Vaginal Fistulas

A fistula is the abnormal connection between two body parts or organs. Genitourinary vaginal fistula is the abnormal opening between the vagina and another organ in the urinary system (i.e., bladder, ureters, rectum, urethra, or large or small intestine).

There are several types of genitourinary vaginal fistulas, with the most common type being vesicovaginal (VVF). This occurs when an opening is formed between the woman's vagina and the bladder, which causes the leakage of urine from the vagina and can result in frequent vaginal or bladder infections.

Other types include:

Enterovaginal, when a fistula develops between the vagina and a small intestine
Rectovaginal (RVF), when a fistula develops between the vaginal and the rectum
Colovaginal, when a fistula develops between the vagina and colon (large intestine)
Ureterovaginal, when a fistula develops between the vagina and ureters
Urethrovaginal, when a fistula develops between the vagina and urethra

If left unrepaired, vaginal fistulas can result in constant or intermittent leakage of urine or feces through the vagina, causing physical and psychological discomfort.

Vaginal Fistula Symptoms

The main symptom of vaginal fistula is constant leakage of urine or feces through the vagina.

Other symptoms can include:

Recurrent urinary tract infections or vaginal infections
Pelvic pain
Pain with intercourse
Abnormal vaginal discharge

Causes and Risk Factors for Vaginal Fistula

In the United States, urogenital fistulas are less commonly caused by obstetric trauma and are more likely to be a result of surgical complications from a procedure such as hysterectomy or from pelvic abscesses or other pelvic inflammatory conditions. A thorough history usually identifies risk factors that may lead to a vaginal fistula, such as recent pelvic surgery, infection or prior radiation.

Prevention Strategies for Vaginal Fistula

Rest assured that people do not spontaneously develop fistulas without an underlying cause discussed above. Depending on the underlying cause of the fistula, it is not always possible to prevent.

Evaluation and Treatment for Vaginal Fistula

An initial exam is required to diagnosis vaginal fistula, which can include a pelvic exam with a speculum, blood work, imaging etc.

Additional diagnostic testing may include:

Dye tests
Cystoscopy
Retrograde pyelograms
Fistulograms
Other imaging studies as needed

After the initial exams are completed, your doctor will determine whether non-surgical or surgical intervention is needed. Treatment is determined based on the type of vaginal fistula, its size, and associated symptoms.

Non-surgical therapy: Traditionally used for smaller vaginal fistulas. If the fistula is associated with the urinary tract, you may need to have your bladder drained through a catheter for a period of time and/or kidneys drained through a ureteral stent or nephrostomy tube. Ureteral stents are thin catheters placed inside the ureters (the tubes that connect the kidneys to the bladder) and can be easily removed.
Surgical intervention: May be required to repair and close the fistula. The type of surgery will depend on the type of fistula and size. Surgery can vary from minimally invasive to open surgery.

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