Fistulas

A fistula is an abnormal connection or passageway between two parts of the body. A vaginal fistula, for example, is an abnormal passage or hole that connects the vagina to other organs, such as the bladder or rectum. This unnatural passageway allows urine or feces to leak into the vagina, causing conditions such as urinary or fecal incontinence. A fistula can also form between other pelvic organs, without the involvement of the vagina.

In addition to the health issues they cause, fistulas involving organs of the female reproductive tract and urinary system can profoundly impact a woman’s quality of life.

A range of treatment options are available to restore the health and well-being of women with fistulas. 

Fistulas may be caused by:

• Infection
• Inflammation
• Injury to the reproductive organs or urinary system, including complications of obstetric or gynecologic surgeries
• Prolonged or obstructed childbirth
• Radiation therapy
• Neoplasm (abnormal growth of tissue)
• Congenital conditions

Fistulas that involve the woman’s urinary tract include:

• Vesicovaginal fistula: an abnormal connection between the vagina and bladder, allowing urine to flow into the vagina (also known as a bladder fistula)
• Urethrovaginal fistula: an abnormal passageway between the vagina and urethra, the tube that carries urine out of the body
• Vesicouterine fistula: a rare type of fistula, or passageway, that occurs between the bladder and uterus, typically caused by trauma to the bladder
• Vesicocutaneous fistula: an abnormal passageway between the skin and the bladder that typically closes spontaneously

Fistulas that involve a woman’s gastrointestinal tract include:

• Rectovaginal fistula: an abnormal connection between the vagina and the rectum, enabling feces to pass into the vagina (also called a rectal fistula)
• Colovaginal fistula: an abnormal connection between the vagina and the large intestine
• Fistula-in-ano: an abnormal connection between the anal canal and the skin surrounding the anus
• Colovesical fistula: an abnormal connection between the colon and the bladder  

The symptoms of fistulas vary based on the type of fistula. If a fistula involves the vagina, there may be uncontrollable leakage of urine, stool, or gas into the vagina.

Other symptoms of fistulas involving a woman’s reproductive organs may include:

• Abdominal pain
• Rectal or vaginal bleeding
• Painful intercourse
• Recurrent vaginal infections, urinary tract infections, or kidney infections
• Fever
• Nausea, vomiting or diarrhea
• Unexplained weight loss

Diagnosis starts with a detailed medical history, a thorough discussion of your symptoms, and a comprehensive physical exam, including a pelvic exam. Imaging (ultrasound or MRI, for example) often plays a crucial role in confirming the diagnosis of a fistula. The type of imaging used varies based on the suspected location of the fistula.

Treatment will depend on the type and cause of the fistula and the patient’s treatment goals and preferences. Treatment options can range from close observation to surgical repair.

Surgical repair of fistulas involves the removal of the fistula tract (passageway) and repair of the openings in the affected organs. Prior to surgery, it’s important to identify and treat the underlying cause of the fistula. 

Call (832) 826-7500 to make an appointment with a Baylor College of Medicine urogynecologist.