What Is a Vaginal Fistula?
A vaginal fistula is an unusual opening that connects your vagina to another organ. For example, a vaginal fistula can link your vagina to your:
- Bladder (vesicovaginal fistula)
- Ureters, the tubes that carry your pee from your kidneys to your bladder (ureterovaginal fistula)
- Urethra, the tube that carries your pee down from your bladder and outside your body (urethrovaginal fistula)
- Rectum, the lower part of your large intestine (rectovaginal fistula)
- Large intestine or colon (colovaginal fistula)
- Small intestine (enterovaginal fistula)
Vaginal Fistula Symptoms
A vaginal fistula doesn’t usually hurt, but it can cause some problems that need medical care. If you have a vesicovaginal fistula (an opening between your vagina and bladder), urine will constantly leak from your bladder into your vagina. This can make you unable to control your urination (incontinent).
Also, your genital area may get infected or sore, and you can have pain during intercourse.
Other symptoms of vaginal fistulas include:
Vaginal Fistula Causes
Most often, the culprit is tissue damage because of things like:
- Abdominal surgery (hysterectomy or cesarean section)
- Pelvic, cervical, or colon cancer
- Radiation treatment
- Bowel disease like Crohn’s or diverticulitis
- Infection (including after an episiotomy or a tear you had when you gave birth)
- Traumatic injury, such as from a car accident
Vaginal Fistula Diagnosis
Your doctor will do a pelvic exam and ask about your medical history to see if you have any risk factors for fistulas, like a recent surgery, infection, or pelvic radiation.
They may also order some tests, including:
- Dye test. Your doctor will fill your bladder with a dye solution. They’ll ask you to cough or bear down. If you have a vaginal fistula, the dye will leak into your vagina.
- Cystoscopy. Your doctor uses a thin device called a cystoscope to look inside your bladder and urethra for signs of damage.
- Retrograde pyelogram. This is a special test in which dye is injected through your bladder into your ureters. An X-ray can show whether there is leakage between a ureter and your vagina.
- Fistulogram. This is an X-ray image of your fistula. It can show your doctor whether you have one or many fistulas and if other pelvic organs may be involved.
- Flexible sigmoidoscopy. Your doctor looks at your anus and rectum with a sigmoidoscope (a thin, flexible tube with a tiny video camera at the tip).
- CT urogram. You have dye injected into a vein, and CT scans make images of your vagina and urinary tract.
- Pelvic MRI. A magnetic field and radio waves take detailed pictures of your rectum and vagina to help show the details of a rectovaginal fistula.
Vaginal Fistula Treatment
Some fistulas may heal on their own. If it’s a small bladder fistula, your doctor might want to try putting a small tube called a catheter into your bladder to drain the pee and give the fistula time to heal by itself.
They might also use a special glue or plug made of natural proteins to seal or fill the fistula. They can also give you an antibiotic to treat an infection caused by the fistula.
Many people who have fistulas need surgery. What kind of surgery you get depends on the type of fistula and where it is. It could be laparoscopic, in which your doctor makes small cuts (incisions) and inserts cameras and tools. Or it could be abdominal surgery, where you get a regular incision with a tool called a scalpel.
For a vaginal fistula that connects to your rectum, your doctor might:
- Sew a special patch over the fistula
- Take tissue from another place in your body to close it
- Fold a flap of healthy tissue over the fistula
- Fix the muscles of your anus if they’re damaged
Vaginal Fistula Complications
Vaginal fistulas can be upsetting and embarrassing when they leak and cause bad smells. But they can also cause complications like:
- Vaginal or urinary tract infections that keep coming back
- Hygiene problems
- Stool or gas that leaks through the vagina
- Irritated or inflamed skin around your vagina or anus
- A swollen clump of infected tissue with pus (abscess) that could be dangerous without treatment
- Fistulas that come back
Women who have Crohn’s disease and develop a fistula have a high risk of complications, such as fistulas forming again later or fistulas that don’t properly heal.