A fistula is an abnormal, tunnel-like connection or passageway between two internal organs or between an internal organ and the outside of the body.
In Kenya, the United Nations Population Fund estimates that about 3,000 new cases occur annually (three or four in 1,000), with fewer than half of affected women accessing treatment. More than 100,000 women are estimated to be living with the condition in the country.
The condition is closely associated with prolonged and obstructed labour and can result in persistent urinary or faecal incontinence, social isolation and other health complications.
Symptoms of fistula vary by location but commonly include chronic pain, swelling, foul-smelling drainage (pus or blood), or uncontrolled leakage of urine, gas, or stool.
Most natural or pathological fistulas require surgical interventions to close the tract and allow proper healing.
At JOOTRH, the treatment of fistula has shown that women who have lived with the condition for years can regain their health and confidence when they receive timely care.
On the plains of Ahero, on the outskirts of Kisumu, Angeline Adhiambo gave birth to her first child in 2003 at the age of 15, unaware that the delivery would mark the beginning of a condition that would affect her life for more than two decades.
A traditional birth attendant helped her deliver the baby. Soon after, Adhiambo began experiencing involuntary leakage of faeces and urine.
At times, when she tried to control the leakage by squeezing, the stool would pass through her vagina. “I had that problem, but I didn’t know it was a problem,” she recalls.
The 39-year-old woman later moved to Ekwanda in Maseno, where she got married and raised her family. She has eight children, although one has since died.
For years, she did not know that the condition could be treated. People around her noticed the problem, with some attributing it to witchcraft, while others believed she had a rare disease.
The leakage left her ashamed, stimatised and made it difficult to interact freely with other people. “I was worried because I was feeling very ashamed,” she recalls. Adhiambo often had to look for water to clean herself whenever the leakage occurred.
The leakage could happen without warning. On one occasion, at around 7 pm, she experienced the problem while asking someone for money. The person noticed what had happened and gave her water.
For 24 years, Adhiambo lived with the condition, limiting her interaction with other people and carrying water whenever she travelled in case she needed to clean herself.
Her turning point came in 2026 when she heard an announcement on a local radio station about a free fistula treatment camp.
The announcement explained that persistent urine or stool leakage could be a medical condition that could be treated.
She informed her family and travelled to Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH), where she received treatment without paying for the surgery.
She spent four days in the ward and was advised to rest during her recovery, receiving support from her husband and children.
The treatment changed how she interacted with other people. “You know, when you can’t stay close to people, your self-esteem goes down, you get stigmatised and isolated,” she says.
Today, Adhiambo says she can travel, visit people and spend time in social settings without the constant fear of leakage. “Now, I can go to places, I can stay with people, and I can go on a trip without any fear,” she laughs. She wishes she had known earlier that the condition was abnormal and treatable.
As a farmer who also earns between Sh.200 and Sh.250 through casual work, Adhiambo now encourages women experiencing involuntary urine or stool leakage to seek medical attention.
For her, treatment has restored a sense of freedom she had lost for years.
“I didn’t know that it would be good and that I would be fine again.”
Dr. Jackson Matioli, an obstetrician-gynaecologist at JOOTRH, describes fistula as an abnormal communication between two body cavities that should ordinarily not be connected.
He explains that there are different types depending on the organs affected. Vesicovaginal fistula (VVF) occurs when there is an abnormal connection between the bladder and vagina, while rectovaginal fistula (RVF) occurs when the rectum and vagina are connected.
Obstetric fistula is mainly associated with poorly managed or unattended prolonged and obstructed labour.
“When the baby’s head is coming down, it is pressing on the urinary bladder,” he explained. “If the labour takes so long and the baby does not come out easily within the required period of time, it causes the tissues of the bladder to undergo a process called necrosis.”
The damaged tissue can eventually create an abnormal opening between the bladder and vaginal wall, resulting in involuntary urine leakage.
Women with rectovaginal fistula may experience involuntary leakage of stool, while some may also lose control of flatus.
Other fistulas can result from gynaecological conditions, including advanced cervical cancer, which can destroy the tissues separating the vagina, bladder and rectum.
Beyond the physical symptoms, fistula can have serious social and psychological consequences. Dr. Matioli described it as a “dehumanising condition”, noting that the smell associated with urine and faecal leakage can cause women to withdraw from their communities.
“It really makes these women feel they are on their own,” he noted. Many patients develop low self-esteem after spending long periods isolated from other people, while stigma and misconceptions can further delay treatment.
Some women believe urine leakage after childbirth is normal, while others attribute the condition to witchcraft and seek help through traditional medicine before eventually reaching health facilities.
“There are those women who think it’s normal that after giving birth, it is normal for you to leak urine,” he explains.
Medical camps and community sensitisation programmes have helped identify women who might otherwise remain untreated.
Earlier this year, JOOTRH partnered with the M-Pesa Foundation, Amref Health Africa, the Flying Doctors’ Society of Africa, Ramogi TV/Radio and the County Government of Kisumu to provide free fistula screening and treatment.
Screening was conducted from February 18 to March 6, 2026, at JOO Ahero TRH and seven other health facilities across Kisumu County, including the Nyakach Muhoroni Rabuor Gita Chulaimbo and Kombewa health facilities.
The main treatment camp ran at JOOTRH from February 27 to March 6. More than 60 women had been screened by the beginning of the surgical phase, with 15 admitted for corrective surgery.
Dr. Matioli notes that more than 200 women were eventually seen during the camp, with more than 150 surgeries performed.
The programme provided specialised fistula repair, counselling and support, while community health workers, nurses from peripheral health facilities, local radio stations and television channels helped spread information about the services.
For women seeking treatment outside such camps, the entry point at JOOTRH is usually the casualty department, from where they can be referred to the general gynaecology clinic.
A gynaecologist assesses the patient and, where fistula is suspected or confirmed, conducts an evaluation to establish the type of fistula before surgery is planned.
Dr. Matioli says recovery from obstetric fistula repair is generally good, with most patients recovering fully.
Patients may remain in hospital for about three to seven days, depending on their condition, before being discharged with a catheter. They later return for catheter removal and follow-up. Fistulas associated with cancer or radiation therapy, however, tend to have poorer outcomes and may recur.
Dr. Matioli said prevention remains critical, particularly through antenatal care, skilled delivery and timely referral.
Community health promoters can provide basic health education and link pregnant women to health facilities, while antenatal care provides an opportunity to dispel myths and identify potential complications before delivery.
Skilled birth attendance is also important because trained healthcare workers can monitor labour and intervene when necessary.
Women with cephalopelvic disproportion (CPD), where the baby’s head or body is too large to pass safely through the mother’s pelvis, may require a timely Caesarean section rather than prolonged labour.
He also highlighted the Labour Care Guide, a tool used to monitor the progress of labour and guide healthcare workers on when intervention may be necessary.
“If we are able to screen carefully and identify this mother, she has a CPD, she cannot deliver normally, and we take her for a caesarean section in a timely manner, and that will help to prevent obstetric fistula,” he says.
Timely management of prolonged labour can also protect babies from severe birth asphyxia, neurological damage, cerebral palsy and death.
Dr. Matioli identified three key gaps in fistula care: increasing the number of trained fistula surgeons, providing sustainable funding for fistula programmes and strengthening prevention through continuous training of healthcare workers. He opines that new nurses and midwives would benefit from induction and refresher courses on labour management, monitoring and delivery.
He also calls for increased funding for sensitisation and treatment camps, noting that a single camp held once a year may not reach all affected women. “If we can have a lot of resources put into this, we can be able to reach these women who are affected in time,” he said.
For women experiencing persistent urine or stool leakage after childbirth, Dr. Matioli urged them to seek medical attention rather than suffer in silence. “She is not alone. We are there for her,” he affirms.
He encourages affected women to seek help through community health workers, peripheral health facilities or directly at JOOTRH. “It is not normal for a woman to leak urine or to leak stool,” he stressed.
The World Health Organization estimates that between 50,000 and 100,000 women develop obstetric fistula globally each year, while more than two million young women in Asia and sub-Saharan Africa are living with untreated fistula.
For women like Adhiambo, access to information was the first step towards treatment, while free screening and surgery provided an opportunity to reclaim lives disrupted by years of stigma and isolation.
With continued community sensitisation, specialised care and resources for treatment programmes, more women living with fistula can be identified and helped to seek care before years pass.
Today, Adhiambo reflects on how the treatment reclaimed a part of her life that the condition had taken away. She can now go through her chores normally and her social activities without the fear of leaking stool unknowingly.
After more than two decades of isolation, she can now travel, visit friends and spend time around people without constantly worrying about leakage. Dr. Matioli hopes more resources can be channeled into fistula programmes to enable more frequent sensitisation and treatment camps and reach women who remain untreated.
By Mabel Keya- Shikuku and Dorothy Pamella and Rose Anyul
