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Introduction

Fistula remains a pressing and painful reality for many women in Nepal. Thousands of women are currently living with the condition, with hundreds of new cases emerging each year. What makes this issue particularly heartbreaking is that fistula is both entirely preventable and treatable. Yet, due to lack of awareness, support and access to quality care, far too many women continue to suffer needlessly.

Q & A on Fistula

What is a Fistula?
Obstetric fistula is a serious medical condition in which a hole develops between the birth canal and the bladder or rectum, resulting in the continuous leakage of urine or stool. It is most often caused by prolonged, obstructed labour without timely medical intervention, or as a result of complications from gynecological surgery.
Who is Affected?
In Nepal, obstetric fistula disproportionately affects women from poor and marginalized communities. These women often live far from healthcare facilities and lack access to skilled birth attendants. Limited awareness, stigma, and financial barriers frequently prevent them from seeking timely help—leaving many to live with the condition for years.
What is the Impact?
Women with fistula often face severe physical and emotional consequences. The constant leakage and associated odour can lead to social rejection, isolation, and shame. Many are forced to withdraw from community life, work, and family activities. Over time, this isolation can lead to depression, anxiety, and other mental health challenges. Physical pain and recurrent infections are also common.
Can Fistula be Treated?
Yes. Fistula is treatable through specialized surgery performed by trained and experienced surgeons. After surgery, patients typically stay in the hospital for around 14 days to recover and are encouraged to attend a follow-up appointment after three months.
How Can Fistula Be Prevented ?
Prevention is possible with proper care.(1) Safe childbirth: Ensuring access to skilled birth attendants and timely obstetric care during labour greatly reduces the risk; (2) Safe surgeries: Gynecological procedures should be conducted by qualified, careful surgeons to avoid preventable complications; (3) Early detection: Frontline health workers trained to recognize symptoms of fistula can help identify and refer patients early for treatment. (4) Increasing awareness: Raise awareness about fistula so women suffering from it understand that it is treatable and can come forward for surgery. (5) Safe family practices: Reducing early marriage and early childbirth, encouraging pregnancy spacing.

what adra does?

ADRA Nepal is actively screening women for fistula during health camps in remote and underserved areas of Sudurpashchim and Madhesh provinces. Identified patients are referred to Kathmandu for fistula repair through the Government of Nepal’s free surgery program, in partnership with UNFPA.

ADRA provides additional support by helping patients with travel logistics, caregiving during recovery, and covering costs not included in the government program.

stories

“Their stories are heartbreaking — but I’m so glad I can help.”

“I am an Administrator for the Obstetric Gynaecology Department, and I am the Fistula Patient Facilitator with the ADRA/UNFPA Project. I’m so happy to be able to meet fistula patients and support them through their recovery. Most come from rural areas outside the valley, and I hear their stories and experiences. As a woman, I feel the pain they’ve been through. I know the emotional support I provide means a lot.  

It’s also good that ADRA can provide additional support when needed. We had a very poor patient from the far west who developed a fistula after the birth of her second child. She suffered for two years. She came with her caregiver and two-year-old child, but they couldn’t afford meals during her hospital stay or transport home. ADRA covered these costs, and they were so grateful.

Another recent patient developed a fistula after prolapse surgery. She was in constant pain and leaking urine at home for three months. Their stories are sad, but I’m glad to be able to help them. They’re so happy when they leave— the successful surgery makes a huge difference in their lives.”

Yamuna Khadka

Office Staff and Fistula Patient Facilitator, Civil Hospital (ADRA/UNFPA Project)

what adra does?

© ADRA Nepal 2024