A fistula is an abnormal connection that develops between the urinary or bowel and genital tract. There are numerous different types of fistulas that can occur i.e. bowel to vagina, bladder to vagina, ureter to vagina, urethra to vagina etc.
Women with fistulas may leak urine or bowel material into their vagina. This can cause discomfort, pain, odor and irritation of the area. Women will notice a constant vaginal discharge that may worsen when going from the lying to standing position.
Who is at Risk for Non-Obstetric Fistulas?
- Post-surgical patients – Women who have recently undergone pelvic surgery are at increased risk for developing a fistula if the surgery was complicated. Pelvic surgery complications can include heavy blood loss, excessive scar tissue, urinary tract damage or uterine fibroids.
- Radiation patients – It is common for women who have undergone pelvic radiation therapy for cancer to sometimes develop fistulas.
- Women with endometriosis – Endometriosis can cause significant scarring in the pelvis and rarely cause a fistula tract to develop.
- Women with diverticulosis – Severe diverticular disease can cause a fistulous tract to develop between the bowel and the vagina.
Women with fistulas most commonly report leakage of material from the vagina. It can be urine or bowel material. The leakage is usually constant. It can be worse when the woman goes from a laying to a standing position.
Diagnosis and Treatment of Non-Obstetric Fistulas
Diagnosis is usually done in the outpatient setting. The physician may use cystoscopy to help diagnose a bladder fistula but may also use radiological studies. Rarely, an exam under anesthesia may be needed to fully understand the extent of the problem.
Treatment for fistulas are surgical. Surgery can be done vaginally or abdominally depending on the extent and location of the fistula.