That as well, Deborah. The trauma causing fistulae is usually attributed to difficult births in very young women. Most African women have an android (male type) pelvis which could cause outlet disproportion resulting in obstructed labor. Poor management of delivering an over 6ib baby and cutting extensive episiotomies greatly damages the pelvic floor causing these fistulae where the young woman has no control over urine & feces. The persistent leakage causes a very offensive odor & the woman is shunned by her people. I have seen a sixteen-year-old girl with such a condition. I admitted her to triage & on assessment, the already demised fetal head was stuck at the introitus with evidence of maceration. An American OB practicing at the hospital where I worked, operated to remove the fetus. I hesitate to explain the gruesome details. But yes, the girl was left with urine & fecal fistulae. But the Dr. did the only procedure that was possible. Via the vagina, he collapsed & extracted the fetal head, then a cesarean section for the meconium stained body of the fetus. This traumatic incidence has remained in my memory since 1962. I remember the fearful young face of the girl. The impaction was the result of being coached by tribal midwives to push constantly when labor pains begin.

Well, enough of that! That is an earful! Blessings, Deborah.