Vesicovaginal Fistula: Symptoms, Causes, Treatment

What are the symptoms of vesicovaginal fistula?

Vesicovaginal fistula is an abnormal connection between the bladder and the vagina. This condition allows urine to flow from the bladder into the vagina, which can lead to various symptoms:

• Continuous Urinary Leakage: Persistent leakage of urine from the vagina, often occurring regardless of whether the patient is urinating or not.
• Frequent Urinary Tract Infections (UTIs): Recurrent infections due to constant exposure of the vaginal area to urine.
• Irritation and Discomfort: Irritation, itching, or a burning sensation in the vaginal area caused by constant moisture and urinary exposure.
• Unpleasant Odor: A noticeable odor from the vaginal area due to urine leakage and possible infection.
• Urinary Incontinence: Inability to control the release of urine, which may be intermittent or continuous.
• Pain or Discomfort During Sexual Activity: Discomfort or pain during intercourse as a result of the fistula.

Symptoms can vary based on the size and location of the fistula, as well as the presence of any associated complications. If any of these symptoms are experienced, it is important to consult a healthcare provider for evaluation and appropriate management.

What are the causes of vesicovaginal fistula?

Vesicovaginal fistula can arise from several different causes. Obstetric complications are a common factor, with prolonged labor, traumatic delivery, and issues like stillbirth or large fetal size potentially leading to injury between the bladder and vagina. Surgical procedures, particularly gynecological surgeries such as hysterectomies or pelvic surgeries, can sometimes result in fistulas if there is unintended damage to the bladder or vaginal tissues. Radiation therapy for cancers, especially those affecting the pelvic area like cervical cancer or rectal cancer, can cause tissue damage that may lead to fistula formation.

Chronic infections or inflammation in the pelvic region can weaken tissues and contribute to fistula development. Certain cancers that affect the pelvic organs, including the bladder cancer or vaginal cancer, can invade adjacent tissues and create a fistula. Trauma or injury from accidents or falls can also cause fistula formation. Chronic diseases like Crohn’s disease or tuberculosis, which cause persistent inflammation, may be involved. In rare cases, congenital anomalies or birth defects can predispose individuals to developing a vesicovaginal fistula. Treatment approaches depend on the underlying cause and the severity of the condition.

What is the treatment for vesicovaginal fistula?

The treatment for vesicovaginal fistula typically involves addressing both the fistula itself and the underlying cause. Here are the main approaches:

• Surgical Repair: The primary treatment is surgical intervention to close the fistula. This usually involves a procedure to remove the abnormal connection between the bladder and vagina and repair the tissues. The surgery is often performed by a urologist or gynecologist and may be done through various methods, including transvaginal, transabdominal, or laparoscopic techniques.
• Management of Underlying Causes: If the fistula is caused by an infection, cancer, or radiation damage, managing these conditions is crucial. This may involve antibiotic treatment for infections, cancer therapy for malignancies, or addressing any complications from radiation.
• Supportive Care: In some cases, supportive measures may be used to manage symptoms until surgery can be performed. This may include using absorbent pads to manage urinary leakage and maintaining good hygiene to prevent infections.
• Nutritional and Physical Support: Ensuring proper nutrition and managing any physical complications, such as pressure sores or infections, is also important in the overall treatment plan.
• Follow-Up and Monitoring: Regular follow-up with a healthcare provider is essential to ensure that the fistula has healed properly and to monitor for any potential complications or recurrence.

Treatment plans are individualized based on the patient’s overall health, the cause of the fistula, and its severity.