Our urinary tract is composed of different organs that process urine and discharge it out from our body. An abnormal opening in any of the organs of the urinary tract is called a urinary fistula. Fistula is basically the hole in the bladder, vagina, or other organs that allows urine and other matter to pass where they should not.

Furthermore, any abnormal connection between the urinary tract organ and other nearby organs like the vagina or colon is also a urinary fistula. Such abnormal condition causes leakage of feces and urine due to abnormal connection, causing problems like incontinence and infection.

Types of urinary fistula

• Vesicovaginal fistula - It is one of the most frequent types of fistulas found among women that open between the vagina and the bladder. Difficult labor or a case of the previous hysterectomy is the major cause of vesicovaginal fistula.
• Enterovesical fistula - Such fistulas open between the bladder and bowel.
• Vesicouterine fistula - It opens between the bladder and the uterus.
• Ureterovaginal fistula - In this condition, an abnormal opening occurs between the vagina and the ureter. It mostly occurs due to prior pelvic surgery or hysterectomy.
• Colovesical fistula - It opens between the bladder and the colon.
• Rectovaginal fistula - It opens between the vagina and the rectum.

What causes urinary fistula?

When the tissues of the urinary tract, pelvic region, or vagina get damaged, either due to injury, accident, radiation treatment, or infection, it causes urinary fistula. In general, weakening and breakdown of the tissues of the pelvic area over time is the primary reason for the occurrence of fistula.

Some major reasons that may cause the tissues to get weak and damage are-

• Hysterectomy and Caesarean section
• Surgery on the perineum, the back wall of the vagina, or anus
• Malignancies in the pelvic region
• Radiation treatment for treating malignancies that makes the tissues fragile
• Inflammatory bowel disease
• Problems resulting from episiotomy incision for childbirth, such as deep tears or infection.

Who is susceptible to urinary fistula?

Urinary fistulas are more common among women, especially those who have undergone very difficult childbirth. The damage in tissues due to deep scars from episiotomy incisions can lead to the problem. However, men also experience urinary fistulas.

What are the symptoms of urinary fistulas?

Some of the most common symptoms indicating urinary fistula are the following-

• Fluid leakage from the vagina
• Continuous leakage of urine from the vagina
• Foul-smelling discharge from the vagina
• Leakage of feces into the vagina
• Frequently occurring urinary tract infections
• Gas leakage from the urethra while urinating
• Irritation in the vulva area
• Pain in the abdomen

How are urinary fistulas diagnosed?

For the diagnosis of urinary fistula, the doctor will perform a pelvic examination. It is very important that you provide your medical history for easy diagnosis and, at the same time, other risk factors that may involve.

You may be advised to perform a few laboratory tests like a urine sample, complete blood count, excretory urogram, fistulogram, cystogram, etc. These tests will help in determining the exact location of the fistula, the severity of the problem, and the most accurate ways to treat the problem.

How are urinary fistulas treated?

Based on the diagnosis, the doctor will decide what type of treatment will correct the issue and repair the urinary fistulas. While most of the fistulas require surgery to repair, there are a few chances when conservative therapy may correct them.

Conservative therapy

Sometimes, the damaged tissues that have caused fistula are small, and the tissues surrounding it are healthy. In such cases, the fistula may be able to heal on their own with time. The doctor will try to heal by correcting the function of the urinary tract without passing the urine from the fistula.

A urinary catheter may be required to drain the bladder in some patients. If the patient is suffering from ureterovaginal fistula, a small stent may be placed in the ureter that will help urine flow correctly from the kidneys to the bladder until the fistulas heal.

Surgery

Most of the urinary fistulas require surgical repair, which is determined by the type and location of the fistula. Surgery may be done through the vagina or abdomen wherein the fistula is repaired by closing the hole and restoring the normal functioning of the urinary tract organs. The surgeon removes the damaged tissues, and the growth of healthy tissues is processed.

The patient may require using a catheter in the bladder for a few weeks until the fistula area has healed. It is very important to consult an experienced doctor and surgeon who can treat the fistula effectively.

Dr. Sumina Reddy is a renowned gynecologist and infertility expert in Hyderabad. With years of experience and expertise, she can deal with different issues and complications in women. Visit Dr. Sumina Reddy’s Clinic to know more about urinary fistulas and get the best treatment.