The price of silence is high, even if some of the affects are not immediately evident. Women with fistulas frequently drink as little as possible in order to leak as little urine as they can, but as the urine becomes more concentrated, it smells stronger. What’s more, not drinking can lead to chronic bladder, kidney and skin infections, and bladder stones. And over time, the vagina may become shorter, narrower and less flexible, hampering a woman’s ability to have sex and lessening the possibility of surgical repair.