Vaginal Fistulas – Symptoms and Causes
A vaginal fistula is an abnormal opening that forms between the vagina and another organ in the body. This opening allows substances like urine, gas, or stool to pass through the vagina.
These fistulas typically develop after childbirth complications, injuries, surgeries, infections, or radiation treatments. Surgical intervention is often needed to repair the fistula.
Several types of vaginal fistulas exist, each named based on the connected organs:
Vaginal Fistulas:
- Vesicovaginal fistula: Forms between the vagina and bladder (most common type).
- Ureterovaginal fistula: Connects the vagina and the ureters (tubes carrying urine from kidneys to bladder).
- Urethrovaginal fistula: Links the vagina and urethra (the tube that expels urine).
Intestinal Vaginal Fistulas:
- Rectovaginal Fistula: Opening between the vagina and rectum (lower portion of the large intestine)
- Colovaginal Fistula: Connection between the vagina and colon.
- Enterovaginal Fistula: Passage between the small intestine and vagina.
Each type of fistula creates different symptoms depending on which organs are involved. The passage of unwanted substances through the vagina can cause significant discomfort and health issues.
Medical professionals diagnose these conditions through physical examinations and various imaging techniques.
Signs and Problems
Vaginal fistulas can cause several noticeable issues:
- Urine or stool leaking through the vagina
- Frequent urinary tract infections
- Unusual-smelling urine or urine with blood
- Strange vaginal discharge (appearance or smell)
- Discomfort during sexual activity
- Pain or swelling in the area between the vagina and anus
- Recurring vaginal infections
When Medical Help Is Needed
Visit a healthcare provider if you notice any symptoms of a vaginal fistula. Seek medical attention if these symptoms interfere with your daily activities, personal relationships, or emotional wellbeing. Don’t delay getting help, as early treatment can prevent complications.
Causes
Vaginal fistulas can develop from several different sources, ranging from surgical complications to medical conditions.
Surgical Complications
Surgery involving the vaginal area can sometimes lead to fistula formation. Operations on the vaginal wall, anus, rectum, or perineum (the area between vagina and anus) carry this risk.
When tissue is damaged during surgery or becomes infected afterward, abnormal connections may form. People with diabetes or those who use tobacco products face higher risks of these complications.
Hysterectomy (removal of the uterus) presents a particular risk. The likelihood increases with:
- Surgeries lasting over five hours
- Operations involving significant blood loss
- Procedures requiring extensive tissue removal
Childbirth-Related Injuries
Though uncommon in developed countries, vaginal fistulas can result from:
- Tears during delivery as the baby passes through the birth canal
- Infections at episiotomy sites (surgical cuts made to enlarge the vaginal opening)
In developing regions, prolonged labor without access to emergency interventions like cesarean sections significantly increases fistula risk.
Inflammatory Bowel Disease
Crohn’s disease, which causes inflammation in the digestive tract lining, can lead to fistula formation. Following prescribed treatment plans greatly reduces this risk.
While ulcerative colitis (another type of inflammatory bowel disease) can also cause vaginal fistulas, this occurs less frequently.
Cancer and Radiation Effects
These conditions may create vaginal fistulas:
- Cancers affecting the anus, rectum, vagina or cervix
- Tissue damage from radiation therapy used to treat pelvic area cancers
Digestive System Issues
Older adults face increased risk from:
- Diverticulitis – a condition involving inflamed pouches in the digestive tract.
- Fecal impaction – severe constipation where hardened stool becomes trapped in the rectum.
Risk Factors
While there are no clearly defined risk factors for vaginal fistulas, certain conditions may increase the chance of developing this condition. These factors remain under medical research.
Complications
Vaginal fistulas can cause several health problems beyond the initial condition. These issues may include:
- Recurring fistulas that return after treatment
- Persistent pelvic infections
- Stenosis (narrowing) of the vagina, anus or rectum
- Fertility challenges
- Stillbirth (pregnancy loss after 20 weeks)
These complications can significantly impact a person’s quality of life and may require additional medical intervention to address.
Prevention
Most vaginal fistulas develop as complications from other medical conditions or procedures. While there are no specific preventive measures guaranteed to prevent vaginal fistulas, understanding risk factors can help reduce the chances of developing this condition.
Some factors that may contribute to fistula development include:
- Surgical complications during pelvic, rectal or vaginal procedures.
- Inflammatory conditions like Crohn’s disease or diverticulitis.
- Radiation therapy to the pelvic area.
- Traumatic injuries during childbirth.
Proper medical care during childbirth and surgery can help minimize risks.
If you have inflammatory bowel conditions, working closely with your healthcare provider to manage these conditions effectively may reduce complications.
For those undergoing radiation therapy, following all treatment guidelines and maintaining communication with your medical team about side effects is important.
Regular check-ups and prompt attention to symptoms of infection or unusual discharge can lead to earlier diagnosis if a fistula does develop.
