Vesicovaginal Fistula

A vesicovaginal fistula (VVF) is a small hole that develops between your bladder and the wall of your vagina. This can make pee leak out of your vagina. It may dribble out lightly or be a steady stream.

A VVF happens when damage to tissue between your vagina and bladder causes the tissue to die. A hole (fistula) then forms, connecting your bladder to your vagina. You’ll still pee through your urethra. But the fistula lets some pee take a “shortcut” into your vagina.

This condition is a physical health problem. But it can cause emotional distress, too. The good news is that VVFs are treatable, often with surgery. Your healthcare team will help you get the treatments and resources you need.

Symptoms of vesicovaginal fistula

Vesicovaginal fistula symptoms can include:

• Leaking pee from your vagina (urinary incontinence)
• Thin and/or foul-smelling vaginal discharge
• Painful intercourse
• Irritation in your vagina or vulva
• Constant wetness in your underwear, even when you just went to the bathroom
• Leaking that starts one to two weeks after pelvic surgery

Your symptoms may vary based on how large the opening is and other factors. Tell a healthcare provider as soon as possible if you have these symptoms.

Vesicovaginal fistula causes

In general, a vesicovaginal fistula forms when there’s damage to tissue between your vagina and bladder that results in the death of that tissue. This forms a hole, or a fistula.

In the U.S. and other high-resource settings, the most common cause of VVF is pelvic surgery that results in accidental tissue damage. Examples include bladder surgery and hysterectomy.

In many parts of the world with fewer resources, a long, difficult labor (obstructed childbirth) is the most common cause.

Less commonly, bladder cancer or cervical cancer, or treatment like radiation, can lead to a VVF.

Complications of this condition

Complications of a vesicovaginal fistula can include:

• An abscess or infection, which could become life-threatening if untreated
• Fistula recurrence (it comes back) after treatment
• Recurrent urinary tract infections (UTIs) or vaginal infections

Living with a vesicovaginal fistula can also affect your mental health and quality of life. It’s important to see a mental health specialist if VVF is causing distress or resulting in social isolation.

How doctors diagnose this condition

To start, a healthcare provider will ask about your symptoms and medical history. They’ll likely do a physical exam and pelvic exam. Your provider will also check that the leak isn’t coming from a ureter (the tube from your kidney to your bladder). Ureter leaks need a different plan.

Your provider will then recommend specific tests to diagnose a vesicovaginal fistula. These tests can also help your provider plan for surgery. Tests may include:

• Dye test: Your provider may fill your bladder with blue fluid. They might also give you medicine that turns your pee orange. You’ll insert a tampon into your vagina. A tampon that turns blue suggests a bladder-to-vagina fistula. Orange without blue suggests a ureter-to-vagina fistula.
• Cystoscopy: A urologist uses a lighted device to look inside your bladder.
• CT urogram: This imaging test uses a contrast dye to take detailed images of your bladder and the rest of your urinary system.
• Other tests: Sometimes, a pelvic MRI or a speculum exam under anesthesia helps map the fistula

How is it treated?

A few small, very new fistulas may close with continuous bladder drainage (a Foley catheter) for several weeks. But most need surgery. The main treatment for a vesicovaginal fistula is surgery to close the opening.

Your surgeon may operate through your vagina or abdomen (sometimes, with laparoscopy or a robot). Together, you’ll decide on the type of surgery that’s best for you.

After surgery, you’ll need a Foley catheter for two to three weeks to drain your pee. Your healthcare provider will want to make sure the fistula has healed before removing the catheter.

Recovery time

It can take six to eight weeks to recover from vesicovaginal fistula surgery. Your healthcare provider will give you specific instructions for recovery. In general, they may recommend you avoid the following for six to eight weeks:

• Sexual intercourse
• Strenuous activity
• Heavy lifting

Avoiding these activities gives the fistula time to heal.

When should I see my healthcare provider?

You’ll need follow-up visits after surgery to make sure the fistula is healing. Let your healthcare provider know if your symptoms get worse or if you develop new ones.

What can I expect if I have this condition?

At centers that do these repairs often, most people (about 85% to 95%) don’t have leakage after one surgery. Some need a second surgery.

Your outlook depends on several factors, like:

• The size and severity of the VVF
• The cause of it
• Your overall health
• The type of surgery you get

In general, complex VVFs are harder to treat than simple ones. Your healthcare provider can give you a better idea of what to expect.