Vaginal Fistula

What is a vaginal fistula?

A vaginal fistula is a tunnel-like opening that develops in the wall of the vagina. Your vagina is the muscular tube between your vulva (outer female genitals) and your cervix, the mouth of your uterus.

A vaginal fistula opens between your vagina and an organ in the urinary system or digestive system. Damage to tissue in your vaginal wall causes a hole to form where it doesn’t belong.

What are genitourinary vaginal fistulas?

Genitourinary vaginal fistulas form between your vagina or uterus (parts of the female reproductive system) and organs in your urinary system. The word genitourinary refers to your genitals and urinary system.

The most common type is a vesicovaginal fistula, where an opening develops between your vagina and bladder (the organ that holds urine).

Genitourinary vaginal fistulas also include:

• Ureterovaginal fistulas between your vagina and ureters, the tubes that carry urine from your kidneys to your bladder.
• Urethrovaginal fistulas between your vagina and urethra, the tube that carries urine from your bladder out of your body.

What are other types of vaginal fistulas?

Fistulas can also form between your vagina and digestive system organs. These include:

• Rectovaginal fistulas between your vagina and rectum, the tube that sends poop (stool) through your anus and out of your body.
• Colovaginal fistulas between your vagina and large intestine (colon).
• Enterovaginal fistulas between your vagina and small intestine.

How common are vaginal fistulas?

The World Health Organization (WHO) estimates that 50,000 to 100,000 women worldwide develop vaginal fistulas every year.

The problem is more common among women who live in countries with limited medical resources. These women may spend days in childbirth. Pressure from the baby pushing against the vaginal wall can cut off the blood supply to vaginal tissue, leading to a fistula. As many as 2 million women in Asia and sub-Saharan Africa live with untreated vaginal fistulas.

What causes vaginal fistulas?

A lack of blood supply to vaginal tissue causes the tissue to die. A hole or fistula forms in the tissue where this happened. These openings can develop in a few days or over several years. Rarely, a person is born with a congenital vaginal fistula.

Causes of vaginal fistulas include:

• Prolonged labor during childbirth.
• Vaginal tears during childbirth or an episiotomy.
• Abdominal or pelvic surgery, including C-sections and hysterectomies.
• Cancer in the pelvic area, such as cervical cancer or colorectal (colon) cancer.
• Inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis.
• Colon infections like diverticulitis.
• Radiation therapy to the pelvic region.

What are vaginal fistula symptoms?

Genitourinary vaginal fistulas that form between your vagina and urinary system organs may cause:

• Constant urine leakage or urinary incontinence.
• Chronic urine odor.
• Skin irritation in your vagina, vulva (vaginal entrance) or perineum (area between your vagina and anus).
• Painful intercourse (dyspareunia).
• Recurrent urinary tract infections (UTIs), kidney infections (pyelonephritis) or vaginal infections (vaginitis).

Fistulas that form between your vagina and organs in your digestive system may cause:

• Abdominal pain.
• Foul-smelling vaginal discharge.
• Gas, pus or stool (fecal incontinence) leaking from the vagina.
• Nausea and vomiting or diarrhea.
• Painful intercourse.
• Recurrent UTIs or kidney infections.
• Rectal bleeding or vaginal bleeding.
• Unexplained weight loss.

How is a vaginal fistula diagnosed?

Your healthcare provider will perform a physical exam, including a pelvic exam, and assess your symptoms.

Diagnostic tests for vaginal fistulas include:

• Complete blood counts and urinalysis to look for infections.
• Dye test, inserting dye in your rectum and checking for signs of leakage from your vagina.
• Fistulogram X-ray to determine the number and size of fistulas.
• Urogram using CT scans to view your vagina and urinary tract.
• Pelvic MRI to view your vagina and rectum.
• Cystoscopy to view inside your bladder and urethra.
• Flexible sigmoidoscopy to view your rectum and lower part of your large intestine (colon).
• Colonoscopy to examine the inside of your rectum and all of your large intestine.
• Retrograde pyelogram using an injectable dye and X-rays to find leakage between your vagina and ureters.

What are vaginal fistula treatments?

Treatment depends on the fistula type. Some small fistulas heal on their own with treatments like:

• Antibiotics for infections or medications for inflammatory bowel disorders.
• Temporary self-catheterization (clean intermittent catheterization) to drain your bladder while a vesicovaginal fistula heals.
• Ureteral stents (kidney stents) to keep your ureters open while a ureterovaginal fistula heals.

Most people with vaginal fistulas need surgery. To repair a vaginal fistula, a surgeon may use your own tissue, lab-made tissue or surgical mesh to close the opening. As many as 9 in 10 women have a complete recovery after vaginal fistula repair surgery.

What happens after vaginal fistula repair?

After surgery for a genitourinary vaginal fistula, you may need help draining urine while the fistula heals. Your healthcare provider can teach you to use a catheter (thin hollow tube inserted into your bladder).

If your provider repairs a large fistula between your vagina and a digestive system organ, you may need a temporary ostomy:

1. A surgeon creates an opening (stoma) in your belly (abdomen).
2. A colostomy for your large intestine or ileostomy for your small intestine sends stool to the stoma.
3. A bag outside your body collects the stool. Your provider will teach you to change the bag and keep the stoma clean.
4. When the fistula heals, you’ll need another surgery to reconnect your intestine to your rectum and close the stoma.

What is recovery like after vaginal fistula repair surgery?

These steps can aid your recovery after vaginal fistula repair surgery:

• Take antibiotics, if prescribed, to prevent an infection.
• Don’t have sexual intercourse, use tampons or douche until your provider gives the OK.
• Prevent constipation and diarrhea (which increase infection risk) by eating a high-fiber diet and staying hydrated. Ask your provider if it’s OK to use laxatives or stool softeners.

What is the outlook for people with vaginal fistulas?

Surgical treatments for vaginal fistulas are highly successful. Most people experience a full recovery and no longer have symptoms.

Some fistulas don’t heal properly or come back after treatment. Problems with healing are most likely to happen if you have cancer or Crohn’s disease. Living with symptoms of an untreated vaginal fistula can lead to depression or anxiety.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the vaginal fistula?
• What type of vaginal fistula do I have?
• How should I care for myself while I have this condition?
• What are my treatment options?
• What complications could occur from surgery?
• Are there steps I can take to prevent getting another vaginal fistula?

Can you feel a vaginal fistula?

No, you can’t feel a vaginal fistula by inserting your fingers into your vagina. And vaginal fistulas rarely cause pain or discomfort. But you’ll likely notice other signs like leaking urine, painful intercourse or increased infections.

What doctors treat vaginal fistulas?

Depending on the fistula type, you may receive care from one or more of these doctors:

• Gynecologist and gynecologic surgeon (female reproductive health specialists).
• Urologist (urinary system specialist).
• Urogynecologist (urology and gynecology specialist).
• Colorectal surgeon (digestive system specialist).

A note from Cleveland Clinic

Vaginal fistulas can cause embarrassing symptoms like urinary or fecal incontinence. Women who experience prolonged labor or undergo pelvic surgery are more at risk for developing fistulas. These openings can form between your vagina and organs in your urinary or digestive systems. Tell your provider if you have symptoms. You may be able to heal with nonsurgical treatments. When needed, surgery is highly successful at treating vaginal fistulas.