein. Marammat mumkin hai, aur aap ilaaj ki haqdar hain.

Yeh aap ki ghalti nahi

Fistula wali bohat si auratein sharminda mehsoos karti hain, ya doosre un ko qasoorwar thehrate hain. Meherbani karke yeh bilkul saaf samajh lein: fistula chot hai, jaise haddi ka tootna ya zakhm. Yeh saza, badduaa, napaaki ki nishani, ya aurat ke kisi kaam ya na kaam ka nateeja nahi. Yeh chhoot ki bimari nahi, aur kisi ko, shohar samet, nahi lag sakti. Jo ghar waley yeh samajhte hain woh aurat ko zaroori sahara de sakte hain, aur jab uski dekh bhaal ki jaye, alag na kiya jaye, to ilaaj ke kamyab hone ka imkaan zyada hota hai.

Yeh kyun hota hai

Fistula tab banta hai jab bladder aur vagina ke darmiyan ki deewar ko nuqsan pohanche. Aam wajohat:

• Lambi, ruki hui zachagi. Jab bachay ki paidaish kai ghanton ya dinon tak na ho sake to bachay ka sar bladder aur vagina ke darmiyan ke tissues par dabao dalta hai aur un ki khoon ki supply rok deta hai. Phir nuqsan-shuda tissue tootna shuru ho jata hai, aam tor par paidaish ke kuch din baad. Un jagahon mein yeh bunyadi wajah hai jahan auratein zachagi mein maahir dekh bhaal tak aasani se nahi pohanch sakti.
• Pelvis ke operation ke dauran chot, jaise caesarean section ya bachadani nikalna (hysterectomy). Achi zachagi dekh bhaal wale mulkon mein yeh sab se aam wajah hai.
• Pelvis mein radiotherapy ya cancer.
• Chot, ya pelvis mein infection ya soojan, jo kam aam hai.

Fistula aam tor par paidaish ya operation ke kuch din se kuch haftay baad nazar aata hai, jab rissna shuru hota hai. Meherbani karke intezar na karein. Jaise hi mehsoos ho, doctor ya daya ko batayein.

Aam nishaniyan

Bunyadi nishani vagina se peshab ka musalsal rissna hai, sirf khansne par ya achanak hajat ke saath nahi. Doosri nishaniyan:

• Musalsal geelapan, jo kapron ya pads ko bhigo de aur laitne par bhi jaari rahe.
• Peshab ki wajah se jinsi hisson aur raanon ki jild mein jalan, zakhm ya daane.
• Boo, kyunke peshab jild aur kapron par rehta hai.
• Baar baar peshab ya vagina ke infection.
• Aam tarah bohat kam peshab aana, kyunke zyada tar rissta hai.

Agar vagina se pakhana ya hawa bhi nikalti ho to meherbani karke doctor ko batayein. Is ka matlab aanton se bhi suraakh ho sakta hai, jis ki jaanch aur marammat bhi zaroori hai.

Jaanch kaise hoti hai

Maahir aam tor par:

• Aap ki tareekh poochhenge, jis mein rissna shuru hone se pehle paidaish ya operation, aur aap ki sehat shamil hai. Meherbani karke khul kar batayein. Khatoon doctor ya nurse ki darkhwast ki ja sakti hai.
• Muaina karenge ke rissna kahan se aa raha hai aur suraakh kitna bada hai.
• Dye test karenge. Catheter ke zariye bladder mein bezarar neela rang dala jata hai, aur vagina mein tampon ya pad dikhata hai ke rang bahar aata hai ya nahi.
• Patli camera se bladder ke andar dekhenge (cystoscopy) taake suraakh aur ureters se us ka faasla dekha jaye.
• Scan karwayenge (aksar contrast ke saath CT scan, ya rang ke saath X-ray) taake kidneys aur ureters dekhe ja sakein, kyunke un ko bhi kabhi nuqsan ho sakta hai.
• Peshab aur khoon ke tests karenge: infection aur kidney ke kaam ke liye.

Ilaaj ke tareeqay

Bunyadi ilaaj fistula ko band karne ka operation hai. Intikhabat:

Pehli marammat ke kamyab hone ka imkaan sab se zyada tab hota hai jab woh tajarbe-kaar surgeon kare, is liye aisi unit dhoondhna faida mand hai jo yeh operation baqaidgi se karti ho. Meherbani karke aise surgeon se marammat qabool na karein jis ko fistula surgery ka kam tajarba ho.

Marammat ke baad

Operation ke baad kuch arse ke liye catheter rehta hai taake bladder aaram kare aur marammat bhar jaye. Hidayat ke mutabiq kaafi pani peeyein, aur catheter ko saaf aur mura hua na rakhein. Jab tak surgeon na kahe, jinsi taluq, tampon aur bhari wazan uthane se bachein. Kuch auratein fistula band hone ke baad bhi thora bahut rissti hain, maslan khansne par. Yeh rissne ki alag qism hai, aur is ka ilaaj ho sakta hai (dekhein urinary incontinence guide). Meherbani karke follow-up visits mein aayein, aur geelapan wapis aaye to doctor ko batayein.

Aaindah hamal

Bohat si auratein jin ki fistula marammat ho chuki ho dobara bachay ko janm de sakti hain. Agar marammat ke baad hamal ho to meherbani karke doctor ya daya ko batayein ke aap ko fistula ho chuka hai, aur aise hospital mein janm ki planning karein jahan surgeon mojood ho. Marammat ko bachane ke liye aam tor par caesarean section se paidaish ka mashwara diya jata hai. Meherbani karke fistula marammat ke baad ghar par paidaish na karein. Aam tor par yeh bhi mashwara diya jata hai ke bachay ki koshish se pehle marammat ke baad kuch arsa intezar karein, jaise aap ke surgeon batayein.

Fistula ke saath zindagi aur sahara

Fistula zindagi ke har pehlu par asar daal sakta hai: sharm, tanhai, kaam ka nuqsan aur shaadi mein dabao, aur kuch auraton ko ghar se nikal diya gaya hai. Yeh haqeeqi nuqsanat hain, lekin in ki wajah se saza ke laiq nahi. Ilaaj ke intezar mein amli qadam madad kar sakte hain:

• Jild ko saaf pani se dhoyein aur narmi se khushk karein, aur kapray ya pads aksar badlein taake zakhm na banein.
• Narm pads ya saaf kapra istemal karein aur kapron ka alag joda saath rakhein.
• Kaafi pani peeyein, agarcheh lagta hai ke rissna barhega. Kam peene se peshab gaarha aur zyada jalan wala hota hai.
• Kisi bharosay ke ghar wale, sehat ke karkun, ya khatoon rishtedar se baat karein. Shohar aur ghar walon ko aksar samjhane ki zaroorat hoti hai, aur doctor yeh samjha sakta hai.
• Doctor se counselling aur khaas fistula services ke baare mein poochein jo madad kar sakti hain.

Pakistan mein fistula wali auraton ko akeli nahi chhorna chahiye. Agar aap ko pata na ho ke kahan jayein to apne qareebi hospital ke zanana ya urology shobay se, ya lady health worker se kahein ke woh aap ko aisi unit ko refer kare jo fistula marammat karti ho.

Fistula se bachao

Paidaish se hone wale zyada tar fistula roke ja sakte hain. Agar zachagi lambi ho ya bachcha na aa raha ho to jaldi hospital jayein aur ghar par intezar na karein. Aisi jagah paidaish ki planning karein jahan maahir dekh bhaal aur caesarean section ka imkaan ho. Jin larkiyon aur jawan auraton ka jism abhi poori tarah nahi barha, un mein zachagi mein khatra zyada hota hai, is liye jism ke mukammal hone tak intezar mehfooz hai. Pelvis ke operation ya bohat lambi zachagi ke baad agar peshab rissne lage to foran doctor ko batayein.

Aam sawalaat

What a vesicovaginal fistula is

A vesicovaginal fistula (VVF) is an abnormal opening between the bladder and the vagina. Urine, instead of being held in the bladder until you go to the toilet, leaks continuously into the vagina and out of the body. Women with a fistula cannot stop or control the leaking, day or night.

This is a medical condition that can be treated. In most women the opening can be closed with an operation, and many become dry. This guide is written for women and their families. It explains why a fistula forms, how it is checked, how it is repaired, and where support can be found.

If you have been leaking urine continuously and have been told to put up with it, please see a specialist. Repair is possible, and you deserve treatment.

It is not your fault

Many women with a fistula feel shame, or are blamed by others. Please know this clearly: a fistula is an injury, like a fracture or a wound. It is not a punishment, a curse, a sign of being unclean, or the result of anything the woman did or did not do. It is not infectious, and it cannot be passed on to anyone, including a husband. Families who understand this can give the woman the support she needs, and treatment is more likely to succeed when she is cared for rather than isolated.

Why it happens

A fistula forms when the wall between the bladder and the vagina is damaged. The common causes are:

• A long, obstructed labour. When a baby cannot be delivered for many hours or days, the baby's head presses on the tissues between the bladder and the vagina, and cuts off their blood supply. The damaged tissue then breaks down, usually a few days after the birth. This is the main cause in places where women cannot easily reach skilled care in labour.
• An injury during an operation in the pelvis, such as a caesarean section or removal of the womb (hysterectomy). This is the commonest cause in countries with good maternity care.
• Radiotherapy or cancer in the pelvis.
• An injury, or an infection or inflammation in the pelvis, which is less common.

A fistula usually becomes noticeable a few days to a couple of weeks after the birth or operation, when the leaking begins. Please do not wait. Tell the doctor or midwife as soon as you notice it.

Common signs

The main sign is leaking of urine from the vagina that is continuous, rather than only on coughing or with a sudden urge. Other signs include:

• Constant wetness, which may soak clothes or pads, and which carries on even when you lie down.
• Skin irritation, sores or rash in the genital area and thighs, from the urine.
• Smell, because urine stays on the skin and clothes.
• Repeated urine or vaginal infections.
• Passing little urine normally, because most of it leaks out.

If stool or wind also comes from the vagina, please tell your doctor. This can mean an opening to the bowel as well, which also needs to be assessed and repaired.

How it is checked

A specialist will usually:

• Ask about your history, including any birth or operation before the leaking began, and about your health. Please be open. A woman doctor or nurse can be requested.
• Examine you, to see where the leak is coming from and how large it is.
• Do a dye test. A harmless blue dye is put into the bladder through a catheter, and a tampon or pad in the vagina shows if the dye comes through.
• Look inside the bladder with a thin camera (cystoscopy), to find the opening, and its distance from the ureters.
• Arrange a scan (often a CT scan with contrast, or an X-ray with dye) to check the kidneys and ureters, because they can sometimes be damaged too.
• Test your urine and blood for infection and kidney function.

Treatment options

The main treatment is an operation to close the fistula. The options are:

The first repair has the best chance of success when it is done by an experienced surgeon, so it is worth finding a unit that does these operations regularly. Please do not accept a repair from a surgeon with little experience of fistula surgery.

After the repair

After the operation a catheter stays in for some time so that the bladder rests and the repair can heal. Drink plenty of fluids as advised, and keep the catheter clean and unkinked. Avoid sex, tampons and heavy lifting until your surgeon says it is safe to start again. Some women still leak a little afterwards, for example when coughing, even if the fistula is closed. This is a different kind of leaking, and it can be treated (see the urinary incontinence guide). Please attend follow-up visits, and tell your doctor if wetness returns.

Future pregnancies

Many women who have had a fistula repaired can have a baby again. If you become pregnant after a repair, please tell the doctor or midwife that you have had a fistula, and plan to give birth in a hospital with a surgeon available. Delivery by caesarean section is normally advised, to protect the repair. Please do not give birth at home after a fistula repair. It is also usually advised to wait for a period after the repair, as your surgeon advises, before trying for a baby.

Living with a fistula, and support

A fistula can affect every part of life: it can cause shame, isolation, loss of work and strain in marriage, and some women have been sent away from their homes. These are real harms, but they are not deserved. Practical steps can help while you wait for treatment:

• Wash the skin with clean water and dry it gently, and change cloths or pads often, to prevent sores.
• Use soft pads or clean cloth and carry spare clothes.
• Drink enough fluids, even though it feels like making the leaking worse. Drinking less makes urine stronger and more irritating.
• Talk to a trusted family member, a health worker, or a female relative. Husbands and families often need an explanation, and the doctor can give it.
• Ask your doctor about counselling and about specialist fistula services that can help.

In Pakistan, women with a fistula should not be left to manage alone. If you do not know where to go, ask your nearest hospital with a women's or urology service, or a lady health worker, to refer you to a unit that repairs fistulas.

Preventing fistula

Most fistulas from childbirth can be prevented. If labour is long or the baby is not coming, go to a hospital early and do not wait at home. Plan to give birth in a place with skilled care and the possibility of a caesarean section. Girls and young women whose bodies are not yet fully grown are at higher risk in labour, so waiting until the body is mature is safer. After a pelvic operation or a very long labour, tell the doctor straight away if you are leaking urine.

Common questions