The most common type of fistula in these systems is a vesicovaginal fistula, in which the woman's vagina is connected to the urinary bladder. This causes leakage of urine from the vagina and results in frequent vaginal and bladder infections. Fistulas may also develop between the vagina and the large intestine (an enterovaginal fistula) or rectum (rectovaginal fistula) so that feces leak from the vagina.
Fortunately, both of these types of fistulas are uncommon in the developed world. However, they are more common in developing countries, resulting from long, difficult labor and childbirth, especially in young girls. As a result, they are sometimes referred to as obstetric fistulas. If left unrepaired, urogenital fistulas result in constant vaginal leakage of urine or feces, causing extreme hardship and psychological trauma.
Risks and Causes
The causes and symptoms of fistulas vary, depending on their location. Anal and rectal fistulas are usually caused by an abscess. Vaginal fistulas may be caused by infection and trauma during childbirth. In the United States, urogenital fistulas are less commonly caused by obstetric trauma and are more likely to be a result of surgical complications from a procedures such as hysterectomy or from pelvic abscesses or other pelvic inflammatory conditions.
Symptoms and Evaluation
The symptoms of vaginal fistulas include leakage of urine or feces through the vagina. Symptoms of anal and rectal fistulas, if caused by an abscess, include constant throbbing pain and swelling in the rectal area. Pus is sometimes visible draining from the fistula opening on the skin. Many individuals have a fever resulting from the infection causing the abscess.
A thorough history usually identifies risk factors that may lead to a vaginal fistula, such as recent pelvic surgery, infection or prior radiation. An initial exam usually includes a pelvic exam with a speculum. Additional diagnostic testing may include dye tests, cystoscopy, retrograde pyelograms, fistulagrams and other imaging studies as needed.
Treatment Options
Conservative (non-surgical) therapy is rarely effective for urogenital fistulas; most vaginal fistulas require surgery to close the opening. Vaginal fistulas are usually treated with surgery through the abdomen or vagina. In certain cases, they may be treated with laparoscopic or robotic surgery.
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