A vaginal fistula, sometimes also known as an obstetrical fistula, is essentially a hole or tear somewhere along the inner wall of the vagina. In most cases these holes create an opening or passageway to some other part of the body, particularly the bowels, colon, or urinary tract. As a result many women with this condition experience an essentially uncontrollable leakage of waste out of their vaginas, which can be embarrassing as well as harmful. Fistulas can be caused by a number of internal problems, but difficult childbirth is usually one of the most common. Women who receive medical care during labor and delivery usually have these sorts of problems identified right away. In most cases diagnosis and treatment is straightforward, but it does require medical intervention. Many experts consider obstetrical fistulas to be a symptom of poverty, and they do tend to be most common — and most extreme — in very poor communities where women have little or no access to post-natal care.
Four Main Types
There are generally four kinds of vaginal fistula: vesicovaginal, colovaginal, rectovaginal and enterovaginal. The main difference between these is where they are located. Vesicovaginal fistulas happen between the vaginal wall and the urinary tract, for instance, while those in the colovaginal category abut the colon; a rectovaginal fistula connects the vagina and the rectum, and holes classed as enterovaginal happen where the vagina presses against the small bowel.
Traumatic or difficult childbirth is the primary cause of all four of these types. A fetus that is awkwardly angled, a pelvis that is too small, or a mother who goes into medical distress during delivery can all cause abnormal pressure on the vaginal walls, which can and often does lead to tearing and tissue death. The tissues of the vagina are generally sensitive to start with, but prolonged pressure and pushing by a misaligned baby often exacerbates the situation. Most of the time babies are stillborn when labor has been traumatic enough to cause fistulas, but not always.
There are also instances in which vaginal fistulas happen independent of labor and delivery. Inflammatory bowel disease is sometimes a cause if pressure from the bowels or rectum is intense enough and prolonged enough to aggravate the outer vagina to the point of tearing; pelvic surgery mishaps or healing problems can also be to blame. Radiation treatment for cervical or ovarian cancer has sometimes been shown to lead to fistulas, as well. In these cases, the hole may not manifest itself for days, weeks, or even years after the original damage was done.
Holes anywhere in bodily tissue tend to be quite painful, and this almost always holds where the vagina is concerned. One of the first signs a woman may notice when she has a fistula is intense, searing pain. This can be difficult to distinguish from the pain normally associated with childbirth, though, which is how the condition is often undetected in women who lack medical care.
It is rare for these sorts of holes to heal on their own. Most of the time they only get worse, and commonly grow infected from constant exposure to moisture and bacteria. One of the most noticeable signs of this sort of fistula is a sour, rancid smell coming from the vagina, and regular leakage of feces and urine out of that orifice. In most cases there is nothing a woman suffering from this can do to better her situation outside of seeking medical attention.
Even if the symptoms seem obvious, medical professionals usually need a precise diagnosis in order to begin treatment. A dye test is frequently given first. In this test, the bladder is filled with a dyed solution. The patient then passes the fluid while the healthcare professional examines the vagina, looking for leakage. The medical professional will also usually 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.
Surgery is almost always required to repair the damage. In the case of severe tearing or extensive dead tissue, the surgeon may introduce new tissue to help aide the recovery. More complicated procedures may also be needed if a bowel disease caused the fistula. In these cases, a partial proctectomy — a surgical removal of a portion of the rectum — may be needed to prevent further complications. Additional treatment to help prevent further fistulas and help promote healing can include changes in diet and the addition of fiber supplements to improve bowel regularity.