Vaginal Fistula Causes

  • Lauretta Iyamu Doctor of Pharmacy- PharmD, University of Benin, Nigeria
  • Arunima Babu Masters, Biomedical Sciences, University of Aberdeen, UK
  • Khushleen Kaur MSci Chemistry with a Year in Industry, Imperial College London, UK

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Vaginal fistula is a severe illness that affects thousands of women worldwide. It can cause a lot of pain, suffering, and shame, making a person feel stressed out and alone.1

But the good news is that vaginal fistula may be prevented and treated. You can avoid the pain and suffering of this condition if you get the right medical care, learn about it, and know about it. In this article, you’ll learn the following:

  • Causes
  • Symptoms
  • Types
  • Risk factors
  • Diagnosis

After reading this article, you will have a good understanding of the causes of vaginal fistula and the precautions you can take to prevent and treat it effectively. Let's get started!

What is a vaginal fistula?

A vaginal fistula is a medical condition that happens when an abnormal opening forms between the vagina and another organ, like the bladder, urethra, or rectum. It can happen because of a birth injury, surgery, radiation treatment, or cancer. Vaginal fistula can also be caused by inflammatory bowel disease, infections, or injuries to the pelvis.1

Causes of vaginal fistula

Several factors can lead to vaginal fistula.1,2,3 These include:

  1. Childbirth Injuries
  2. Surgery
  3. Radiation Treatment
  4. Inflammatory Bowel Disease
  5. Infections
  1. Childbirth Injuries

Injuries sustained during childbirth are the leading cause of vaginal fistulas. During delivery, the baby's head can put pressure on the vaginal tissue, which can tear or stretch. This can lead to an abnormal connection between the vagina and other organs.

  1. Surgery

Surgery in the pelvic region, such as hysterectomy and C-sections, can lead to vaginal fistulas. When surgery is done on the bladder or rectum, the chance of getting a fistula is higher.

  1. Radiation Treatment

When X-rays are used to treat pelvic cancer, for example, they can damage the vaginal tissue and cause a vaginal fistula to form.

  1. Inflammatory Bowel Disease

Inflammatory bowel diseases, like Crohn's disease or ulcerative colitis, can cause inflammation and scarring of the rectal tissue, leading to fistula formation.

  1. Infections

Infections like tuberculosis or sexually transmitted diseases can damage tissue and lead to vaginal fistulas.

Symptoms of vaginal fistula

The symptoms of a vaginal fistula can vary based on where the abnormal opening is and how big it is. Some common signs and symptoms are:1,2

  • Leakage of urine or feces through the vagina
  • Foul-smelling vaginal discharge
  • Recurrent urinary tract infections
  • Pain during sexual intercourse
  • Chronic pelvic pain
  • Inability to hold urine or feces
  • Social stigma and embarrassment

Types of vaginal fistula

There are several types of vaginal fistulas. These fistulas are grouped based on the location and type of abnormal opening. The most common types include:3,4,5

Vesicovaginal fistula

A vesicovaginal fistula develops when there is an abnormal connection between the bladder and the vagina. It causes urine to leak through the vagina, which can cause a person a lot of social and mental stress.

Rectovaginal fistula

A rectovaginal fistula can happen when there is an abnormal connection between the uterus and the womb. It can cause faeces or gas to leak out of the vagina, making a person feel embarrassed and alone.

Urethrovaginal fistula

A urethrovaginal fistula is an abnormal connection between the urethra and the vagina. It can cause urine to leak out of the vagina, which can be embarrassing and cause social stigma.

Complex fistula

A complex fistula is a group of vaginal fistulas that connect more than one organ, like the bladder, rectum, and urethra. Treatment for complex fistula can be more challenging than for other types of fistula and may require a team of experts from other disciplines, including urology, gynaecology, and colorectal surgery.

Vesicouterine Fistula: In this type of fistula, the bladder and uterus are abnormally connected. It may result in vaginal or cervicovaginal urine leakage.

Ureterovaginal Fistula: In this type of fistula, the ureter (the tube that delivers urine from the kidney to the bladder) and the vagina form an improper connection. It may be linked to kidney issues and cause urine to seep from the vagina.

Entero-vaginal Fistula:  It involves an abnormal connection between the small intestine or the colon and the vagina. It may be linked to inflammatory bowel illness or cancer and can lead to the vaginal leakage of faeces, gas, or mucus.

Hystero-vaginal Fistula: Here, the uterus and vagina are abnormally connected. A previous surgery, injury, or infection could cause this, resulting in vaginal discharge.

Fistula-in-ano: In this condition, the anal canal and the skin surrounding the anus are abnormally connected. It may be connected to diseases like Crohn's disease or anal abscesses and can result in discharge, pain, and infection.

Risk factors

Some common factors that increase the risk of developing a vaginal fistula include [1][3][6]:

  • Prolonged labour or obstructed labour during childbirth
  • History of pelvic surgery, especially in the bladder or rectum
  • Radiation treatment for pelvic cancer
  • Inflammatory bowel disease
  • In women, infection of the genital tract
  • Injuries or sexual violence to the pelvic region
  • Malnutrition and poor health status

Vaginal fistula diagnosis

Your healthcare provider will use your medical history, a physical exam, and diagnostic tests to determine if you have a vaginal fistula.

  • Urinalysis: to check for the presence of bacteria, blood, or other abnormalities in the urine
  • Cystoscopy: a procedure that involves the use of a thin tube with a camera to examine the inside of the bladder
  • Barium enema: a test that uses a contrast material and X-rays to visualize the rectum and lower intestines
  • Magnetic resonance imaging (MRI) or computed tomography (CT) scan: imaging tests that can provide detailed images of the pelvic region

Treatment and home remedies

The best way to treat a vaginal fistula depends on where it is, how big it is, and how bad it is [1][3][7]. Some common choices of treatment include:

  1. Surgery

Surgery is the most common treatment for vaginal fistula. Depending on where the fistula is and how big it is, different types of surgeries could be done. Some common surgical procedures include:

  • Fistulotomy: a procedure that involves cutting and removing the abnormal tissue to close the fistula
  • Flap procedures: a procedure that uses healthy tissue from another part of the body to cover the fistula
  • Sphincteroplasty: a procedure that involves repairing the muscle that controls bowel movements
  • Colostomy or ileostomy: a procedure that involves creating a new opening in the abdomen to allow faeces to bypass the fistula
  1. Home Remedies

Home remedies can be used along with medical care to help ease symptoms and speed up recovery. Some common home remedies include:

  • Maintaining good hygiene to prevent infection
  • Drinking plenty of water to stay hydrated
  • Eating a healthy and balanced diet to support healing
  • Performing pelvic floor exercises to strengthen the muscles that control urination and bowel movements

When to seek medical attention?

If you experience any of these vaginal fistula symptoms1,3 such as:

  • Urine or faeces coming out of the vagina, 
  • Foul-smelling vaginal discharge
  • Constant pelvic pain

You should see a doctor. A vaginal fistula is a serious health problem that needs to be diagnosed and treated right away.

Summary

A vaginal fistula is a painful medical condition that can majorly affect a person's physical and mental health. It can be caused by injuries during childbirth, surgery, radiation therapy, inflammatory bowel disease, infections, or trauma to the pelvic area. The symptoms may differ depending on where the abnormal opening is and its size. 

You can get treatment through surgery, home remedies, or a mix of both. If you think you might have a vaginal fistula, it's important to see a doctor.

References

  1. Gebremedhin S, Asefa A. Treatment-seeking for vaginal fistula in sub-Saharan Africa. Ameh CA, editor. PLoS ONE [Internet]. 2019 Nov 1 [cited 2023 Mar 11];14(11):e0216763. Available from: https://dx.plos.org/10.1371/journal.pone.0216763
  2. United Nations Population Fund. Campaign to end fistula. 2019. “Some Problems Don’t Have Answer, this One Does.” End Fistula, https://endfistula.org/what-is-fistula. Accessed 11 Mar. 2023.
  3. Tuma F, McKeown DG, Al-Wahab Z. Rectovaginal fistula. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2023 Mar 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK535350/
  4. Rajaian S, Pragatheeswarane M, Panda A. Vesicovaginal fistula: Review and recent trends. Indian J Urol [Internet]. 2019 [cited 2023 Mar 11];35(4):250. Available from: http://www.indianjurol.com/text.asp?2019/35/4/250/268298
  5. Reddy SG, Parihar P, Dhande R, Gupta RG, Nagendra V. Ureterovaginal fistula post vaginal hysterectomy. Cureus [Internet]. 2022 Oct 26 [cited 2023 Mar 11]; Available from: https://www.cureus.com/articles/121232-ureterovaginal-fistula-post-vaginal-hysterectomy
  6. Jhingran A. Updates in the treatment of vaginal cancer. Int J Gynecol Cancer [Internet]. 2022 Mar [cited 2023 Mar 11];32(3):344–51. Available from: https://ijgc.bmj.com/lookup/doi/10.1136/ijgc-2021-002517
  7. Polan ML, Sleemi A, Bedane MM, Lozo S, Morgan MA. Obstetric fistula. In: Debas HT, Donkor P, Gawande A, Jamison DT, Kruk ME, Mock CN, editors. Essential Surgery: Disease Control Priorities, Third Edition (Volume 1) [Internet]. Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2015 [cited 2023 Mar 11]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK333495/

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This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Lauretta Iyamu

Doctor of Pharmacy- PharmD, University of Benin, Nigeria

Lauretta Iyamu is a medical and health content writer with a strong passion for health, medicine, and well-being having exposure to clinical and management roles between the hospital and community healthcare sectors.
She has 5 years of experience as a registered clinical pharmacist and started her medical writing career in 2018.
Lauretta is currently undertaking the “Digital Content Marketing and Data Analytics” course online from Google.

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