Vaginal Fistula: Causes, Symptoms, and Treatments

A vaginal fistula is an opening, like a tunnel, that forms between the vaginal wall and another nearby organ – urinary tract, rectum, colon or small intestine. Depending on which tissue is affected, symptoms may vary.

The cause of vaginal fistulas

The cause of a fistula anywhere on the body is tissue damage, for example, surgery, radiation treatment¹, inflammatory bowel disease (Crohn’s disease, ulcerative colitis), diverticulitis, or a deep tear or cut during childbirth.

There is some research stating that around 85 per cent of anovaginal fistulas are caused by childbirth. Crohn’s disease is the second leading cause, at about 10 per cent.²

A fistula can form when blood supply is restricted to an area of tissue, resulting in the death of the tissue.

There are four types of vaginal fistula:

Vagina and urinary tract – vesicovaginal fistula
Vagina and rectum – rectovaginal fistula
Vagina and colon – colovaginal fistula
Vagina and small bowel – enterovaginal fistula

You may hear other names, such as anovaginal fistula.

Symptoms of a vaginal fistula

There may be no symptoms
If urinary (vesicovaginal) – urine may leak out of the vagina (painlessly), with uncontrollable incontinence and a constant dribble of urine out of the vagina
If rectal or colonic (rectovaginal, colovaginal, enterovaginal) – foul-smelling discharge, pus, gas or faeces may leak out of the vagina depending on the location and severity of the fistula
If small bowel (enterovaginal) – faeces may come out of the vagina
Vaginal infections and symptoms may be the outcome, as protective vaginal flora are harmed by the change in environment and possible incoming pathogens from the bowel
Soreness, infection
Painful sex

Other symptoms common to both vaginal fistulas and rectovaginal fistulas include:

Frequent infections
Diarrhea
Abdominal pain
Fever
Weight loss
Nausea
Vomiting

Being diagnosed with a vaginal fistula

Your medical history and symptoms are the most important factors that help determine if a vaginal fistula is one of the diagnostic options. You will be examined vaginally, and then special tests may be performed that include the use of dye (bladder or rectum) to find a leak, urinalysis (to check for urinary tract infections), and blood tests.

Some more advanced imaging may be ordered, such as x-ray, endoscope or MRI³.

Treatment of vaginal fistulas²

Surgery is the most common repair tool, with a few important considerations, such as is the tissue in good enough shape to repair⁴. Preparations may be required for the surgery, which your doctor will talk through with you.

Fistulas range from extremely complex to relatively straightforward in terms of surgical repair, and the nature of your circumstances must be taken into account. Your doctor is the best person to speak to for advice.

References^5–7

1.
Iwamuro M, Hasegawa K, Hanayama Y, et al. Enterovaginal and colovesical fistulas as late complications of pelvic radiotherapy. J of Gen and Family Med. Published online June 21, 2018:166-169. doi:10.1002/jgf2.184
2.
Bhama AR, Schlussel AT. Evaluation and Management of Rectovaginal Fistulas. Diseases of the Colon & Rectum. Published online January 2018:21-24. doi:10.1097/dcr.0000000000001004
3.
Sheedy SP, Bruining DH, Dozois EJ, Faubion WA, Fletcher JG. MR Imaging of Perianal Crohn Disease. Radiology. Published online March 2017:628-645. doi:10.1148/radiol.2016151491
4.
Beksac K, Tanacan A, Ozgul N, Beksac MS. Treatment of Rectovaginal Fistula Using Sphincteroplasty and Fistulectomy. Obstetrics and Gynecology International. Published online 2018:1-5. doi:10.1155/2018/5298214
5.
Zheng Y, Zhang N, Lu W, et al. Rectovaginal fistula following surgery for deep infiltrating endometriosis: Does lesion size matter? J Int Med Res. Published online September 25, 2017:852-864. doi:10.1177/0300060517728208
6.
Mocumbi S, Hanson C, et al. Obstetric fistulae in southern Mozambique: incidence, obstetric characteristics and treatment. Reprod Health. Published online November 10, 2017. doi:10.1186/s12978-017-0408-0
7.
Bahadursingh A, Longo W. Colovaginal fistulas. Etiology and management. J Reprod Med. 2003;48(7):489-495. https://www.ncbi.nlm.nih.gov/pubmed/12953321