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Vaginal fistulas are holes or tears in the vaginal wall that can lead to uncontrollable leakage of waste from the body. They are often caused by difficult childbirth and are more common in poor communities. There are four types of vaginal fistulas, and surgery is usually required for treatment.
A vaginal fistula, also sometimes known as an obstetric fistula, is essentially a hole or tear somewhere along the inside wall of the vagina. In most cases these holes create an opening or passageway to some other part of the body, especially the intestines, colon or urinary tract. As a result, many women with the condition experience essentially uncontrollable leakage of waste from their vaginas, which can be embarrassing as well as harmful. Fistulas can be caused by a variety of internal problems, but a difficult birth is usually one of the most common. Women who receive medical care during labor and delivery usually have these types of problems identified. In most cases, diagnosis and treatment are simple, but require medical intervention. Many experts consider obstetric fistulas a symptom of poverty, and they tend to be more common – and more extreme – in very poor communities where women have little or no access to postnatal care.
Four main types
There are generally four types of vaginal fistula: vesicovaginal, colovaginal, rectovaginal, and enterovaginal. The main difference between these is where they are located. Vesicovaginal fistulas occur, for example, between the vaginal wall and the urinary tract, while those of the colovaginal category abut the colon; a rectovaginal fistula connects the vagina and rectum, and holes classified as enterovaginal occur where the vagina presses against the small intestine.
Main causes
Traumatic or difficult childbirth is the main cause of all four of these types. A fetus that is awkwardly angulated, a pelvis that is too small, or a mother who goes into medical difficulties during delivery can cause abnormal pressure on the vaginal walls, which can and often does lead to tearing and tissue death. The tissues in the vagina are usually sensitive at first, but prolonged pressure and pushing from a misaligned baby often aggravates the situation. Most babies are stillborn when the labor has been traumatic enough to cause fistulas, but not always.
There are also cases where vaginal fistulas occur regardless of labor and delivery. Inflammatory bowel disease is sometimes a cause if the pressure from the intestines or rectum is intense enough and long enough to aggravate the external vagina to the point of tearing; Pelvic surgery accidents or healing problems can also be the cause. Radiation treatment for cervical or ovarian cancer has sometimes been shown to lead to fistulas as well. In these cases, the hole may not show up for days, weeks, or even years after the original damage has been done.
Symptoms
Holes anywhere in body tissue tend to be quite painful, and this is almost always the case with the vagina. One of the first signs a woman may notice when she has a fistula is intense, burning pain. However, this can be difficult to distinguish from the pain normally associated with childbirth, which is why the condition often goes undetected in women without medical care.
These types of holes rarely heal on their own. Most of the time they get worse and commonly become infected due to constant exposure to moisture and bacteria. One of the most obvious signs of this type of fistula is a sour, rancid smell coming from the vagina and a regular flow of stool and urine from that orifice. In most cases there is nothing a woman suffering from this can do to improve her situation other than seeking medical attention.
Basics of diagnosis
Even if the symptoms seem obvious, medical professionals usually need an accurate diagnosis to start treatment. A dye test is often administered first. In this test, the bladder is filled with a colored solution. The patient then passes the fluid while the healthcare provider examines the vagina, looking for leaks. The doctor will usually also use various scopes to inspect the vagina, ureters, bladder, anus, and rectum. X-rays may also be taken to see if multiple fistulas are present.
Treatment options
Surgery is almost always needed to repair the damage. If you have severe tears or extensive dead tissue, your surgeon may introduce new tissue to aid recovery. More complicated procedures may also be needed if bowel disease has caused the fistula. In these cases, a partial proctectomy — a surgical removal of a portion of the rectum — may be necessary to prevent further complications. Additional treatment to help prevent further fistulas and help promote healing may include dietary changes and the addition of fiber supplements to improve bowel regularity.
