A vaginal or genital fistula is an abnormal opening in the vagina that connects to another organ in the pelvic floor, such as your colon, urethra, bladder, or rectum. Although a vaginal fistula doesn’t typically cause pain, it can lead to other problems that will require medical attention.
Our Columbia and Weill Cornell physicians are well-versed in the different types of vaginal fistulas and their causes, symptoms, and complications. We’ll walk you through your diagnosis and treatment options with thoroughness and care.
What is a Vaginal Fistula?What is a Vaginal Fistula?
A vaginal fistula is an irregular passageway that allows urine or feces to leak into places it shouldn’t — the bladder, rectum, colon, urethra, kidneys, or the large and small intestines. This can lead to infection and other health issues. Since the vagina is a muscular tube that runs from the uterus to the vaginal opening, any hole in its walls can lead to nearby organs in the urinary or digestive systems.
Types of Vaginal FistulasTypes
There are specific types of fistulas that can occur in the vagina: genitourinary, ureterovaginal, urethrovaginal, rectovaginal, enterovaginal, and colovaginal. The type of vaginal fistula is defined by where the abnormal opening leads in the body.
“Genitourinary” refers to the urinary and genital organs. Genitourinary fistulas are irregular connections in the vagina that lead to other parts of the female reproduction system, like the uterus or the urinary system. They are the most common type of fistulas and fall into several categories:
- Vesicovaginal fistulas - This is the most common type of genitourinary fistula. Also referred to as a “bladder fistula,” these openings occur between the vagina and urinary bladder.
- Ureterovaginal fistulas - Occur between the vagina and the ureters, the tubes between your kidney and bladder. The urine from the ureter bypasses the bladder and flows into the vagina.
- Urethrovaginal fistulas - Occur between the vagina and the urethra, the tube that takes urine from your bladder and out of your body
Other types of fistulas
Certain types of vaginal fistulas can open up between your vagina and your digestive organs:
- Rectovaginal fistulas - Occur between your vagina and rectum, the lower portion of your large intestine where stool passes out of your anus
- Enterovaginal fistulas - Occur between your vagina and the small intestine
- Colovaginal fistulas - Occur between your vagina and the large intestine (colon)
Causes of Vaginal FistulasCauses
A fistula begins with a lack of blood supply to the vaginal tissue, which causes the tissue to weaken and die. The holes can take days or, in some cases, years to develop. The initial damage may be caused by traumatic injury, certain treatments, or disease in the area.
Common causes of vaginal fistulas:
- Cancer, including colon or cervical cancer
- Radiation for cancer treatments in the pelvic area
- Surgery on the rear wall of the vagina, anus, rectum, or perineum, including hysterectomies and C-sections
- Infections, such as diverticulitis
- Diseases, including inflammatory bowel disease (IBD), ulcerative colitis, and Crohn’s disease
- Traumatic injury
Signs & Symptoms of Vaginal FistulasSymptoms
Vaginal fistulas have a range of signs and symptoms. Fistula symptoms may differ depending on whether you have a genitourinary fistula that leads to the genital or urinary organs or a fistula between the vagina and digestive system.
Symptoms of genitourinary vaginal fistulas:
- Recurring urinary tract infections (UTIs)
- Urinary incontinence or chronic urine leakage
- Constant smell of urine
- Pain during intercourse (dyspareunia)
- Skin irritation in the vagina, around the vulva, or between the vagina and anus
- Kidney infections
- Vaginal infections
Symptoms of fistulas between the vagina and digestive organs:
- Foul-smelling vaginal discharge
- Reoccurring UTIs or kidney infections
- Leaking pus, gas, or stool from the vagina
- Nausea and vomiting
- Unexplained weight loss
- Vaginal or rectal bleeding
- Pain during intercourse
How common are vaginal fistulas?
The World Health Organization (WHO) estimates that between 50,000 and 100,000 women worldwide develop vaginal fistulas every year. They are more prevalent in low-resource countries, as women have limited access to proper healthcare and may have longer, more traumatic child labor. Many of these vaginal fistulas remain untreated, causing discomfort and shame due to the chronic urine or fecal odor.
Most vaginal fistulas don’t heal on their own. In addition to the lingering, unpleasant odor, other complications can arise if a fistula remains untreated, including:
- Recurring urinary and vaginal infections
- Gas or stool leaking through the anus or vagina
- Hygiene issues
- Swollen or irritated skin around the anus or vagina
- An abscess (inflamed and infected tissue with pus that would require treatment)
- Chronic fistula recurrence
Find Vaginal Fistula Care at NewYork-Presbyterian
At NewYork-Presbyterian, our doctors understand how unsettling urogynecology and pelvic floor issues can be. Our fistula experts will provide you with a professional diagnosis, help you understand your options, and guide you through your treatment with sensitivity.