A vaginal fistula is an abnormal opening between the vagina and other nearby organs in the pelvis, including the bladder or rectum. A fistula can cause many complications, such as urinary and fecal leakage, abnormal vaginal discharge, tissue damage, kidney infections and other irritative type symptoms.

Types of Vaginal Fistulas

There are several types of vaginal fistula, which are defined by the location of the opening and the connection that is formed.

Types of vaginal fistulas can include:

• Vesicovaginal – opening between the vagina and the bladder
• Rectovaginal – opening between the vagina and rectum/lower part of the large intestine, which carries stool out of the body
• Colovaginal – opening between the vagina and colon
• Enterovaginal – opening between the vagina and small intestine
• Ureterovaginal – opening between the vagina and the tubes (ureters) that carry urine from your kidneys to your bladder
• Urethrovaginal – opening between the vagina and urethra, a part of the bladder

Vaginal Fistula Symptoms

Common symptoms of a vaginal fistula include (symptoms may depend on the specific type of fistula):

• Urinary and fecal leakage
• Abnormal vaginal discharge
• A foul odor in urine or vaginal discharge
• Recurrent infection including recurrent UTIs
• Abdominal pain
• Rectal or vaginal bleeding
• Tissue damage
• Kidney infections
• Fever
• Weight loss
• Nausea
• Vomiting
• Diarrhea
• Other irritative type symptoms

Risk Factors for Vaginal Fistula

Common causes of a vaginal fistula include:

• Childbirth, especially prolonged or obstructed childbirth
• Complications from pelvic surgery
• Cancer/radiation treatment
• Crohn’s Disease or ulcerative colitis
• Infection
• Other pelvic injury
• Retained foreign material in the vaginal (e.g., vaginal pessary)

Vaginal Fistula Diagnosis

A doctor will review your medical and surgical history as well as perform a complete physical exam, including pelvic exam, to assess your vaginal fistula.

Additional diagnostic testing may include:

• Dye Test – inserting dye in the bladder and or the rectum to check for leakage of dye into the vagina
• Imaging studies - such as ultrasound, CT scan or MRI
• Colonoscopy - using a camera to look into the colon to screen for other potential causes of fistulas, including inflammatory bowel disease
• Cystourethroscopy - using a camera to look into the bladder and urethra to potentially identify the location of the fistula

A doctor will review these results with you to develop your care plan.

Treatment for Vaginal Fistula

Treatment can vary depending on the location and type of vaginal fistula. In some cases, a fistula may be small enough to heal on its own with the use of a bladder catheter, but frequently, surgical repair either from the abdomen or through the vagina may be required to close the opening.

Your doctor may also recommend working with a physical therapist as part of your care.