The cause of fistula during childbirth is the result of several days of labor without access to medical care. The constant pressure of being in labor creates the fistula (hole) to the bladder or rectum, or both. Many women labor for 3 or more days at home, then walk or take a motorbike to find health care and eventually have a caesarean section to remove the baby. Sadly, 90% of the babies are born dead.

If untreated, women are shunned by their families and villages because of the smell. Their husbands abandon them, often forcing them to live alone, ashamed, and destitute. Because their babies are usually stillborn, they may be considered “hexed” and unable to return to their village for fear of causing other stillborn babies, even after their fistula has been repaired.

The only treatment is surgical repair to close the fistula. Ideally, it is done soon after the birth before the tissue becomes damaged. Sadly, some women live years or decades with their fistulas, leaking and humiliated. It is not unusual for women to have multiple surgeries before they are finally dry. In some cases, though, women will never be completely dry.