Topic Overview

What is a vaginal fistula?

A fistula is a passage or hole that has formed between:

  • Two organs in your body.
  • An
    organ in your body and your skin.

A fistula that has formed in the wall of the vagina is called a
vaginal fistula.

  • A vaginal fistula that opens into the urinary
    tract is called a vesicovaginal fistula.
  • A
    vaginal fistula that opens into the rectum is called a rectovaginal fistula.
  • A vaginal fistula that opens
    into the colon is called a colovaginal fistula.
  • A vaginal fistula that opens into the small bowel
    is called a enterovaginal fistula.

See pictures of a
vesicovaginal fistula and a
rectovaginal fistula.

What causes a vaginal fistula?

A vaginal fistula starts with some kind of tissue damage. After
days to years of tissue breakdown, a fistula opens up.

A vaginal fistula sometimes happens after:

In areas where women have no health care nearby,
vaginal fistulas are much more common. After days of pushing a baby that does
not fit through the birth canal, very young mothers can have severe vaginal,
bladder, or rectal damage, sometimes causing fistulas.

What are the symptoms?

A vaginal fistula is usually painless. But a fistula lets urine or feces
pass into your vagina. This is called incontinence. And it can cause
soiling problems that you cannot control.

  • If you have a vesicovaginal fistula, you most
    likely have fluid leaking or flowing out of your vagina.
  • If you
    have a rectovaginal, colovaginal, or enterovaginal fistula, you most likely
    have foul-smelling discharge or gas coming from your vagina.
  • Your
    genital area may get infected or sore.

How is a vaginal fistula diagnosed?

Your symptoms are the most clear signs of a vaginal fistula. Your
doctor will want to talk about your symptoms and about any surgery, trauma,
or disease that could have caused a fistula. For a physical exam, your doctor
will use a
speculum to look at the vaginal walls. You may have
other tests, such as:

  • The use of dye in the vagina (and maybe the
    bladder or rectum) to find all signs of leakage.
  • Urinalysis to
    check for infection.
  • Blood test (complete blood count) to check for
    signs of infection in your body.

Your doctor may also use an X-ray, endoscope or MRI to get a clear look
and check for all possible tissue damage.

How is it treated?

If you have a vaginal fistula, you will most likely need surgery
to repair it. Before surgery, your doctor will see whether the tissue is
healthy or needs to heal first.

  • You may need medicine or wound care to heal
    the tissue before surgery.
  • If you have inflammatory bowel disease,
    your doctor will not do surgery during a symptom flare.
  • If you
    have a large rectovaginal fistula, you may first have a
    colostomy. This is to keep the fistula clear for the
    surgery. After the fistula repair heals, the colostomy is taken out.

After fistula repair surgery, be sure to follow your doctor’s
instructions. See your doctor right away if you have signs of infection, such
as a fever, tenderness, swelling, or redness.

Other Places To Get Help

Organization

American Congress of Obstetricians and Gynecologists
(ACOG)
www.acog.org

References

Other Works Consulted

  • Katz VL (2012). Postoperative counseling and management. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 583-621. Philadelphia: Mosby.
  • Lentz GM (2012). Anatomic defects of the abdominal wall and pelvic floor. In GM Lentz et al., eds., Comprehensive Gynecology, 6th ed., pp. 453-474. Philadelphia: Mosby Elsevier.
  • Wong M, Ozel B (2010). Fistulae. In Management of Common Problems in Obstetrics and Gynecology, 5th ed., pp. 328-332. Chichester, UK: Wiley-Blackwell.

Credits

ByHealthwise Staff
Primary Medical Reviewer Sarah Marshall, MD – Family Medicine
Kathleen Romito, MD – Family Medicine
Martin J. Gabica, MD – Family Medicine
Specialist Medical Reviewer Deborah A. Penava, BA, MD, FRCSC, MPH – Obstetrics and Gynecology

Current as ofOctober 6, 2017