Urinary Fistula in Women: Symptoms and Causes
A urinary fistula in women is an abnormal opening between urinary tract organs that process and expel the urine out of the body (kidneys, ureter tubes, bladder, urethra). Urinary fistulas are abnormal connections that can form between a urinary tract and another organ nearby, such as the vagina or colon. Vaginal or urinary organ connections are also known as vaginal fistulas.
A fistula is a hole in the vagina, bladder or another organ that allows urine, stool, or other matter to pass through where it should not. As a result of the abnormal connection, faeces and urine may leak from the vagina.
Numerous types of fistula are possible, they are :
- A vesicovaginal fistula develops between the vagina and the bladder. This is the most common type of urinary fistula in women. It occurs most often due to previous hysterectomy. A vesicovaginal fistula can occur as a result of a difficult labour.
- An enterovesical fistula develops between the bladder and the bowel. This is one of the most common urinary fistulas.
- A vesicouterine fistula develops between the urinary bladder and the uterus.
- A ureterovaginal fistula develops between the ureter (the tube that carries urine between the kidneys and bladder) and the vagina. The majority of ureterovaginal fistulas are caused by previous hysterectomy or other pelvic surgery.
- A urethrovaginal fistula develops between the vagina and the urethra (the tube that expels urine out of the body).
- A colovesical fistula develops between the colon and the bladder.
- A rectovaginal fistula develops between the vagina and the rectum.
Fistulas are more common in females than in males. Vaginal fistulas are more common in developing countries where healthcare is limited. Extremely difficult childbirth can cause tissue damage in these areas, causing fistulas to open.
Symptoms
Most people become aware that they have fistula as a result of their symptoms. These symptoms could include:
- Continuous leakage of urine from the vagina
- Foul-smelling gas or discharge from the vagina
- Feces leaking into the vagina
- Frequent urinary tract infections(UTI).
- Passing gas from the urethra while urinating
- Irritation in the vulva area
- Abdominal pain
- Chills, fever, nausea and vomiting
- Diarrhoea
Causes of urinary fistula
Damage to the urinary tract, pelvic region, or vaginal tissues can create the conditions for a fistula. Urinary fistula can form as a result of an injury or accident, surgery, radiation treatment, or infection. The fistula may open after tissue degrades over time, which can range from days to years. Urinary fistula can occur from one of the causes below.
Fistulas sometimes happen due to:
- The most vesicovaginal fistulas are caused by hysterectomy and Caesarean section. Other surgeries on the vaginal back wall, perineum, anus, or rectum can lead to fistula formation.
- Cancers of the pelvic region, such as colon and cervical cancer.
- Radiation therapy for pelvic cancer can cause tissue to become thin and fragile.
- Fistula can be an issue for people with inflammatory bowel disease such as Crohn’s disease or colitis.
- Problems due to episiotomy incision during childbirth, such as deep tear or infection.
Diagnosis and Treatment
The doctor will first examine the patient to determine the cause of the fistula.The doctor will take the Complete patient's medical history to determine the possible cause of the fistula as well as any other risk factors. The doctor will perform a pelvic examination.
The doctor may recommend a few additional tests to determine the precise location of the fistula and the best way to treat it. These tests might include:
- A sample of urine will be sent to a laboratory for testing. This test looks for urinary tract infections or other issues.
- Complete blood count: It is done to look for signs of infection in the body.
- Excretory urogram: In this test a contrast dye is injected into the urinary tract and x-rays are taken to examine the urinary bladder.
- Dye test: A dye is injected into the bladder of the patient, and the patient coughs or bears down. The doctor can then check for bladder leakage caused by a fistula by looking for dye in the vagina.
- A doctor can use a cystoscope (a long, thin device with a camera) to inspect the urethra and bladder for fistulas or other damage.
- Retrograde pyelogram: This test, like the excretory urogram, uses dye and X-rays to look for leakage specifically between the vagina and the ureter.
- Fistulogram: It is an x-ray image of the fistula(s) which can show whether one or more fistulas exist and which organs are affected.
- Computerised tomography (CT) urogram: This test is similar to an excretory urogram in that dye is injected into a vein to allow the doctor to examine the vagina and lower urinary tract.
- Magnetic resonance imaging (MRI): MRI can produce detailed images of internal organs and tissues, allowing a doctor to locate a fistula, determine its size, and evaluate how it is changing.
- Cystogram: The bladder is filled with contrast dye to determine the location of urinary leakage.
These tests will be used by the physician to determine the type, location, and severity of the fistula and then recommend a treatment plan.
Treatment
Some fistulas may only require conservative treatment. However, most fistulas require surgery to repair.
Conservative therapy
- Some simple fistulas may heal on their own. This may be possible if the fistula is small and the tissue surrounding the fistula is healthy.
- The doctor may help a person's urinary tract function normally without urine passing through the fistula to allow it to heal. In such patients, a urinary catheter may be used to drain the bladder.
- A small stent (a tube that keeps the ureter open) may be placed in the ureter of people who have ureterovaginal fistulas. This stent can help urine to flow correctly from the kidneys to the urinary bladder while the fistula heals.
Surgery
- The majority of fistulas must be surgically repaired. The type of the surgery will depend on the type and location of the fistula. Some surgeries are performed through the Vagina,while others are performed through the abdomen. Some cases can be treated with laparoscopic surgery (small incisions) or robotic surgery (precise movements).
- The goal of surgery is to close the fistula opening and allow healthy tissue to grow, restoring normal function to the affected organs. The surgeon will remove any damaged tissue as well as any other material (such as a tumour) that may be interfering with the fistula.
- The doctor will make the tissue around the fistula as healthy as possible before the surgery. This may include medications or wound care to aid in tissue healing.
- The doctor may recommend a colostomy before surgery if the fistula is large and involves the bowel or colon. This procedure will keep the fistula clear and prepared for surgery. When the fistula heals, the doctor can usually remove the colostomy.
- Most of the patients will have a catheter in the bladder for a few weeks following fistula repair surgery. Once the fistula area has healed, the catheter can be removed.
Dos and Don’ts
A urinary fistula can form at any part of the urinary tract system. Managing urinary fistula requires a high level of care and a set of dos and don’ts to be followed.
| Do’s | Don’ts |
| Drink plenty of liquids | Drink excess alcohol and caffeine |
| Eat a balanced diet | Eat bakery items such as pastries, food made of refined flour, hydrogenated oils, etc. |
| Keep your genital area clean | Ignore cleaning your genitals after sexual activity |
| Check for any urinary tract abnormalities | Take any over-the-counter medications without consulting the doctor |
| Wear clean undergarments | Use sprays or powders in the genital area |
Care at Medicover Hospitals
At Medicover hospitals, we have the most reliable medical experts, like urologists who plan a personalized treatment pathway for each patient. We believe in a multi-disciplinary approach to manage urinary fistulas that have gone serious or affected other organs as well. However, our treatment plan addresses this condition with precision and brings the best results ensuring continued recovery. our goal is to deliver the best treatment results and pleasing patient experiences at a affordable cost.
