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Vaginal fistula occurs when the vagina and an organ in the urinary or digestive system has formed an unusual hole between them such as a vaginal fistula can connect the vagina to the bladder, urethra, or rectum. A hole develops because of damage or trauma to the tissue in the vaginal wall.
Vaginal fistula affects 50,000 to 100,000 women yearly around the world. It occurs from damages caused by childbirth, infection, chronic disease, radiation therapy, and surgery trauma. Doctors explain this condition as having a hole in the vagina that permits the stool, urine, or gas to pass through it.
The most common types of vaginal fistulas are:
- Vesicovaginal fistula: One of the most common types of fistula. The opening occurs between the bladder and vagina. Bladder is the organ that stores urine.
- Ureterovaginal fistula: The opening occurs between the vagina and the ureters. Ureters are tubes that transports urine from the kidneys to the bladder.
- Urethrovaginal fistula (urethral fistula): The opening occurs between the vagina and the urethra. Urethra is the tube that removes urine from the body.
- Rectovaginal fistula: The opening occurs between the vagina and the rectum. Rectum is the lower region of the large intestine that removes stool from the body through the anus.
- Colovaginal fistula: The opening occurs between the vagina and the colon.
- Enterovaginal fistula: The opening occurs between the vagina and the small intestine.
The fistula itself will not cause pain but the symptoms that can come with it may give discomfort. Some fistulas heal on its own, but most cases will require surgery to repair it.
Symptoms
The signs and symptoms depending on the organ the fistula has linked the vagina with such as in the urinary system or digestive system organs.
Vaginal fistula between the urinary organs may include the following symptoms:
- Sore and irritated vaginal area
- Urinary incontinence or leakage
- Chronic urine odor
- Pain during intercourse
- Recurrent urinary tract infections, vaginal infections, and kidney infections
Common symptoms of vaginal fistulas between the vagina and the digestive system are:
- Vaginal discharge with foul odor
- Abdominal pain
- Fecal leakage or incontinence
- Diarrhea
- Nausea and vomiting
- Painful intercourse
- Recurrent UTIs or kidney infections
- Rectal or vaginal bleeding
- Unexplained weight loss
Causes
A fistula occurs when the vaginal tissue in a specific area has damage or trauma therefore it is not receiving enough blood and eventually dies. Vaginal fistula may appear within a few days or years after the damage.
Commonly, a fistula may occur after:
- Long hours of labor during childbirth
- Episiotomy
- Abdominal or pelvic surgery
- Pelvic, cervical or colon cancer
- Traumatic injury from accidents
- Inflammatory bowel diseases (IBD) like Crohn’s diseases and ulcerative colitis
- Colon infections
- Radiation treatment
A vaginal fistula at birth is rare but possible.
Diagnosis
The diagnosis of vaginal fistula begins with assessing the medical history of the patient to determine the risk of the patient to have a fistula. The doctor may perform a pelvic exam as part of the assessment as well as other tests for diagnosis such as:
- Complete blood counts (CBC) and urinalysis: This test checks the blood and urine for signs of infection by sending samples to the laboratory for analysis.
- Dye test: A dye solution will be inserted into the bladder or rectum. To confirm if the patient has a fistula, the doctor may require the patient to cough or bear down to check the vagina for leakage.
- Fistulogram: This test shows the fistula in X-ray images to determine the number of fistulas, the size and whether other pelvic organs are affected.
- Retrograde pyelogram: This tests for leakage between the vagina and ureters through X-rays. The dye is injected into the ureters through the bladder.
- Computed tomography (CT) urogram: This test examines the urinary system for fistulas or other diseases. It uses a CT scan and a special dye injected into the vein.
- Pelvic magnetic resonance imaging (MRI): This test provides the doctor with a very clear image of the rectum and vagina, and whether a rectovaginal fistula exists.
- Cystoscopy: The bladder and urethra are examined for signs of trauma.
- Flexible sigmoidoscopy: The doctor uses a sigmoidoscope to check the condition of the colon and rectum.
- Colonoscopy: A colonoscope is used to check the inside of the large intestine and rectum for signs of fistula.
Treatment
The treatment will depend on the type of fistula diagnosed by the doctor. In some cases, small fistulas may heal without medical intervention, however, in most cases, surgery may be required.
Minor fistulas may be treated with the help of:
- Antibiotics: For infections caused by the fistula or medications for inflammatory bowel disorders.
- Temporary self-catheterization: The doctor may want to insert a tiny catheter into the bladder to empty the urine while waiting for the fistula to heal naturally.
- Ureteral stents: Also called as kidney stents. This holds the ureters open while the fistula heals naturally.
The surgical treatment of vaginal fistula can be laparoscopic or abdominal surgery. Laparoscopic surgery is when the doctor makes incisions and inserts equipment and cameras. Abdominal surgery uses scalpel to make a standard incision. The patient’s own tissue, surgical mesh or tissue created in the lab can be used to close the fistula.
What happens after the surgical treatment?
The patients will require monitoring post-surgery. Usually, the doctor may insert a catheter into the bladder to drain the urine while still healing. The doctor will instruct the patient on how to properly use the catheter.
Temporary ostomy may be required after successful repair of large fistula between the vagina and the digestive system organ. An ostomy is a surgical procedure that makes an opening in the abdomen, adjusting how waste leaves the body. It usually includes:
- Creating a stoma in the abdomen
- Stool is sent to the stoma either a colostomy for the large intestine, or an ileostomy for the small intestine.
- The stool is placed outside of the body in a bag. Patients are advised on how to clean the stoma and change the bag.
- Require another surgery to return the intestine to the rectum and close the stoma after the fistula has healed.
