Vaginal Fistula – Symptoms, Causes, and Management

A vaginal fistula is an abnormal connection between the vagina and any other neighboring organ, allowing urine or stool to pass through the vagina. These fistulas cause physical discomfort, emotional distress, and impact self-esteem. These are not usually painful but if left untreated, they can get infected and cause severe pain during intercourse.

Symptoms of vaginal fistula

Fistulas cause different symptoms, concerning their location and size. Some common signs and symptoms include:

  • Passage of gas, urine, pus, or stool from the vagina
  • Foul-smelling vaginal discharge
  • Pain in pelvis
  • Recurrent UTIs
  • Dyspareunia
  • Irritation in vulva
  • Urinary incontinence
  • Fever
  • Pain in abdomen
  • Weight loss
  • Nausea and vomiting
  • Diarrhea

Causes of vaginal fistula

Vaginal fistulas can be formed due to several reasons:

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  • Injuries to the vaginal canal during childbirth: Tears in the perineum often extend to the bowel or the episiotomy scar. The scar may also affect the anal sphincter.
  • Crohn’s disease: This is an inflammatory bowel disease that can result in the formation of a fistula.
  • Radiation exposure: Radiation exposure can result in the formation of fistulas within 6 months to two years of exposure.
  • A surgical procedure in vagina, perineum, rectum, or anus: Surgical procedure can also result in scar formation which can later develop into a fistula.
  • Diverticulitis: Long-standing diverticulitis can also cause injury and thus fistula formation.
  • Trauma: Any sort of traumatic injury can also cause tears and thus fistulas formation.

Types of vaginal fistula

There are different types of fistulas, some of these are:

  • Vesicovaginal fistula: This is an opening between the bladder and vaginal canal, discharge is urine.
  • Ureterovaginal fistula: Fistula between ureters and vaginal canal.
  • Rectovaginal fistula: Fistula between vagina and rectum, discharge is thick and dark brown.
  • Colovaginal fistula: Opening between vagina and colon, greenish discharge.
  • Enterovaginal fistula: The opening is between the small intestine and vagina, greenish discharge.
  • Uretherovaginal fistula: Connection between urethra and vagina.

Risk factors

Although vaginal fistulas form due to complications some people are more at risk than others:

  • Obese females
  • With recurrent UTIs
  • Patients with Crohn’s disease
  • Congenital vaginal fistulas
  • History of hysterectomy

Complications of vaginal fistula

Some of the complications of an untreated vaginal fistula are:

  • Fecal incontinence
  • Recurrent UTIs
  • Abscess formation
  • Hygiene issues
  • Recurrence of fistulas

Management of vaginal fistula

Vaginal fistulas can cause serious discomfort and affect the healthy lifestyle of an individual if not properly managed.

Diagnosis

For diagnosis of a vaginal fistula, your doctor will take a detailed history of your symptoms and look for risk factors, followed by a pelvic examination. Some investigations are also ordered to find out the exact location and severity of the fissure.

  • Dye Test: The bladder is filled with a dye solution and then the patient is asked to cough to see if the dye appears in the vagina.
  • Cystoscopy: A cystoscope is used to look inside the bladder and urethra for any sign of trauma.
  • Xrays: Pyelogram is a test that involves an injection of dye to check leakage between the vagina and ureter.
  • Sigmoidoscopy: A sigmoidoscope is used to visualize the anus and rectum.
  • Ct urogram: CT is used to make images of the vagina and urinary tract after injecting dye into the veins.
  • Pelvic MRI: To get detailed images of a fistula.

Treatment

A vaginal fistula can only be treated by invasive procedures. Some of the methods are:

  • Small fistulas are allowed to heal on their own by passing a catheter to drain urine
  • A plug can also be inserted to seal the fistula
  • A patch is often sewn onto a rectovaginal fistula, along with fixing of anal muscles
  • The laparoscopic or open surgical approach is also used to treat large fistulas
  • Antibiotics and pain relievers are advised after the surgical procedure as supportive treatment

Lifestyle changes and home remedies

  • Keep the area clean
  • Strict aseptic measures should be taken to avoid any sort of infection which may lead to abscess formation
  • Avoid spicy foods if you have a rectovaginal fistula

When to Consult a Doctor?

If you experience any of the symptoms above you should consult the doctor to look for your treatment options before the condition aggravates.

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FAQ

How can you heal a fistula without surgery?

A small fistula can be treated using several methods other than surgical:

  • A plug is inserted to seal it
  • By passing a catheter to drain urine and allowing the fistula to heal on its own
  • A medical glue is used to close the opening

What color is fistula discharge?

  • The drainage is mostly liquid and green in color in case of an opening in the small intestine
  • Drainage from descending colon is dark brown in color and thick in consistency
  • Drainage from the bladder is urine, which is watery in consistency and yellow in color

Can you fart through a fistula?

In colovaginal fistulas, vaginal gas has a strong odor of fecal matter.

Can a fistula cause pelvic pain?

A throbbing pain is often experienced in the pelvic region which mostly aggravates during sexual intercourse.

Last medically reviewed on August 20, 2021.