What are pelvic fistulas?
Pelvic fistulas are abnormal connections or holes that form between two organs in the pelvic floor. In women, fistulas involving the genital and urinary tracts are the most common and happen due to obstructed or prolonged childbirth, infection, inflammation, or radiation treatment in the pelvis or genital area, and injury during pelvic surgery.
The most common fistulae in women is one that occurs between the bladder and vagina (known as a vesicovaginal fistula) and one that occurs between the rectum and vagina (known as a rectovaginal fistula). A vesicovaginal fistula is usually associated with urinary incontinence or leakage of urine into the vagina, which can be quite severe. A rectovaginal fistula can lead to fecal incontinence or leakage of feces into the vagina.
The fistulas that involve other genital organs include:
- Cervical (either an abnormal opening into the cervix or in the neck)
- Vesico-uterine (between the uterus and bladder)
Ureterovaginal (between the ureter and vagina)
- Metroperitoneal (between the uterus and peritoneal cavity)
- Enterovaginal (between the bowel and vagina)
- Recto-uterine (between the uterus and bowel)
- Anal fistula (a small tunnel with an internal opening in the anal canal and an external opening in the skin near the anus)
What are the causes of fistulas?
The most common cause of a connection between the vagina and the bladder in the US is an injury to the bladder during pelvic surgery, particularly hysterectomy. While the symptoms may occur immediately after surgery, it is something they can be delayed for 1-2 weeks. A rectovaginal fistula may occur after childbirth and is associated with a large vaginal tear.
Urogenital and colorectal fistulas can also be caused by:
- Pelvic fractures
Cancer or radiation therapy targeted at the pelvic area
- Inflammatory bowel diseases such as Crohn’s Disease and ulcerative colitis
- Abscess of the glands near the rectum
- Infected episiotomies after childbirth
What are the symptoms of fistulas?
A leak between the bladder and vagina (a vesicovaginal fistula), can be painless but will cause uncomfortable urinary incontinence problems that cannot be controlled. The genital area may also become sore or infected, and you may experience pain during intercourse.
Women with a rectovaginal fistula, or a leak between the rectum and vagina, may experience the passage of foul-smelling gas, stool or pus from the vagina, as well as painful intercourse.
Other symptoms common to both vaginal and rectovaginal fistulas include:
- Abdominal pain
- Frequent infections
- Weight loss
What are the treatment options for pelvic fistulas?
Proper medical care makes pelvic fistulas both treatable and preventable. As part of a physical exam, your provider may conduct blood tests, use a dye to locate all areas of leakage, and check for a urinary tract infection. An X-ray or scope may also be used to get a clear look and check for all possible tissue damage.
Fistulas generally do not heal on their own. Some small vesicovaginal fistulas that are detected early may be treated by placing a catheter in the bladder for some time. However, the treatment for most fistulas is surgery. Most often, vesicovaginal fistula can be repaired by a minimally invasive vaginal approach. In some cases, a minimally invasive laparoscopic or robotic surgery may be preferred.
During surgery, Dr. Antonini will check the damaged area for cellulitis, edema, or infection, while also removing any scar tissue and ensuring proper blood supply. After surgery, antibiotics or other medications may be prescribed.
Request an appointment in Austin, Texas
If you have been diagnosed with fistulas or are experiencing symptoms associated with fistulas, contact us to request an appointment with one of our urogynecologists to learn more about your treatment options. If surgery is necessary, Dr. Antonini can also perform the operation. Request an appointment by filling out the form on our website, or give us a call at 512-716-0861 today.