A bladder fistula is an abnormal, tunnel-like connection that forms between the bladder and another nearby organ or external surface. This unintended passageway allows for the inappropriate exchange of contents, leading to significant physical distress. While treatable, it is considered a serious medical problem requiring timely professional intervention to prevent severe complications and minimize the risk of long-term health issues.
What Exactly Is a Bladder Fistula?
A bladder fistula, also known as a urinary fistula, is an irregular opening that connects the bladder to a separate internal organ, such as the bowel, or to the skin, creating a direct tract where none should exist. Normally, organ systems, like the urinary tract and the gastrointestinal tract, function as closed and separate units, and the formation of this abnormal duct disrupts this natural separation.
The bladder’s primary function is to store urine before expulsion through the urethra, but a fistula redirects this flow. Urine may leak into another organ, or foreign material like gas or fecal matter can enter the bladder. This inappropriate mixing compromises the sterility and function of the involved organs, and the size of the opening influences the extent of leakage and symptom severity.
The Immediate Health Impact and Seriousness
A bladder fistula is a serious condition due to the high risk of severe, recurrent infections. When a fistula forms between the bladder and the colon, bacteria-laden fecal matter enters the sterile environment of the urinary tract. This introduction commonly causes severe and recurring urinary tract infections (UTIs) that may be difficult to clear with standard antibiotics.
Unresolved infections can ascend to the kidneys, leading to pyelonephritis and kidney damage. Uncontrolled infection can also spread to the bloodstream, causing a life-threatening systemic infection known as sepsis. The constant leakage of urine, particularly with a vesicovaginal fistula, causes continuous, involuntary incontinence and chronic irritation of the surrounding skin and tissue. This ongoing leakage significantly impairs quality of life and can lead to emotional distress.
Physical symptoms often include abdominal pain, unexplained weight loss, and changes in bowel habits. If the fistula is caused by underlying conditions such as cancer, the prognosis is more complicated and requires intensive intervention. Neglecting the condition allows for the development of abscesses, chronic inflammation, and tissue damage, making prompt medical care necessary.
Identifying the Source: Common Types and Causes
Bladder fistulas are classified based on the two organs they connect. Common types include colovesical (connecting the bladder to the colon), enterovesical, and vesicovaginal. Vesicovaginal fistulas, which connect the bladder and the vagina, are a common cause of continuous urine leakage in women.
Causes of fistula formation involve injury, inflammation, or malignancy in the pelvic area. In developed countries, a common cause is a complication following pelvic surgery, particularly gynecological procedures like a hysterectomy. The bladder can be unintentionally injured during the operation, or tissue can become devascularized, leading to necrosis and subsequent fistula formation.
Inflammatory conditions are a frequent source, with diverticulitis accounting for 50 to 70 percent of enterovesical fistulas. Crohn’s disease, a type of inflammatory bowel disease, causes these tracts due to chronic inflammation and ulceration. Radiation therapy used to treat pelvic cancers can cause delayed tissue damage and necrosis, leading to fistula development months or even years after treatment.
Path to Recovery: Diagnosis and Treatment Options
Diagnosing a bladder fistula begins with a thorough medical history and physical examination, followed by specific tests to confirm the presence and location of the abnormal connection. A common diagnostic step is cystoscopy, where a thin, lighted tube is inserted into the bladder to visually inspect the bladder wall for an opening. Imaging studies like a CT scan or MRI, often performed with a contrast dye, help visualize the fistula tract and the organs involved.
The definitive treatment for most bladder fistulas is surgical repair, as they rarely heal spontaneously. The surgical approach depends on the fistula’s size, location, and underlying cause, potentially involving a vaginal, abdominal, or minimally invasive laparoscopic technique. During the procedure, the damaged tissue is excised, and the openings in both organs are closed with sutures.
For a small percentage of very small or simple fistulas, non-surgical management, such as prolonged catheter drainage, may be attempted to allow the tract to close on its own. However, in cases involving malignancy or extensive tissue damage from radiation, the surgical repair can be more complex, sometimes requiring the use of healthy tissue grafts to reinforce the repair site. Successful surgical closure is high, offering a favorable path to recovery and resolution of symptoms.