Vaginal Fistula

Overview

A fistula is a hole or passage that has formed between an organ in your body and your skin or between two organs in your body. There are different types of fistula that can develop in your body. Among them is vaginal fistula also called obstetric fistula which is an abnormal hole that connects your vagina to another body organ such as colon, bladder, rectum, urethra, ureters, large intestine or small intestine.

Vaginal fistula can be highly embarrassing and upsetting because they leak and lead to very bad smells. They can develop because of an injury, an infection, surgery, or radiation treatment. Whatever the cause, you may need to have it closed through a surgical process to restore normal function.

The World Health Organization estimates that between 50,000 and 100,000 women globally develop vaginal fistula every year. The Fistula Foundation estimates that about 56, 000 new fistula cases are reported every year. A study conducted by scholars from the Lancet Global Health in 2015 concerning the prevalence of vaginal fistula in sub-Saharan Africa indicates that 3 out of 1000 of reproductive age are diagnosed with vaginal fistula.

Types

There are many types of vaginal fistulas:

  • Ureterovaginal fistula: Happens when the abnormal opening develops between the vagina and the ureters – ducts that carry urine from kidneys to the gall bladder.
  • Vesicovaginal fistula: Also called bladder fistula, this opening takes place between the urinary bladder and the vagina, and it is the most common type of vaginal fistula.
  • Urethrovaginal fistula: Happens when the opening develops between the vagina and urethra.
  • Colovaginal fistula: The hole occurs between the vagina and the colon
  • Eterovaginal fistula: The hole occurs between the vagina and the small intestine
  • Rectovaginal fistula: The opening occurs between the vagina and lower section of the large intestine (rectum)

Symptoms

A vaginal fistula is normally painless, but it shows a few signs and symptoms:

  • Incontinence: Urine or feces pass into the vagina and cause bad smell
  • If you have a vesicovaginal fistula, you will likely have fluid flowing or leaking out of your vagina
  • If you have a colovaginal, rectovaginal, or enterovaginal fistula, you will likely have gas coming from your vagina and/or foul-smelling discharge
  • The genital area may get sore or infected

Causes

Vaginal fistula occurs because of tissue damages that occur due to:

  • Cervical, pelvic or colon cancer
  • Abdominal surgery (C-section or hysterectomy)
  • Radiation treatment
  • Infection that may include a tear that occurred during birth or after episiotomy
  • Bowel diseases like diverticulitis or Crohn’s
  • Traumatic injury such as an accident

Diagnosis

  • The symptoms are the clearest signs of a vaginal fistula. The doctor will mostly ask you questions concerning the symptoms you experience, about any trauma, surgery, or disease that could have led to the fistula.
  • A physical examination would involve speculum used to look at the vaginal walls.
  • Use of dye in the vagina to find all signs of leakages
  • A blood test to check signs of infection in your body
  • Urinalysis to check for infection
  • In rare cases, the doctor may use MRI, X-Ray, or endoscope to get a clear vision of potential tissue damages

Treatment

The only solution to vaginal fistula is surgery. However, before the doctor carries out a surgery process, he or she may check if:

  • You may require wound or medicine care to heal the tissue before surgery
  • You have a large rectovaginal fistula; you may have a colostomy to keep the fistula clean and ready for surgery. After the surgery, the colostomy is removed.
  • You may have inflammatory bowel disease, and the doctor cannot proceed with surgery during a symptom flare

Sources

https://www.who.int/bulletin/volumes/93/1/14-141473/en/

https://www.the-star.co.ke/news/2018-04-17-are-6-million-kenyan-women-currently-suffering-from-obstetric-fistula/

https://www.researchgate.net/publication/275015643_Prevalence_of_symptoms_of_vaginal_fistula_in_19_sub-Saharan_Africa_countries_a_meta-analysis_of_national_household_survey_data

https://www.webmd.com/women/guide/hysterectomy

https://www.healthlinkbc.ca/health-topics/tn10138

https://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/symptoms-causes/syc-20355762