Genital Tract Fistula

A fistula is abnormal connection or tunnel between two organs in the body, or between an organ and your skin. Fistulas occur when the tissue between two organs is damaged so severely that part of the normal tissue dies off.  This leaves a gap in the normal barrier that becomes permanent as the surrounding area heals. The most common fistulas in the female genital tract are vesicovaginal fistulas, between the bladder and vagina, and the rectovaginal fistula, between the rectum and vagina. 

The damage to the vaginal tissue that results in a genital tract fistula can occur because of multiple causes, including childbirth, surgery, pelvic injury, cancer, and chronic bowel conditions. 


How do you know if you have genital tract fistula
The creation of a passage between a pelvic organ and the vagina allows the contents of that organ to enter the vagina.  In the case of a vesicovaginal fistula between the bladder and vagina, urine leaks into the vagina.  There are other types of urine leakage described under Urinary Incontinence, but the leakage associated with a vesicovaginal fistula is different as urine flows into the vagina constantly.  Similarly, women with a rectovaginal fistula, between the rectum and vagina, have leakage of stool into the vagina.

If you have been diagnosed
The diagnosis of a genital tract fistula begins with a thorough assessment of your symptoms and pelvic exam.  It is important to rule out other causes of urinary and anal incontinence.  This may require imaging tests such as a  CT scan of MRI scan.  In other cases tests are done that allow your provider to look in the bladder (cystoscopy) or rectum (proctoscopy).

Treatment options
For a vesicovaginal fistula, if the fistula is small, has just formed, and has not fully healed, then it may respond to conservative treatment. This usually involves placing a tube or catheter in the bladder of ureter, which attaches the bladder to the kidney.  This provides diversion of the urine flow that may allow the hole to close.  Most cases are managed by surgically repairing the hole.