Vaginal fistula

Overview

A vaginal fistula is an unusual opening that forms between the vagina and another organ, such as the bladder, colon or rectum. Your healthcare professional might describe a vaginal fistula as a hole in the vagina that lets urine, gas or stool pass through the vagina.

Vaginal fistulas can form after childbirth or after an injury, a surgery, an infection or radiation treatment. You may need surgery to fix a fistula.

There are various types of vaginal fistulas. They are named based on the location of the fistula and organs they affect:

• Vesicovaginal fistula. Also called a bladder fistula, this opening forms between the vagina and urinary bladder. This is one of the most common fistulas.
• Ureterovaginal fistula. This type of fistula happens when an unusual opening forms between the vagina and the tubes that carry urine from the kidneys to the bladder. These tubes are called ureters.
• Urethrovaginal fistula. The opening forms between the vagina and the tube that carries urine out of the body, called the urethra. This type of fistula also is called a urethral fistula.
• Rectovaginal fistula. In this type of fistula, the opening is between the vagina and the lower portion of the large intestine, called the rectum.
• Colovaginal fistula. The opening happens between the vagina and colon.
• Enterovaginal fistula. The opening is between the small intestine and the vagina.

Symptoms

Vaginal fistula symptoms can include:

• Leaking of urine or stool, or passing of gas, through the vagina.
• Urinary tract infections that happen often.
• Urine that has an unusual odor or contains blood.
• Vaginal fluid called discharge that looks or smells unusual.
• Pain during sex.
• Pain, swelling or irritation in the area between the vagina and the anus, called the perineum.
• Repeated infections of the vagina.

The exact symptoms a person has depend in part on the location of the fistula.

When to see a doctor

Get a healthcare checkup if you think you have symptoms of a vaginal fistula. Tell your healthcare professional if you have symptoms that affect your daily life, relationships or mental health.

Causes

Vaginal fistulas have many possible causes, including certain medical conditions and problems that can happen because of surgery. These causes include the following:

• Surgery complications. Surgeries that involve the vaginal wall, anus or rectum can lead to vaginal fistulas. So can surgery on the area between the vagina and anus, called the perineum. Fistulas can form for reasons such as injuries during surgery and infections after surgery. Skilled surgeons can repair injuries while operating, which lowers the risk of fistula. But complications such as fistulas are more common after surgery in people with diabetes or in people who use tobacco.

  Surgery to remove the uterus, called a hysterectomy, is an example of an operation that can raise the risk of a vaginal fistula. The risk is higher if the hysterectomy is more complex. For example, the risk rises if the surgery takes longer than five hours, or if it involves larger blood loss or the removal of more surrounding tissue.

• Childbirth injuries. A vaginal fistula could stem from tearing that sometimes happens when a baby's head comes through the opening of the vagina. Or a fistula might form due to an infection of a surgical cut made between the vagina and the anus to help deliver a baby. This cause is not common in developed countries.

  Being in labor a long time because the baby can't move into the birth canal can raise the risk of a vaginal fistula, mainly in developing countries. That's partly because access to emergency delivery measures such as C-section may be limited.

• Crohn's disease. This condition inflames tissue that lines the digestive tract. If you follow your Crohn's treatment plan, you're not likely to get a vaginal fistula. Crohn's is a type of inflammatory bowel disease (IBD). Another type of IBD called ulcerative colitis also may lead to vaginal fistulas, but the risk of that happening is even lower.
• Certain cancers and radiation therapy. Cancer of the anus, rectum, vagina or cervix can lead to a vaginal fistula. So can damage from radiation therapy for the treatment of cancer in the pelvic area.
• Diverticulitis. This condition involves small, bulging pouches in the digestive tract. Diverticulitis that leads to a vaginal fistula is more common in older people.
• A large amount of stool stuck in the rectum. This condition is known as a fecal impaction. It also is more likely to cause a vaginal fistula in an older person.

Risk factors

A vaginal fistula has no clear risk factors.

Complications

Vaginal fistulas can lead to other health conditions called complications. Complications of vaginal fistulas include:

• Fistulas that keep coming back.
• Ongoing pelvic infections.
• Narrowing of the vagina, anus or rectum. This also is called stenosis.
• Trouble becoming pregnant.
• Loss of a pregnancy after 20 weeks, also called stillbirth.

Prevention

There are no steps you need to take to prevent a vaginal fistula.