A vaginal fistula is an abnormal connection or passageway that forms between the vagina and another internal organ, typically those in the urinary or digestive systems located nearby in the pelvis. This tunnel-like defect allows for the continuous and involuntary leakage of contents, such as urine or stool, into the vagina. This condition is physically debilitating, often leading to chronic infections and significant emotional distress.
Understanding the Types of Fistulas
Vaginal fistulas are classified based on the two organs they connect, which determines the type of substance that leaks through the abnormal tract. The most common type is the vesicovaginal fistula, connecting the bladder and the vagina, causing urine to leak continuously into the vagina.
Another frequent type is the rectovaginal fistula, which forms a passageway between the rectum and the vagina. This connection allows gas and stool to pass uncontrollably through the vagina. Identifying the specific type is important because the location dictates the symptoms and the appropriate surgical repair strategy.
Other types include:
- Urethrovaginal fistula, connecting the urethra to the vagina.
- Ureterovaginal fistula, linking the ureters (tubes carrying urine from the kidneys) directly to the vagina.
- Enterovaginal fistula, involving the small intestine.
- Colovaginal fistula, involving the colon.
Causes of Fistula Development
Vaginal fistulas develop when the tissues separating the vagina from a neighboring organ become damaged and die, creating a hole. A major cause is obstetric complications, particularly prolonged, obstructed labor in regions with limited emergency care. The baby’s head presses against pelvic tissues for an extended time, cutting off blood flow and causing tissue breakdown.
In developed countries, non-obstetric causes are more frequent, often triggered by surgical complications. Damage to the bladder or ureters during pelvic surgeries, such as a hysterectomy or Cesarean section, can inadvertently lead to fistula formation. These defects may appear immediately after surgery or develop weeks later as the damaged tissue dies.
Certain medical conditions also increase the risk, most notably inflammatory bowel diseases like Crohn’s disease. The chronic inflammation associated with these conditions can erode the tissue layers between the rectum and the vagina. Radiation therapy administered for pelvic cancers can also damage healthy tissue, making it fragile and prone to breakdown, sometimes leading to a fistula months or years after treatment.
Identifying the Symptoms
The presence of a vaginal fistula is signaled by the involuntary and persistent leakage of bodily fluids from the vagina. If the fistula involves the urinary tract, continuous dribbling of urine occurs, ranging from mild dampness to a severe flow. This leakage often results in a strong, persistent odor.
When the fistula connects to the rectum or colon, symptoms involve the unintended passage of gas or stool through the vagina. This effluent can cause significant irritation and soreness of the external genital and perineal skin. Constant contamination also leads to recurrent urinary tract or vaginal infections.
Other common symptoms include pain during sexual intercourse, a persistent vaginal discharge, and localized pain or swelling in the pelvic area. While the fistula may not always cause direct pain, the resulting skin irritation and chronic infections contribute significantly to discomfort and a reduced quality of life.
Treatment and Recovery Options
Diagnosis begins with a thorough physical and pelvic examination, often supplemented by dye tests to confirm leakage into the vagina. Imaging techniques like CT scans, MRIs, or specialized X-rays (fistulograms) help precisely map the location and size of the abnormal tract. This information is necessary for planning the appropriate treatment strategy.
Small, uncomplicated fistulas may sometimes heal on their own with conservative management, such as temporary placement of a urinary catheter to divert urine away from the defect. However, most vaginal fistulas require surgical intervention for permanent closure. Before surgery, any surrounding infection or inflammation must be treated, often using antibiotics.
The goal of surgical repair is to excise the fistula tract and close the opening by stitching together healthy tissue layers. The approach depends on the fistula’s location: the surgeon chooses between a transvaginal approach (through the vagina) or a transabdominal approach (through an abdominal incision). The abdominal route is typically reserved for more complex or high-lying fistulas.
In complex cases, especially those involving the rectum, the surgeon may use a tissue flap or biological mesh to reinforce the repair. For large or recurrent rectovaginal fistulas, a temporary colostomy may be created to completely divert the fecal stream. This allows the repair site to heal without contamination and is usually reversed in a subsequent procedure.
Surgical repair typically has a high success rate, often exceeding 90%, particularly when the surrounding tissue is healthy and the fistula is not related to cancer or radiation. Recovery time varies but involves several weeks of restricted activity for complete healing. Post-operative care includes monitoring for recurrence and sometimes physical therapy to restore pelvic floor function.