Vaginal Fistulas
At Mount Sinai, our fistula experts are second to none in terms of surgical experience, patient care, and supportive services. We take a multidisciplinary and individualized approach to fistula care.
What is a Vaginal Fistula?
A vaginal fistula is an abnormal opening between your vagina to another organ, such as the bladder, rectum, urethra, ureters, or the small or large intestine. A fistula allows urine, feces, and/or gas to pass through the vagina and can be difficult to correct. Fistulas develop for a variety of reasons including childbirth, surgical complications, inflammatory bowel disease, pelvic cancers, and radiation treatment.
Treatment of Fistulas
Rectovaginal Fistula
The most common fistula seen in the United States is a rectovaginal fistula, which is an opening between the rectum and vagina and is usually caused by complicated childbirth. Symptoms may include:
- Irritation or pain in the vulva, vagina, and in the area between the vagina and anus
- Pain during intercourse
- Passage of gas and/or stool from the vagina
- Recurrent vaginal or urinary tract infections
- Vaginal discharge, likely with a foul odor
The most common symptom of a rectovaginal fistula is the incontrollable loss of gas through the vagina. If the connection is large enough, stool (feces) may also pass through the vagina. Depending on the size of the connection, this may only occur when the stool is very soft, as in diarrhea. If the connection is small, in addition to gas, there may also be small browning particles that will have the odor of feces.
Diagnosis
We diagnose a rectovaginal fistula through a vaginal and rectal exam. If we need more information to be certain, we conduct a barium enema or CAT scan with oral and rectal contrast.
Treatment
We treat rectovaginal fistula by performing a multi-layer repair of the area between the rectum and the vagina. Most women have enough tissue in this area that we can place multiple layers between the previous defects in the rectum and the vagina to ensure that the fistula does not return. If you have large defects or have had multiple previous failed attempts at closing the fistula, we may need to use tissue flaps to aid in closure. We build these tissue flaps by moving part of the rectal mucosa downward to cover the defect or transplanting fat, muscle, or skin from areas on or near the outside of the vagina.
Vesicovaginal Fistula
A vesicovaginal fistula, an opening between the bladder and vagina, is commonly caused by complications during hysterectomy.
Symptoms
Symptoms can include:
- Continuous flow of fluid or urine through the vagina (most common)
- No urge to empty a full bladder
- Sore or infected genital area
If you have this type of fistula, you probably experience a continuous flow of urine through your vagina. If the connection is small, the flow may change depending on your position and what you are doing.
Diagnosis
We diagnose this condition with a pelvic exam. We place a catheter into your bladder and fill it with a colored fluid. Then we examine your vagina to see if the fluid flows into the vagina. If the connection is small, we may insert a tampon and ask you to return in a few hours so we can re-evaluate your vagina.
The next step is to perform a cystoscopy, which is an in-office test that involves placing a small camera into your bladder through your urethra. Additionally, if necessary, we may also perform a computerized tomography scan of your urinary tract.
Treatment
We treat vesicovaginal fistulas through a minimally invasive procedure, entering through the vagina. We either surgically remove the connection between the bladder and vagina by sealing the two organs separately or by closing off the connection at the very top of the vagina.
Occasionally, we may need to perform the minimally invasive procedure through your belly. We usually perform this laparoscopic procedure by making tiny incisions in the belly and placing a small camera and instruments through them. For complicated cases, we may use robotics to aid in the repair.