Authored By: Dr. Vinatha Puli
MBBS, DGO, DFSRH, MRCOG, CCT (UK)
Clinical Director – Obstetrics & Gynaecology
What is a fistula?
A fistula is an abnormal connection or channel or passage way connecting one internal organ to the other or to outside of the body.
Where all can fistula form?
Fistulas can form between anal passage and skin (back passage to surface of skin) called perinatal fistula.
- Bladder to bowel called enterovesical or colovesical fistula
- Bowel to vagina – recto education or enterovesical fistula
- Bowel to skin – enterocutaneous fistula
- Bowel to bowel – enteroenteric or enterocolic fistula
- Bladder to vagina – vesicovaginal fistula
What is vesico-vagina fistula?
Vesico-vaginal fistula is an abnormal connection between the bladder and vagina. When you have this fistula urine will constantly leak from vagina as vagina is not drained to hold urine like bladder.
What are the symptoms of fistula?
Vaginal fistulas does not cause pain but it can cause some problems that will need medical care for example if there is vesico vaginal fistula- due to constant leak of Irvine genital area may get infected or sore. You can even experience pain during sexual intercourse. Sometimes fever, pain in the tummy, loose motions, weight loss, nausea and vomiting can happen. Most of the time quality of life is affected due to embarrassment of leaking that can lead to lot of psychological problems
What are the reasons & why some women develop fistula?
Most often child birth is the reason especially if very prolonged labour and difficult delivery. Other reasons or causes include abdominal surgeries like caesarean or hysterectomies.
- Cancers- cervical or colon cancers
- Radiation treatment
- Bowel disease like crowns or diverticulitis
- Infections after episiotomy or deep perineal tears at child birth
- Traumatic injury like after a road traffic accident
How do I know if I have a fistula?
If you have any of the above said symptoms your doctor will do internal examination and can also perform some tests.
Due test where your bladder will be filled with a floured s ok union and a tampon is placed in the vagina. If you have a fistula dye will leak into the vagina and tampon will be coloured.
Sometimes X- rays, camera tests like cystoscope or sigmoidoscope, CT scan of MRI will be used to diagnose fistulas.
What treatments are available for fistulas?
Some fistulas may heal on their own especially if it is very small.
A small tube or catheter is passed into your bladder so that urine is drained constantly allowing fistula to heal.
Sometimes special hours or plugs can be used to seal or fill the fistula.
Antibiotics might be used to treat infect caused by fistula.
Many people might need surgery. The type of surgery depends on the type of fistula, where it is located and the size of the fistula.
It could be done laparoscopic (key hole) or Abdominal (through a cut in your tummy) or through vagina. Special patches can be seen over the fistula of tissues from another place be used to close the fistula especially if fistula is between back passage and vagina.
What will happen if I don’t get treated for fistulas?
- Vaginal or urinary tract infections can keep coming back
- Hygiene problems
- Stool or gas can leak through vagina and anus
- Pus can collect called access
Fistulas can sometimes comeback despite treatment. Women who have crowns disease are especially at high risk of this recurrence.