Vaginal fistula

A fistula essentially is an abnormal opening from one organ to another. There are several types of vaginal fistulas, depending upon the organ that they create the passage to. These are:

• Enterovaginal fistula: An opening between the small intestine and the vagina 
• Rectovaginal fistula: An opening between the vagina and the rectum 
• Urethrovaginal fistula: An unusual passage between the vagina and the urethra; that is, the tube responsible for carrying urine out of the body. It is also known as a urethral fistula.
• Ureterovaginal fistula: Ureters are ducts that carry urine from the kidneys to the bladder. When an abnormal opening develops between the vagina and the ureters, it is called a ureterovaginal fistula.
• Colovaginal fistula: An opening between the vagina and the colon or large intestine
• Vesicovaginal fistula: An opening between the wall of the vagina and the bladder

Vaginal fistulas are usually painless. They may, however, cause incontinence and involuntary soiling problems. The following are a few other symptoms of vaginal fistulas:

• Diarrhoea
• Weight loss
• Nausea
• Fever
• Pain in the belly
• Soreness in genitals
• Pain during intercourse

A fistula opens up due to tissue damage. Most often, it takes place over the years. The most common culprit of tissue damage are things like:

• A hysterectomy (surgery to remove the uterus) is often found to be the cause of vesicovaginal fistulas
• Traumatic injury 
• Colon cancer 
• Cervical cancer
• A tear in the perineum wall during childbirth
• Infected episiotomy after childbirth (an episiotomy is a surgical cut made to reduce the chances of severe perineum tears during vaginal delivery)
• Crohn’s disease
• Diverticulitis (inflammation in a part of the large intestine)

The symptoms of vaginal fistula are the most prominent indicators of vaginal fistula, making it relatively easy to diagnose. However, certain exams as well as tests may be ordered by the physician. These are:

• Urinalysis in order to check for infection 
• Dye test to confirm leakage 
• Pelvic MRI
• Sigmoidoscopy, a type of endoscopy to examine the anus and rectum. A sigmoidoscopy is less invasive than a colonoscopy. 
• CT urogram: A dye is in injected in the vein and images of the vagina and urinary tract are obtained through CT scans.

Sometimes vaginal fistulas heal on their own. However, most people may need surgery. The kind of surgery needed depends largely on the type of fistula and its location. It could be an abdominal surgery or it could be a minimally invasive laparoscopy (for vesicovaginal fistula). If a large rectovaginal fistula is present, a colostomy may be needed.

A special glue made of natural proteins may also be used to plug or seal the fistulas. The doctor is likely to prescribe antibiotics to treat any infection the fistula may have caused.