Fistulas

A fistula is an abnormal connection or passageway between two parts of the body. A vaginal fistula, for example, is an abnormal passage or hole that connects the vagina to other organs, such as the bladder or rectum. This unnatural passageway allows urine or feces to leak into the vagina.

In addition to causing medical conditions such as incontinence, fistulas involving organs of the female reproductive tract and urinary system can profoundly impact a woman's emotional well-being and quality of life.

Types of fistulas include:

Vesicovaginal fistula (bladder/vagina). Also known as a bladder fistula, this type of fistula occurs between the vagina and urinary bladder, allowing urine to flow into the vagina.

Vesicouterine fistula (bladder/uterus). This rare type of fistula occurs between the bladder and uterus and is typically caused by trauma to the bladder.

Vesicocutaneous fistula (bladder/skin). An opening between the skin and the bladder that typically closes spontaneously.

Rectovaginal (rectum/vagina). Also called rectal fistulas, these occur between the vagina and the rectum, enabling feces to pass into the vagina.

Urethrovaginal fistula (fistula/diverticulum). This unnatural passageway occurs between the vagina and urethra, the tube that carries urine out of the body.

Possible causes of fistulas include:

• Infection
• Inflammation
• Neoplasm (abnormal growth of tissue)
• Congenital conditions
• Trauma
• Injury to the reproductive organs or urinary system
• Radiation therapy
• Complications of gynecologic and obstetric procedures and surgeries
• Complications of interventional radiologic procedures
• Fulguration (destruction of tissue by electric current)

Symptoms vary based on the type of fistula but may include:

• Incontinence
• Abdominal distention
• Fever
• Stool, air or fluid in the vagina
• Menouria (menstruation occurring through the bladder)
• Amenorrhea (absence of menstruation)

Imaging plays a crucial role in diagnosing fistulas and varies by the location of the fistula.

Treatment is individualized and will depend on the type and cause of the fistula. Treatment options can range from close observation to surgical repair.