Overview
A vaginal fistula is an unusual opening that develops between the vagina and another organ, such as the bladder, colon, or rectum. This hole in the vagina allows for the passage of urine, gas, or stool through the vagina. Vaginal fistulas can occur after childbirth, an injury, surgery, infection, or radiation treatment. Treatment often involves surgery to repair the fistula. There are several types of vaginal fistulas, including vesicovaginal fistula, ureterovaginal fistula, and rectovaginal fistula.
Understanding the disease
Symptoms
The symptoms of vaginal fistulas include:
- Abnormal discharge from the vagina, which may be foul-smelling or contain urine or stool.
- Pain in the pelvic region, which may be constant or intermittent, and may be described as burning, irritation, stinging, rawness, soreness, or sharp.
- Pain or discomfort during sexual intercourse.
- Difficulty controlling urine or feces.
- Increased urgency or frequency of urination.
- Fever or chills, if an infection is present. It's important to note that the symptoms may vary from person to person, and some individuals with vaginal fistulas may not experience any noticeable symptoms. If you suspect you may have a vaginal fistula, it's important to consult with a healthcare provider for proper evaluation and treatment.
Risk Factors
Risk factors for developing vaginal fistulas include:
- Childbirth, especially in cases of a large baby, difficult labor or trauma during delivery.
- Age at first delivery, particularly in older women.
- Chronic constipation or straining during bowel movements.
- Chronic cough, such as from smoking.
- Obesity.
- Previous pelvic surgery.
- Weak connective tissue, which may be genetic or part of a family history.
- Being Hispanic or white. Vaginal fistulas can also occur due to infections, injuries, or radiation treatment.
Development
Vaginal fistulas develop when an abnormal opening forms between the vagina and another organ, such as the bladder, colon, or rectum. This can occur due to several reasons, including:
- Childbirth: Vaginal fistulas can develop as a result of trauma sustained during childbirth, especially in cases where the mother has a high-risk pregnancy or undergoes a prolonged or complicated delivery.
- Injury or surgery: Trauma or surgical procedures in the pelvic area, such as hysterectomy or repair of a rectocele, can sometimes lead to the formation of a vaginal fistula.
- Infection: Infections like septicemia, pelvic inflammatory disease, or abscesses can cause fistulas to develop.
- Radiation therapy: In some cases, radiation therapy for cancer treatment can result in the formation of a vaginal fistula. The specific type of vaginal fistula depends on the location and organs involved, such as vesicovaginal fistula (bladder), ureterovaginal fistula (ureters), or colovaginal fistula (colon). Surgery is often necessary to repair vaginal fistulas and alleviate associated symptoms.
Assessment and Diagnosis
Management and Treatment
Complications
Complications of vaginal fistulas may include recurrence of the fistula, incontinence, and difficulty maintaining hygiene.
Treatment
Treatment for vaginal fistulas typically involves surgery, as it is the most effective way to repair the abnormal opening. The type of surgery performed depends on the location and cause of the fistula. Some common surgical procedures for treating vaginal fistulas include:
- Fistula repair: In this procedure, the surgeon will close the abnormal opening between the vagina and the affected organ. The surgery may involve pulling the fistula tract together and sewing it closed. In cases of vesicovaginal fistulas, the surgeon may use a flap of skin from the vaginal wall to cover the bladder neck, helping to prevent recurrence.
- Fistulotomy: If the fistula is too large or complex, the surgeon may perform a fistulotomy. This procedure involves cutting around the fistula to release the tension and allowing the fistula to stretch open. The surgeon can then remove the dead tissue and close the healthy edges together.
- Seton placement: For vesicovaginal fistulas resulting from a urethral sphincter mechanism incompetence, a seton may be placed. A seton is a fine, flexible thread that is inserted into the fistula tract, gradually narrowing it over time, which helps to restore the sphincter function.
- Advancement flap: In cases where the fistula is too large or complex, an advancement flap procedure may be performed. This surgery involves using a flap of skin from another part of the body to cover the fistula, helping to prevent recurrence. In some cases, nonsurgical treatments may be considered, such as antibiotics to treat underlying infections, drainage of abscesses, or the use of fibrin glue to close the fistula. However, surgery is generally the most effective and long-lasting treatment option for vaginal fistulas. Please consult a healthcare professional for personalized advice and guidance on the best course of treatment for a vaginal fistula.