Vaginal fistula

Diagnosis

The diagnosis of vaginal fistula begins with assessing the medical history of the patient to determine the risk of the patient to have a fistula. The doctor may perform a pelvic exam as part of the assessment as well as other tests for diagnosis such as:

• Complete blood counts (CBC) and urinalysis: This test checks the blood and urine for signs of infection by sending samples to the laboratory for analysis.
• Dye test: A dye solution will be inserted into the bladder or rectum. To confirm if the patient has a fistula, the doctor may require the patient to cough or bear down to check the vagina for leakage.
• Fistulogram: This test shows the fistula in X-ray images to determine the number of fistulas, the size and whether other pelvic organs are affected.
• Retrograde pyelogram: This tests for leakage between the vagina and ureters through X-rays. The dye is injected into the ureters through the bladder.
• Computed tomography (CT) urogram: This test examines the urinary system for fistulas or other diseases. It uses a CT scan and a special dye injected into the vein.
• Pelvic magnetic resonance imaging (MRI): This test provides the doctor with a very clear image of the rectum and vagina, and whether a rectovaginal fistula exists.
• Cystoscopy: The bladder and urethra are examined for signs of trauma.
• Flexible sigmoidoscopy: The doctor uses a sigmoidoscope to check the condition of the colon and rectum.
• Colonoscopy: A colonoscope is used to check the inside of the large intestine and rectum for signs of fistula.

Treatment

The treatment will depend on the type of fistula diagnosed by the doctor. In some cases, small fistulas may heal without medical intervention, however, in most cases, surgery may be required.
Minor fistulas may be treated with the help of:

• Antibiotics: For infections caused by the fistula or medications for inflammatory bowel disorders.
• Temporary self-catheterization: The doctor may want to insert a tiny catheter into the bladder to empty the urine while waiting for the fistula to heal naturally.
• Ureteral stents: Also called as kidney stents. This holds the ureters open while the fistula heals naturally.

The surgical treatment of vaginal fistula can be laparoscopic or abdominal surgery.  Laparoscopic surgery is when the doctor makes incisions and inserts equipment and cameras. Abdominal surgery uses scalpel to make a standard incision. The patient’s own tissue, surgical mesh or tissue created in the lab can be used to close the fistula.

What happens after the surgical treatment?
The patients will require monitoring post-surgery. Usually, the doctor may insert a catheter into the bladder to drain the urine while still healing. The doctor will instruct the patient on how to properly use the catheter.

Temporary ostomy may be required after successful repair of large fistula between the vagina and the digestive system organ. An ostomy is a surgical procedure that makes an opening in the abdomen, adjusting how waste leaves the body. It usually includes:

• Creating a stoma in the abdomen
• Stool is sent to the stoma either a colostomy for the large intestine, or an ileostomy for the small intestine.
• The stool is placed outside of the body in a bag. Patients are advised on how to clean the stoma and change the bag.
• Require another surgery to return the intestine to the rectum and close the stoma after the fistula has healed.