You are visiting a doctor who works with Medicines Sans Frontiers in Chad, in he

Question

You are visiting a doctor who works with Medicines Sans Frontiers in Chad, in her clinic in a rural village. the village is six hours by truck from the nearest hospital, although few of the impoverished villagers have access to automobiles. A young woman, age 18, is brought to the clinic. She is very thin, showing signs of malnourishment, and small for her age. She delivered a stillborn baby two years ago, after a prolonged labor that lasted for days. Since then she has suffered from complete incontinence: fecal matter leaks constantly from her vagina. She has been abandoned by her husband and ostracized by her family because of the unpleasant smell and her inability to have more children. the young woman came to the village looking for work, and was referred to the clinic by a local woman. the doctor thinks the young woman can be helped. Based on the young woman's situation and history, what diagnosis will the doctor make? How do you explain the incontinence and fecal matter leaking from the vagina? How can this young woman's condition be treated? Why are cases like this more common in impoverished nations than in wealthy ones?

Explanation / Answer

1. This is the case of rectovaginal fistula. In this case a connection develops between the vag*na and rectum and results in stool being passed uncontrollably through the va*ina. The most common cause for this is, birth trauma. A difficult vaginal delivery cause a partial tear in the muscles of the anal sphincter due to which normal elimination of fecal matters through an*s is interrupted and hence rectva*inal fistula developes.

Diagnosis: There are two types of diagnosis for this case: 1. Physical: The doctor inspectins va*ina, an*s and the area between them (perineum) with a gloved hand. 2. Tests for identifying fistulas: If doctor do not find fistula through physical examination then some tests are performed. For example: Contrast test, Blue dye test, CT scan, MRI, Anorectal ultrasound, Anorectal manometry, etc.

2. Due to partial tear in the muscles of the anal spinchters (controls the movement of fecal matters) the movement of fecal matters get interrupted. Hence a connection between va*ina and rectum developes through which fecal matters leak out in uncontrolled way.

3. Surgery is the most common way to treat this problem but generally doctors advice antibiotics for three to six months before surgery to make the surgery region infection free and some times fistula closes on its own after the use of antibiotics.

4. Poverty is main underlying factor for rectova*inal fistula. Child bearing before the pelvis is fully developed and malnutrition is the major cause. Hence this is more common in impoverished nation.

Here i have put * at the place of i and u as it is not offering submission of the answer

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