A vaginal fistula is an abnormal opening between the vagina and a nearby organ, such as the bladder, rectum, or ureter. This opening creates a passage that shouldn’t exist, allowing urine, stool, or gas to leak through the vagina. Globally, between 50,000 and 100,000 women develop obstetric fistulas each year, and more than 2 million women in Asia and sub-Saharan Africa live with an untreated one.
Types of Vaginal Fistulas
The type of fistula depends on which organ connects to the vagina through the abnormal opening. The most common type is a vesicovaginal fistula, which forms between the bladder and the vagina and causes continuous urine leakage. A rectovaginal fistula connects the rectum to the vagina, leading to stool or gas passing through the vaginal canal. Less common types include ureterovaginal fistulas, which involve the tubes connecting the kidneys to the bladder, and urethrovaginal fistulas, which form between the urethra and the vagina.
Some women develop more than one fistula at the same time, particularly after radiation therapy or complicated surgery. The location and size of the opening determine both the severity of symptoms and how the fistula is treated.
What Causes a Fistula to Form
In high-income countries, vaginal fistulas most often result from pelvic surgery. Hysterectomies, cesarean sections, and other abdominal procedures can damage tissue between the vagina and surrounding organs, and the injury sometimes doesn’t become apparent until days or weeks later when the tissue breaks down and an opening forms.
In lower-income countries, the leading cause is prolonged, obstructed labor during childbirth. When labor stalls for hours or days without access to a cesarean section, the baby’s head presses against the vaginal wall and cuts off blood flow to the surrounding tissue. That tissue dies and eventually breaks down, leaving a hole. Most of these fistulas occur among women living in poverty, in settings where emergency obstetric care is limited.
Pelvic cancers, including cervical cancer and colorectal cancer, can also cause fistulas, either because the tumor erodes through tissue or because radiation therapy used to treat the cancer damages the vaginal wall. Radiation-related fistulas sometimes appear months or even years after treatment ends.
Symptoms and Warning Signs
The hallmark symptom is leakage you can’t control. With a bladder-to-vagina fistula, you’ll notice a constant or near-constant trickle of urine from the vagina. With a rectal fistula, the leakage involves stool, gas, or foul-smelling discharge. Other signs include recurring urinary tract infections, irritation or pain in the vulva and vaginal area, and pockets of pus (abscesses) near the vaginal opening.
The leakage typically doesn’t respond to pelvic floor exercises or pads the way stress incontinence might. It tends to be steady rather than triggered by coughing or sneezing, which is one way to distinguish it from other causes of urinary leakage.
How Fistulas Are Diagnosed
Diagnosis usually starts with a physical and pelvic exam. Your provider will look for scarring, abnormal discharge, and signs of urine or stool leaking from the vaginal wall.
One straightforward test involves filling the bladder with a colored dye solution. You’re then asked to cough or bear down. If dye appears in the vagina, or shows up on a tampon after movement, it confirms a connection between the bladder and vagina. For fistulas involving the rectum, imaging plays a bigger role. A pelvic MRI can map the exact path of the fistula, which helps surgeons plan a repair. A cystoscopy (a tiny camera inserted into the bladder) lets providers see the fistula opening from the bladder side, while a colonoscopy or sigmoidoscopy can check the rectal side.
If there’s any concern that cancer caused the fistula, a small tissue sample may be taken for biopsy. An X-ray called a fistulogram can also reveal whether more than one fistula is present.
Treatment Options
Surgery is the primary treatment for most vaginal fistulas. The approach depends on the fistula’s cause, size, location, and how much the surrounding tissue has been affected. Some repairs are done through the vagina, which tends to involve less recovery time and avoids the need to disturb the intestines. This vaginal approach can be especially beneficial for women whose fistulas resulted from radiation. Other repairs require an abdominal incision, and increasingly, surgeons use laparoscopic or robotic-assisted techniques that reduce recovery compared to open surgery.
Not every fistula requires immediate surgery. Your provider may recommend waiting 3 to 6 months before operating, particularly if there’s active infection or inflammation. This waiting period allows surrounding tissue to heal and gives small fistulas a chance to close on their own. During this time, you might use a catheter to continuously drain the bladder and keep urine from passing through the fistula. For some small fistulas, continuous bladder drainage alone can lead to closure, though results vary widely, with reported success rates ranging from 12% to 80% depending on the individual case.
When surgery is performed, success rates are generally high. In one published series, fistula repair without removing the fistula tract achieved a 100% closure rate, though outcomes depend on factors like the fistula’s complexity, whether the tissue has been irradiated, and whether it’s a first-time or repeat repair.
What Recovery Looks Like
After surgical repair of a bladder-to-vagina fistula, you’ll typically have a catheter in place for about three weeks to keep pressure off the repair site while it heals. Most people take the full three weeks off work while the catheter is in. Total recovery time varies based on the surgical approach, your overall health, and how complex the repair was.
During recovery, you’ll likely be advised to avoid heavy lifting, sexual intercourse, and anything that puts strain on the pelvic area. Your surgical team will schedule follow-up visits to confirm the fistula has closed and leakage has stopped.
Emotional and Social Effects
The physical symptoms of a fistula, especially constant leakage and odor, carry a heavy psychological toll. A large meta-analysis of studies on women living with genital fistulas found that roughly 65% experienced depression and about 52% experienced anxiety. Suicidal thoughts were reported in 14 separate studies.
Many women withdraw from social life entirely. They skip weddings, funerals, religious services, and informal gatherings out of fear that others will notice the odor or leakage. Internalized shame is common: more than half of women studied reported low self-esteem, and many initiated their own divorce or separation. Across the pooled data, 35% of women with fistulas had experienced divorce or separation. Lost employment and income compound the isolation, creating a cycle where the condition erodes nearly every part of a woman’s life.
These effects are most severe in settings where women lack access to surgical repair, but even in countries with readily available treatment, the time between developing a fistula and getting it fixed can be deeply distressing. The constant management of symptoms, including staying clean, wearing protective garments, and limiting social exposure, becomes an exhausting daily burden.