Vaginal Fistula

What is a vaginal fistula?

A vaginal fistula is an abnormal connection or opening that develops between your vaginal wall and a nearby organ. Most often, they develop between your vagina and an organ in your urinary system or in your digestive system. They most often occur due to damage to your vaginal tissue from things like childbirth, surgery, injury or infection.

What are genitourinary vaginal fistulas?

Genitourinary vaginal fistula is a term to describe a fistula that forms between your vagina or uterus and organs in your urinary system. The most common type is a vesicovaginal fistula, where an opening develops between your vagina and bladder (the organ that holds your pee).

Genitourinary vaginal fistulas also include:

• Ureterovaginal fistulas between your vagina and ureters, the tubes that carry pee from your kidneys to your bladder.
• Urethrovaginal fistulas between your vagina and urethra, the tube that carries pee 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 (butthole) 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 people assigned female at birth (AFAB) worldwide develop vaginal fistulas every year.

The condition is more common among people who live in countries with limited medical resources. For example, in some parts of the world, people spend days in childbirth. Pressure from the fetus pushing against the vaginal wall during delivery can cut off the blood supply to vaginal tissues, leading to a fistula.

What are vaginal fistula symptoms?

Vaginal fistulas that form between your vagina and nearby organs don’t always cause pain. Your symptoms typically depend on where the fistula is, how large the opening is or other factors. You may notice any of the following symptoms if you have a fistula:

• Leaking pee or urinary incontinence.
• Skin irritation in your vagina, vulva or perineum (area between your vagina and anus).
• Painful intercourse (dyspareunia).
• Recurrent urinary tract infections (UTIs), kidney infections or vaginal infections (vaginitis).
• Foul-smelling vaginal discharge.
• Poop (fecal incontinence) leaking from your vagina.
• Rectal bleeding or vaginal bleeding.

Can you feel a vaginal fistula?

No, you can’t feel a vaginal fistula by inserting your fingers into your vagina. You also may not feel pain or discomfort from a fistula.

What does a vaginal fistula look like?

You won’t be able to see a fistula. Your healthcare provider will be able to determine where it is in your body based on an exam and imaging tests that’ll show tissue damage and where the leakage is occurring.

What causes vaginal fistulas?

A lack of blood supply to vaginal tissue causes the tissue to die or become damaged. A hole or fistula forms in the tissue where this damage occurs. These openings can develop in a few days or over several years. Rarely, a person is born with a 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 your pelvic area, like 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.
• Trauma or injury.

Is a fistula an STD?

No, a vaginal fistula isn’t a sexually transmitted infection (STI).

What are the risk factors for vaginal fistulas?

Your risk of developing a vaginal fistula increases if you experience one of the direct causes of a fistula like childbirth, infection, surgery or any of the medical conditions listed above.

What are the complications of vaginal fistulas?

Vaginal fistulas can be a burden both physically and emotionally. You may feel awkward if you leak pee or poop in front of others. Other potential complications include:

• Frequent infections in your urinary tract, vagina or kidney.
• Narrowing of your vagina, anus or rectum (stenosis).
• A fistula coming back.

What happens if a vaginal fistula bursts?

A vaginal fistula can’t burst because it’s not a fluid-filled sac. A fistula is an abnormal opening that can cause fluid like pee and poop to flow freely. But the flow isn’t contained within a sac that can burst.

How is a vaginal fistula diagnosed?

Your healthcare provider will perform a physical exam, including a pelvic exam, and assess your symptoms. Let your healthcare provider know about all your symptoms so they can best help you. Sometimes, a pelvic exam and going over your symptoms are enough to diagnose a fistula. Other times, your provider will order more tests.

Diagnostic tests for vaginal fistulas include:

• Complete blood counts (CBC) and urinalysis to look for infections.
• Dye test, inserting dye in your bladder or rectum and checking for signs of leakage from your vagina.
• Fistulogram X-ray to determine the number and size of fistulas.
• CT urogram (computed tomography urogram) to view your vagina and urinary tract.
• Pelvic MRI (magnetic resonance imaging) to view your vagina and rectum.
• Cystoscopy to view inside your bladder and urethra.
• Flexible sigmoidoscopy to view your rectum and the 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 where the fistula is and the type. Some small fistulas heal on their own with conservative treatments like:

• Antibiotics for infections or medications for inflammatory bowel disorders.
• Temporary catheterization to drain your bladder while a vesicovaginal fistula heals.
• Ureteral stents to keep your ureters open while a ureterovaginal fistula heals.

Most times, surgery is necessary to close the opening. There are a few ways your surgeon can do this. How your surgeon reaches the fistula depends on what kind of fistula you have. Surgical methods include vaginally, laparoscopically or robotically (through small incisions on your abdomen and a camera and instruments), or rectally.

A surgeon may use your own tissue, lab-made tissue or a surgical mesh patch to close or seal the opening.

As many as 9 in 10 people with a vaginal fistula have a complete recovery after surgery.

What happens after a rectovaginal fistula repair?

If your provider repairs a large fistula between your vagina and a digestive system organ like your rectum, 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 how 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 place anything inside your vagina until your provider gives the OK.
• Prevent constipation and diarrhea by eating a high-fiber diet and drinking water. Ask your provider if it’s OK to use laxatives or stool softeners.

Can a vaginal fistula go away on its own?

Yes. Sometimes, a small vesicovaginal fistula or rectovaginal fistula can go away with antibiotics and a catheter to drain pee away from the fistula (giving it time to heal).

Can you prevent a vaginal fistula?

Developing a vaginal fistula is usually something you can’t prevent. But you can be aware of the things that cause fistulas and try to modify those things. For example, you can:

• Manage chronic conditions like Crohn’s disease or ulcerative colitis.
• Treat pelvic infections right away and follow your provider’s exact treatment plan.
• Get regular prenatal care so that your provider can detect complications that may prolong your labor and delivery.
• Choose a provider who has extensive experience with surgeries like hysterectomies to minimize your risk for complications that lead to fistulas.

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.

When should I contact my healthcare provider?

Contact a healthcare provider if you notice any signs of a vaginal fistula, including:

• Leaking poop or pee from your vagina.
• Pain during sex.
• Abdominal pain, fever, nausea or diarrhea.

What doctors treat vaginal fistulas?

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

• Gynecologist.
• Urologist.
• Urogynecologist.
• Colorectal surgeon.

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 a fistula?
• What are my treatment options?
• What complications could occur from surgery?
• Are there steps I can take to prevent getting another vaginal fistula?

A note from Cleveland Clinic

Vaginal fistulas can cause embarrassing symptoms like urinary or fecal incontinence. Certain events like prolonged labor or pelvic surgery may put you at a higher risk for developing fistulas. Developing a fistula isn’t always something you can prevent, especially if it happens after trauma or injury. Tell your provider if you have symptoms like leaking pee and poop or pain with sex. You may be able to heal small fistulas with nonsurgical treatments. Surgery to close a fistula is highly successful and your risk of developing one again is small.