A vaginal fistula is a hole or passage that forms within the vaginal wall. It can open into a woman’s urinary tract (vesicovaginal fistula, ureterovaginal fistula, or urethrovaginal fistula), into her rectum (rectovaginal fistula), into her colon (colovaginal fistula), or into her small bowel (enterovaginal fistula). These holes cause urine or stool to move through the vagina.
This condition begins with some form of damage to the tissue, and after a period of days or years, the tissue continues to break down, causing the fistula to open.
A vaginal fistula can occur following a surgery involving the back wall of a woman’s vagina, or surgery of the perineum, rectum, or anus. An open hysterectomy can also cause vaginal fistulas.
Other causes of vaginal fistulas include inflammatory bowel disease, diverticulitis, radiation therapy for pelvic cancer, an infected episiotomy following childbirth, or a tear in the perineum following childbirth.
Even though a vaginal fistula will not cause pain, it will cause incontinence as stool or urine passes into the vagina. This can also cause soreness and infection in the genital area.
In the case of a rectovaginal, enterovaginal, or colovaginal fistula, a woman would experience gas or a foul smelling discharge from the vagina.
In the case of a vesicovaginal fistula, symptoms would include a fluid flowing or leaking from the vagina.
Vaginal fistulas can occur for a number of reasons. The first of these worth mentioning is surgery in the pelvic region. Although very uncommon, sometimes complications that arise during surgery or during the healing process can result in a fistula forming. Similarly, radiation treatment, usually used as a treatment for cancer, can cause vaginal fistulas. Women with cervical, endometrial, ovarian, uterine or vulval cancer might undergo radiotherapy on their pelvic region, and in rare cases this might lead to a fistula.
Sometimes vaginal trauma is to blame for a vaginal fistula. In these cases, the fistula may occur as a direct result of the trauma, or as a complication of surgeries performed to rectify the trauma.
In some instances, infection could also be to blame for a vaginal fistula, particularly in the case of rectovaginal fistulas. In these cases, an infection within the anus or rectum, perhaps caused by an anal fissure or similar minor injury, creates an abscess. When the abscess is drained, a tunnel may remain and develop into a fistula which spans from the rectum to the vaginal canal.
Finally, childbirth is occasionally to blame for vaginal fistulas. Usually, fistulas will only occur if the pelvic region is injured during vaginal delivery, perhaps as a result of an obstruction or of a long, difficult labor.
Regardless of the type of vaginal fistula you have or what caused it, surgery will be required to close it and restore normal bodily function to the area. You may also require wound care and medications to treat infections.
To prevent vaginal fistulas being caused by childbirth, doctors will usually recommend C-section delivery of the baby. This is true of instances where there is an obstruction in the vagina, the delivery is prolonged and difficult, or there are other complications. For this reason, fistulas are incredibly rare in the US since antenatal care is highly advanced and the chances of obstetric trauma are slim.
When it comes to vaginal fistulas caused by surgery and radiotherapy, there is very little to be done to prevent the problem. Doctors will always take all precautions necessary to minimize the risk of complications, but unfortunately sometimes fistulas occur beyond their control.
To minimize the risk of fistulas occurring as a result of infection, it’s important to practice good hygiene, particularly around the anus where there is always a risk of fecal matter causing an infection in any tears in the rectal wall. It’s also important to avoid placing foreign bodies into the anus or vagina unless they have been sanitized with cleaners which are safe for intimate use.