What is a Fistula?
A fistula is an abnormal connection formed between the vagina and the bladder or lower part of the large intestine/rectum.
Causes of Fistula formation
The possible causes of a vaginal fistula include:
- Injuries in childbirth
- Surgical complications from previous gynecologic, urologic or colo-rectal surgery
- Radiation therapy around the pelvic region
- Inflammatory bowel conditions such as Crohn’s disease
- Uncared for vaginal pessary
- Diverticulitis
- Vaginal trauma from accidents
Symptoms of vaginal Fistula
Signs related to vaginal fistula depend on the organ involved, and include:
- Presence of urine or stool in your vagina
- Uncontrollable urine or gas/stool passage through your vagina
- Foul-smelling vaginal discharge
- Recurrent vaginal or urinary tract infections
- Unexplained pain or irritation around the vaginal region or the perineum region, the area between the anus and vagina.
- Pain during sexual intercourse
- Trouble controlling urination or bowel movements
Diagnosis of vaginal Fistula
Your doctor will first enquire about your symptoms and perform a careful physical examination to check for the presence of any possible vesicovaginal or rectovaginal fistula.
To identify a fistula your doctor may order different tests including:
- Contrast tests: These tests include the use of contract agents in the bladder, a barium enema or a vaginogram to obtain contrast X-rays of your pelvis to identify the presence of a fistula.
- Blue dye test: In this test, a tampon will be placed in your vagina and a blue dye injected into your bladder or rectum. The tampon is removed after some time and checked for blue staining, which indicates the presence of a
- Endovaginal 3D and anorectal ultrasound: This procedure involves the use of ultrasound to visualize your bladder, urethra, anus and rectum to check for the fistula.
- Computerized tomography (CT) scan: This study creates highly detailed images of the abdomen and pelvis.
- Magnetic resonance imaging (MRI): A magnetic field and radio waves are used to create images of the internal soft tissue structures to help identify the fistula.
- Cystoscopy or anoscopy is used to visualize the bladder and/or rectum for the presence of a fistula opening.
Treatment of a vaginal Fistula
Initially, you may be prescribed antibiotics or other medications to heal any infection in the area. In some instances, your doctor might recommend waiting for a few months to see if the fistula may heal on its own. Wearing a bladder catheter for a few weeks may help a vesicovaginal fistula spontaneously heal. Often surgery may be necessary. Surgical options include:
- Most vaginal fistulas can be effectively repaired via a vaginal procedure. In an ambulatory surgery procedure, the fistula can be surgically buried with healthy tissue (Latzko procedure for vesicovaginal fistula) or entirely removed and the defect closed in layers (rectovaginal fistula).
- Use of a biologic tissue plug to seal the fistula and guide your body to heal around the plug – for rectovaginal fistulas
- Patching up the fistula using a tissue graft obtained from adjacent healthy tissue
- Repairing sphincter muscles which may have been damaged due to the fistula may be needed to prevent incontinence
- In some rare or complex cases, a colostomy is also performed to divert your urine or stool through an opening in your abdomen while your fistula heals.
