An abnormal opening in the vagina? Let's talk about Vaginal Fistula!

Do you sometimes feel like you're leaking urine or stool through your vagina? Or do you often get vaginal infections? These things are a little difficult to talk about. But sometimes these can be symptoms of a condition called Vaginal Fistula. So today we'll talk about this in detail, as if we were talking to a friend. Don't be afraid, it's very important to be aware of this.

What is a vaginal fistula?

Simply put, a vaginal fistula is an abnormal connection, like a small hole or a drain, between the wall of your vagina and another nearby organ. Think of it this way: your vagina is one passageway, your bladder is another, and your rectum is another. These usually don't have a direct connection. But when a fistula forms, an unwanted connection is created between these organs.

Most often, this type of fistula develops between the vagina, part of your urinary system, or part of your digestive system. The main cause of this is damage to the vaginal tissue due to childbirth, surgery, an accident, or infection.

What are the types of vaginal fistula?

Let's see what these types of fistulas are. There are two main types, depending on where the fistula forms.

Genitourinary vaginal fistulas

This refers to a fistula that forms between your vagina or uterus and organs in your urinary system. This causes urine to leak into your vagina.

• Vesicovaginal fistula: This is the most common type. This is where a hole forms between the vagina and the bladder, where urine collects. Then, urine from the bladder starts to leak into the vagina.
• Ureterovaginal fistula: This is what it's called when there's a connection between the ureters that carry urine from your kidneys to your bladder and the vagina.
• Urethrovaginal fistula: A fistula can develop between the urethra, the tube that carries urine from the bladder to the outside of the body, and the vagina.

Digestive tract fistula

This type of condition involves a connection between the vagina and the organs of your digestive system, allowing stool to pass through the vagina.

• Rectovaginal fistula: This is a hole that forms between the vagina and the rectum, where stool can pass into the vagina.
• Colovaginal fistula: This is the name given to a connection between the vagina and the colon.
• Enterovaginal fistula: In this, a fistula forms between the vagina and the small intestine.

What are the symptoms of a vaginal fistula?

A vaginal fistula doesn't always cause pain. Symptoms depend on factors such as the location of the fistula and its size. Look for these symptoms:

• Urinary incontinence: Do you accidentally leak urine when you cough, laugh, or lift something? Or do you feel like your vagina is always wet?
• Inflammation and itching of the skin around the vagina, vulva, or anus: These discomforts can occur due to constant moisture.
• Pain during sexual intercourse (Dyspareunia).
• Frequent urinary tract infections (UTIs), kidney infections, or vaginal infections (vaginitis).
• A foul-smelling vaginal discharge.
• Fecal incontinence or wind.
• Bleeding from the rectum or vagina.

If you have one or more of these symptoms, it is very important to seek medical advice without being ashamed or afraid, because there are good treatments for this condition.

Can you feel or see a vaginal fistula?

No, you can't feel a fistula with your fingers. And you may not even feel any pain. The fistula is not visible from the outside. A doctor will do tests to find out exactly where it is.

Why does this vaginal fistula occur?

The main reason is that the blood supply to the tissues of the vagina is reduced, and the tissue dies or becomes damaged. This damage causes a hole, called a fistula, to form. This can happen in a few days or take years. Very rarely, someone can be born with a fistula.

Let's look at a few main reasons:

• Prolonged labor: This is the most common cause in developing countries. If the baby takes too long to be born, it can cause pressure on the vaginal tissues and impair blood flow.
• Vaginal tearing or episiotomy during childbirth: Sometimes, a small cut is made in the vagina to make childbirth easier, called an episiotomy. If these wounds do not heal properly, a fistula can develop.
• Abdominal or pelvic surgery: Fistulas can rarely develop after surgeries such as cesarean sections (C-sections) and hysterectomies.
• Pelvic cavity cancers: Conditions such as cervical cancer or colorectal cancer.
• Chronic inflammatory conditions of the digestive system (Inflammatory bowel diseases - IBD):Examples include Crohn's disease and ulcerative colitis .
• Colon infections: such as diverticulitis.
• Radiation therapy to the pelvic area.
• Some accident or injury.

Is a fistula a sexually transmitted disease (STD)?

No. Vaginal fistula is not a sexually transmitted infection (STI). Don't confuse that with a sexually transmitted infection (STI).

Who is at higher risk of developing a vaginal fistula?

The reasons mentioned earlier, such as complications during childbirth, surgery, and infections, increase your risk of developing a fistula.

What are the possible complications of vaginal fistula?

Vaginal fistula is a very stressful condition, both physically and mentally. Imagine how embarrassing it would be if you could leak urine or stool without realizing it. You might even feel embarrassed to go in front of others.

Other complications:

• Frequent urinary tract, vaginal, or kidney infections.
• Narrowing of the vagina and anus (Stenosis).
• The fistula can recur even after treatment.

Can a vaginal fistula burst?

No, a vaginal fistula is not a fluid-filled sac, so it won't burst. A fistula is an unnatural opening. Things like urine and stool can leak through this opening, but it's not something that collects in a sac and bursts.

How do doctors diagnose a vaginal fistula? (Diagnosis)

When you see a doctor, he or she will first listen to your symptoms and learn about them. Then they will do a physical exam, including a pelvic exam. Be sure to tell your doctor about all of your symptoms. Sometimes these tests can help determine if you have a fistula. Otherwise, further tests may be needed.

Several tests are performed to detect fistula:

• Complete blood count (CBC) and urinalysis: Check for infections.
• Dye test: A special dye is placed in the bladder or rectum to see if it comes out through the vagina.
• Fistulogram X-ray: See how many fistulas there are and their size.
• CT urogram (computed tomography urogram): Take images of the vagina and urinary system.
• Pelvic MRI (magnetic resonance imaging): See the vagina and rectum clearly.
• Cystoscopy: A tube with a camera is used to look inside the bladder and urethra.
• Flexible sigmoidoscopy:The rectum and lower part of the large intestine are examined.
• Colonoscopy: Examines the entire large intestine and the inside of the rectum.
• Retrograde pyelogram: A dye and X-ray are used to check for leaks between the vagina and urethra.

What are the treatments for vaginal fistula?

Treatment depends on the location and type of fistula.

Cases that heal without surgery

Some small fistulas, especially those involving the bladder, can heal without surgery. For this:

• Antibiotics: To control infections, if present. Medications are also given for inflammatory bowel disease (IBD).
• Temporary catheterization: This helps drain urine until a vesicovaginal fistula heals, allowing the fistula to heal.
• Ureteral stents: These are placed to keep a fistula involving the ureters open until the tubes heal.

Treatment by surgery

Often, surgery is required to close the fistula. There are several ways the surgeon can do this, depending on the type of fistula. The surgery can be done through the vagina, through a few small incisions in the abdomen using a camera and instruments (Laparoscopically or Robotically), or through the anus.

The surgeon can use your own tissue, tissue made in a lab, or a special mesh (surgical mesh patch) to close the opening.

The good news is that 9 out of 10 women with vaginal fistula make a full recovery after surgery!

What happens after a rectovaginal fistula is healed?

If you have a large fistula between your vagina and a part of your digestive system, such as your anus, and it is repaired with surgery, you may need to have a temporary ostomy.

• In this case, the surgeon creates a small opening (stoma) in your abdomen (belly).
• A colostomy for the large intestine and an ileostomy for the small intestine are connected to this opening, allowing stool to exit the body through it.
• A bag is attached to the outside of the body to collect the stool. The medical staff will teach you how to change this bag and how to keep the stoma clean.
• After the fistula has completely healed, another surgery will reconnect the intestine to the anus and close the stoma.

What is the recovery time like after vaginal fistula surgery?

These things will help you recover quickly after surgery:

• Use antibiotics exactly as prescribed to prevent infections.
• Do not have sex, use tampons, or insert anything into the vagina until your doctor gives you permission.
• To prevent constipation and diarrhea, eat a high-fiber diet and drink plenty of water. If necessary, ask your doctor about taking laxatives or stool softeners.

Can a vaginal fistula heal on its own?

Yes. Sometimes, a small vesicovaginal fistula or rectovaginal fistula can heal on its own with antibiotics and a catheter (giving the fistula time to heal).

Can vaginal fistula be prevented?

It is often difficult to prevent the development of a vaginal fistula. However, you can be aware of some of the factors that contribute to the development of a fistula and try to control them. For example:

• If you have long-term conditions like Crohn's disease or ulcerative colitis , keep them well controlled.
• If you develop a pelvic infection, seek treatment promptly and follow the treatment instructions given by your doctor exactly.
• Continue to go for prenatal care during pregnancy. This will help you identify complications that could delay delivery.
• If you are having surgery, such as hysterectomies, choose a doctor who has experience in the procedure. This can help reduce the risk of developing a fistula.

What is the outlook for women with vaginal fistula?

Surgical treatment is very successful. Most women make a full recovery and live normal lives without symptoms.

However, some fistulas may not heal properly or may recur after treatment. This is especially true if you have cancer or Crohn's disease. Living with the symptoms of a fistula without treatment can lead to depression or anxiety.

When should I see a doctor?

See a doctor immediately if you have any of these symptoms of a vaginal fistula:

• Vaginal discharge of stool or urine.
• Pain during sex.
• Stomach pain, fever, nausea, or diarrhea.

Who are the doctors who treat vaginal fistulas?

Depending on the type of fistula you have, one or more of these doctors will treat you:

• Gynecologist
• Urologist
• Urogynecologist
• Colorectal surgeon

What should I ask the doctor?

You can ask these questions when you see your doctor:

• How did I get this vaginal fistula?
• What type of vaginal fistula do I have?
• How should I take care of myself if I have a fistula?
• What treatment options do I have?
• What are the possible complications of surgery?
• Are there things I can do to prevent a vaginal fistula from developing again?

Take-Home Message

Vaginal fistula is a condition that can cause very uncomfortable and embarrassing symptoms, especially incontinence. This risk can be increased by prolonged labor or pelvic surgery. Although it is not always possible to prevent fistulas, it is important to seek medical attention as soon as symptoms appear.

Remember, you are not alone. There are very effective treatments for this condition. Small fistulas can sometimes heal without surgery. The chances of a full recovery after surgery are also high. So, don't be afraid or embarrassed to talk to your doctor about this. With early treatment, you can get well soon!

` Vaginal fistula, women's health, urination, defecation, gynecology, surgery, childbirth