What is Vesicovaginal Fistula?

 A fistula is an unwanted opening that develops between two parts of the body. Causes of fistulas include infection, injury, and inflammation. These can occur in many parts of the body.

A vesicovaginal fistula develops between the bladder and the vaginal wall. The result is that urine comes out of the vagina, sometimes slightly, but if the fistula is large it is stable. Besides being a serious medical problem, this condition can be very bothersome. Leaks are embarrassing and smell bad.

Causes

A vaginal fistula begins with tissue damage. After days and years of tissue breakdown, a fistula opens.

Vaginal fistulas sometimes occur after:

● Surgery of the back wall of the vagina, perineum, anus, or rectum. Open hysterectomy is associated with most vesicovaginal tract fistulas.

● Radiation therapy for pelvic cancer.

● Period of inflammatory bowel disease (including Crohn's disease and ulcerative colitis) or diverticulitis.

● Deep tear in the perineum or episiotomy after delivery.

In areas where there is no medical care around women, vaginal fistulas are very common. Days after pushing an unsuitable baby through the birth canal, most young mothers can have severe damage to the vagina, bladder, or rectum, sometimes with fistulas.

Diagnosis

Your Gynaecologist will perform a pelvic exam and ask about your medical history looking for risk factors for fistulas, such as recent surgery, infection, or pelvic radiation.

They may also order some tests:

● Color test. Your doctor will fill your bladder with a colored solution. They will ask you to cough or hold. If you have a vaginal fistula, the color will leak into your vagina.

● Cystoscopy Your doctor will use a thin device called a cystoscope to view your bladder and the inside of your bladder.

● X-rays: Retrograde pylogram. This is a special test in which the dye is pumped through the bladder and into the ureters. The x-ray shows if there is a leak between the ureter and the vagina.

Fistulogram This is an X-ray image of your fistula. This will show your doctor if you have one or more fistulas and other pelvic organs.

● Flexible sigmoidoscopy. Your doctor will look at your anus and rectum with a sigmoidoscope (a thin, flexible tube with a small video camera on the end).

● Eurogram CT. Color is injected into the vein, and CT scans create images of the vagina and urinary tract.

● Lumbar MRI. A magnetic field and radio waves take detailed pictures of your rectum and vagina, helping to show the details of a rectovaginal fistula.

Treatment

Some fistulas can heal on their own. If it is a small bladder fistula, your doctor may try inserting a small tube called a catheter into your bladder.

They can also use a plug made with special glue or natural proteins to close or fill the fistula. You may be given an antibiotic to treat an infection caused by a fistula.

Most people with fistulas need surgery. The type of surgery you have will depend on the type of fistula and its location. It can be laparoscopic, in which your doctor makes small incisions (cuts) and inserts cameras and tools. Or it could be abdominal surgery, in which a simple incision is made with a tool called a scalpel.

For a vaginal fistula that connects to your rectum, see your doctor:

● Sew a special patch on the fistula.

● Close the tissue from another area of ​​your body.

● Fold the healthy tissue flap over the fistula

● If your anus muscles are damaged, fix them.

Complications

A vaginal fistula is an abnormal opening that connects the vagina to another organ, such as the bladder or intestines. This condition can cause leaks and bad odors. This can also cause problems:

● Vaginal or urinary tract infections keep coming back

● Hygiene problems

● Stool or gas coming out of the vagina

● Irritated or inflamed skin around the vagina or anus

● Pus - inflammation of pus-infected tissue, which can be fatal if left untreated

● Recurrent fistulas

 

 

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