A fistula is an unusual connection or passageway that links two vessels or organs that should not usually connect. They can occur anywhere between the skin and the intestine, between the rectum and vagina, and other sites. The most common site for a fistula is always around the anus.
The most common fistula type in female folks is one that occurs in between the vagina and bladder (vesicovaginal fistula) and another that occurs in between the vagina and rectum (known as a rectovaginal fistula). A vesicovaginal type of fistula is usually linked with urinary incontinence or urine leakage into the vagina, which may be quite severe. A rectovaginal fistula, on the other hand, can lead to fecal leakages into the vagina or fecal incontinence.
Fistulas can also affect many other genital organs:
- Cervical (either an abnormal opening into the neck or the cervix)
- Enterovaginal (occurring in between the vagina and bowel)
- Metroperitoneal (between the peritoneal cavity and uterus)
- Recto-uterine (between the bowel and uterus)
- Vesico-uterine (between the bladder and uterus)
- Ureterovaginal fistulas (between the vagina and ureter)
- Anal fistula (small tunnel with both an internal opening of the anal canal and an external aperture in the skin close to the anus)
How Common Are Fistulas?
The World Health Organization (WHO) estimates that there are 50,000-100,000 new cases of fistulas every year. In places like Africa, obstetric fistulas are often left unaddressed due to a lack of obstetric care. Thankfully in the United States, fistulas are often diagnosed early and cared for appropriately.
Prevention is the best treatment. Maintaining a good nutritional habit is a great way to maintain healthy tissue and ward off fistulas. Also, abstaining from smoking is important to promote fistula healing.
What Causes A Fistula?
In Africa, the prominent cause of fistulas is childbirth and hindered labor that is left unrelieved. While fistulas incidence due to complicated births is minimal in the U.S. (United States), other causes may trigger this troublesome condition. Diverticular disease and Crohn’s disease are well known to foster fistula formation. Also, those who go through radiation therapy are at a higher risk for different forms of fistulas.
The prominent cause of a link between the bladder and the vagina in the United States is damage to the bladder in pelvic surgery, basically hysterectomy. While the sign may occur immediately just after surgery, something may also be delayed for about 1-2 weeks. Rectovaginal fistula may occur immediately after childbirth, characterized by a large vaginal tear.
In the developing world, fistulas are most often associated with dystocia (prolonged labor). The WHO (World Health Organization) has named fistulas “the most dramatic upshot of neglected or prolonged childbirth,” estimating over 2 million women living with fistulas globally. In developing countries, the issue arises during dystocia (spanning up to 3-5 days), with the unborn fetus pressing against its mother’s birth canal very firmly, cutting off blood supply to the tissues in between the rectum, vagina, and/or bladder. It causes the tissues to rot away and disintegrate, thus allowing an opening to form.
Colorectal and urogenital fistulas can also be triggered by pelvic fractures, abortions, cancer or radiation therapy at the pelvic area; inflammation of the glands near the rectum; IBD (inflammatory bowel disease) like ulcerative colitis Crohn’s Disease; and after childbirth infected episiotomies. Sexual abuse such as rape can also be a great factor in the formation of fistulas.
What Are The Traits To Look Out For In Fistulas?
A leak between the vagina and bladder (vesicovaginal fistula) can occur without pain but will cause incontinence issues that cannot be easily controlled as urine continuously leaks into the vagina upon flowing into the bladder.
The genital region may also become infected or sore, and pain may be felt during intercourse.
Female with a rectovaginal fistula, or a link between the vagina and rectum, may be characterized by the passage of a foul-smelling stool, gas, or pus from the vagina and also pain during intercourse.
Depending on the fistula type, here are some signs
- Constant leakage of urine from the vagina
- Irritations in the female genital organs
- Urinary tract infections (UTIs)
- Leakage of foul-smelling gas, pus, or feces into the vagina
- Fluid dripping from the vagina
- Abdominal pain
Should you exhibit any of the above-mentioned traits, ensure to swiftly discuss them with your healthcare provider (pharmacist or doctors).
What Are The Treatment Options Of Fistulas?
Proper medical attention makes fistulas both preventable and treatable.
Your healthcare-trained expert will talk to you about the symptoms and what possible things could have caused them. As a part of physical examinations, your doctor may lookout for a urinary tract infection or conduct some blood tests and probably use a dye to detect all areas of leakage. A scope or X-ray may also be used to have a clearer look and detect all possible tissue damage.
Fistulas do not cure on their own. However, some small vesicovaginal fistulas, when detected early, may be cured by inserting a catheter into the bladder for some time. However, the remedy for most fistulas is the surgical approach.
Vesicovaginal fistula most often can be treated by an invasive vaginal approach. Sometimes a minimally invasive robotic or laparoscopic, or open surgical approach may be used.
During surgical operations, your doctor will look out for the damaged area for cellulitis, infection, or edema while also cleaning any scar tissue and making sure proper blood is supplied. After the operation, medications like antibiotics may be prescribed.
Should you have been diagnosed with any of the fistulas or are exhibiting symptoms linked with fistulas, contact your urogynecologists to book an appointment to learn more about your treatment options.
- Fibrin glue: A definite medicinal adhesive used to seal up fistulas.
- Plug: This is a collagen matrix used to fill up fistulae.
- Used to sap fistulas, catheters are often employed on small types of fistulas to control infection.
- Laparoscopic surgery: A minimally invasive surgical operation involving a tiny incision and the utilization of small tools and cameras to repair the fistula.
- Transabdominal surgery: The fistula is got into an incision through the abdominal wall.
Antibiotics or using any other medication may also cure any infection linked with the fistula. Yet, no pharmaceutical solutions exist to eradicate fistulas.
Vagina Fistula Is More Common
A vaginal fistula is among the most common type of fistulas. It is an unusual aperture that links your vagina to another close organ. For instance, a vaginal fistula can connect your vagina to:
- Ureters carrying your urine from kidneys to your bladder (ureterovaginal fistula)
- Bladder (vesicovaginal fistula)
- Urethra carrying your urine down from your bladder to be expelled (urethrovaginal fistula)
- Rectum, the lower division of your large intestine (rectovaginal fistula)
- Colon large intestine (colovaginal fistula)
- Small intestine (enterovaginal fistula)
Vaginal Fistula Causes
Commonly, the guilty party is tissue damage due to things like:
- Abdominal surgery (cesarean section)
- Cervical, pelvic, or colon cancer
- Radiation treatment
- Bowel diseases like diverticulitis or Crohn’s
- Infection (after an episiotomy or a tear after delivery)
- Traumatic injury, like a car accident
Diagnosis of Vaginal Fistula
Your healthcare-trained provider will do a pelvic examination and ask about your previous medical history to find out if you have any possible risk factors for fistulas, such as an infection, recent surgery, or pelvic radiation.
Some tests may also be ordered, including:
- Dye test: Your health care provider will load up your bladder with a dye solution. He’ll also ask you to either cough or bear down. If you truly have a vaginal fistula, the dye will not be held but would leak into the vagina.
- Cystoscopy: Your health care provider uses a slim device known as a cystoscope to look through your urethra and bladder for signs of damage.
- Fistulogram: An X-ray picture of fistula. It can tell whether or not you have one or many fistula types and if other pelvic organs are involved.
- Retrograde pyelogram: This is a distinctive test in which a dye is injected through the bladder into the ureters. An X-ray may show whether or not there is leakage between your vagina and ureter.
- Flexible sigmoidoscopy: Your health care provider looks at your rectum and anus with a sigmoidoscope.
- CT urogram: Dye is injected into a vein, and these CT scans make pictures of your urinary tract and vagina.
- Pelvic MRI: Radio waves and magnetic fields take a detailed image of your vagina and rectum to show the information of a rectovaginal fistula.