A fistula is an abnormal passageway between two organs within the body or between an organ and the skin. Fistulas can develop in various parts of the body, typically as a result of tissue damage caused by surgery, trauma or disease. Gradual erosion eventually causes the tissue to wear through, causing the fistula. Vaginal fistulas may occur after childbirth, surgery in the region, radiation treatment, or inflammatory bowel disease.
Types of Vaginal Fistulas
There are several types of vaginal fistulas, all forming in the wall of the vagina. The fistulas are differentiated according to the location of the opening as follows:
- Vesicovaginal fistulas open into the urinary tract
- Rectovaginal fistulas open into the rectum
- Colovaginal fistulas open into the colon
- Enterovaginal fistulas open into the small intestine
There are two types of vesicovaginal fistulas: urethrovaginal fistulas that open into the urethra and ureterovaginal fistulas that open into the ureters.
Causes of Vaginal Fistula
Vaginal fistulas are more common in women who have limited access to health care and, therefore, much more prevalent in underdeveloped countries. In locations where women give birth without being monitored or assisted, severe vaginal tears that lead to fistulas occur more frequently. Even in areas where good health care is readily available, women may develop vaginal fistulas after one of the following:
- Surgery of the vagina, perineum, anus, or rectum
- Radiation therapy for pelvic cancer
- Acute episodes of inflammatory bowel disease
- Deep tears during childbirth
- Infected episiotomy incisions
Most vaginal fistulas affecting the urinary tract are associated with open hysterectomy procedures.
Symptoms of Vaginal Fistulas
Although most vaginal fistulas begin as painless openings, patients experience many uncomfortable and disconcerting symptoms that adversely affect their quality of life. These include:
- Urinary or fecal incontinence
- Possibly malodorous vaginal discharge or vaginal gas
- Genital soreness, inflammation, or infection
In addition to the embarrassment of some of the symptoms of vaginal fistulas, genital inflammation can be extremely uncomfortable, making sexual activity undesirable or impossible.
Diagnosis of Vaginal Fistulas
To diagnose a fistula, the doctor will review all symptoms and conduct a physical examination, including a pelvic exam. A complete medical history will be taken to reveal any disease, trauma, or surgery that may have caused a fistula to develop. Other tests may be needed as well, including some of the following:
- Blood tests
- Intravenous pyelogram
- Gynecological endoscopy
- MRI scan
The intravenous pyelogram is test that uses contrast dye to detect and measure any fluid leakage in the urinary tract.
Treatment of Vaginal Fistulas
In most cases, a vaginal fistula requires surgical repair to close up the abnormal opening. Medication or wound care may be necessary to heal the affected tissue before the operation. In the case of fistulas that involve the intestinal tract, patients may be required to follow a special diet to lessen the amount of stool produced so that the affected area can heal prior to surgery. In patients with inflammatory bowel disease, care will be taken so that the surgical intervention does not occur during flareup. When a patient has a large rectovaginal fistula, she may have to undergo a temporary colostomy to ensure that the area being operated upon is clear during, and just after, surgery.