Fistula means an abnormal passage that can connect two separate organs of the body. Creating this hole in women is known as vaginal fistula. This complication occurs due to the loss of the sensitive tissue of the walls of the rectum, urethra, bladder or its surrounding areas, which is caused by continuous inflammation and eventually leads to the creation of this abnormal path. This complication is mostly caused by anal abscess. The development of this condition in women, which is known as vaginal vesicosa, can connect the vagina to nearby organs. An anal abscess occurs when the glands near the anus become blocked. These glands, which secrete substances into the intestine, appear as a result of blocking the accumulation of infection or anal abscess.
Adib Elixir, a producer of products such as Inolix urine burn ointment, Fengrix capsule (diabetes medicine), Daminest capsule (women’s sexual enhancement), Vigress capsule (men’s sexual enhancement), Silidianin fatty liver treatment capsule, Punica capsule (ovarian cyst medicine), Karodib tea, Adib Derm burn ointment (ointment for burns), Adib Derm’s acne cream and anti-stain cream, Estorest capsule (treatment of menopause problems), scar healing ointment (ointment for scars) etc. are available in Iran.
Types of vaginal fistula
There are different types of vaginal fistula and all of them are created in the vaginal wall. Fistulas are divided into the following types according to the location of their formation in the opening:
- A vesicovaginal fistula that connects to the urinary tract or bladder.
- A ureteral fistula that connects from the kidneys to the bladder.
- Rectovaginal fistulas that connect to the rectum or lower part of the colon
- Colovaginal fistulas that connect to the large intestine or the colon.
- Enterovaginal, which connects from the vagina to the small intestine.
- Intestinal fistulas that connect to the small intestine.
Causes of vaginal fistula
Among the causes of fistula, the following can be briefly mentioned:
- Complications during childbirth
- Inflammatory bowel disease
- Colon and cervical cancer
- Pelvic radiation therapy
- History of vaginal or anal surgery
- An infection in the anal canal
- fecal hernia
- HIV infection
- rape
Symptoms of vaginal fistula
This complication usually occurs sometimes without causing pain, but it may gradually cause serious problems. The problems that appear as a result of this complication include urinary incontinence or the spread of infection from the bladder and feces to the vagina, fever, diarrhea, vomiting, nausea, abdominal pain, and weight loss. These problems may worsen genital infection and sores and cause pain during intercourse. These symptoms are more common in women after childbirth.
- Pain around the anus and genital tract: one of the common symptoms of this complication is pain and burning in the anus and genital tract. In addition to feeling pain in these areas, the area around the anus and genitals may swell. An anal fistula in the anus area can cause pain during defecation. Vaginal fistula causes pain during sex.
- Abnormal bleeding and discharge: an anal fistula may be associated with bleeding and discharge around the anus and genitals. The secretions are sometimes purulent and have a bad smell. In vaginal fistula, these symptoms appear in the form of purulent vaginal secretions along with feces. Another symptom of vaginal fistula is vaginal gas.
- Urinary tract problems: urinary problems are another symptom of bladder fistula. The following symptoms are related to bladder fistula: urinary tract infection, abnormal urine discharge (vaginal discharge) and difficulty holding and inability to control it, gas coming out of the urinary tract during stool, change in color and bad smell of urine.
- Gastrointestinal symptoms: pain in the pelvis and abdomen, nausea and vomiting are symptoms of this condition. These symptoms may be related to the presence of other problems, but if accompanied by symptoms related to fistula, such as pain and secretions in the genital area, it is a sign of fistula.
- General symptoms: in addition to the mentioned cases that showed fistula symptoms in certain areas, there are other general symptoms that may be a sign of infection. These symptoms are fever and chills, fatigue and feeling sick.
How to diagnose a fistula by a doctor
In case of symptoms, you should see a doctor. Not paying attention to these symptoms and not treating the fistula on time will cause infection and more damage to the surrounding tissue. When visiting a doctor, you must share all the symptoms you have with him. Inform him of your medical history and medical conditions and medications you are taking. During the examination, the doctor checks for symptoms such as bumps, allergies and other symptoms such as infection. He performs a pelvic exam to check for symptoms related to vaginal fistula. For this purpose, he uses a speculum to look inside the vagina. For anal or intestinal fistula, the doctor may need to examine the rectum with fingers and gloves or with the help of an anoscope. An anal fistula can be examined through a hole in the skin around the anus.
X-Ray
If the doctor gives the possibility of a fistula after the examination, he prescribes one or more imaging tests, which include the following:
- X-rays of the anus, urinary tract, and genital tract. You may need an injection or enema (through radioactive iodine or barium) aimed at showing the fistula on an X-ray.
- CT scan or MRI
- Ultrasound of the anus and vagina
colonoscopy
If an intestinal fistula is suspected, the doctor may prescribe a colonoscopy. This operation is possible by inserting a small camera into the colon through the anus and using a long and flexible tube. Colonoscopy is performed under local anesthesia. Therefore, no pain or discomfort will be felt.
Blood test
Blood tests are needed to diagnose some types of fistula. This test is useful for diagnosing Crohn’s disease, which is one of the most common causes of fistula.
Blue or two color test
This test is used to diagnose vaginal and bladder or rectal fistula. In this method, the patient must swallow the dye or the doctor injects it directly into the rectum or bladder. Then, he puts a tampon in the vagina. If the tampon turns blue, it is a sign of fistula. The two-color test is to show the location of the fistula between the vagina and the urethra, and the blue color test is to detect the fistula between the rectum and the vagina.
Other tests
Other tests that the doctor may perform include a biopsy of intestinal tissue to check for Crohn’s disease and tests to check the function of the rectum and sphincter.
Vaginal fistula treatment
Fistula has various treatments, the type of treatment depends on the location and size of the complication and other things. Your doctor may refer you to a gynecologist or urologist. Types of fistula treatment include the following:
- A bladder catheter that is inserted into the fistula and drains the infected material and accumulated fluid.
- Surgery to treat fistula
- Antibiotics to treat infection
- Using special collagen adhesives to fill the fistula cavity
- Treatment of fistula between the anus and the surface of the skin by making a small incision in the skin and muscles above the fistula.
Risk factors
The presence of underlying diseases such as Crohn’s and ulcerative colitis increases the risk of developing a fistula. If you see symptoms of fistula and suspect intestinal inflammation, see a doctor. The symptoms of inflammatory bowel disease include the following:
- diarrhea
- flatulence
- abdominal contraction
- bloody stool
- fever
- nausea and sudden weight loss
Diverticulitis also causes fistula. Diverticulitis is caused by small pockets that form in the colon and is inflamed and infected.
Birth history
Difficult childbirth is another factor that increases the risk of fistula. In this case, a fistula may form around the outside of the anus. In case of any injuries as a result of childbirth, go to the obstetrician and gynecologist and make sure to solve any problems after childbirth. If you have symptoms of infection and fistula, such as fever, pain, and foul-smelling discharge, see a doctor after delivery.
History of pelvic injury or infection
Any damage to the intestine or pelvis increases the risk of fistula. Pelvic injuries may occur as a result of an accident or hip surgery. In this regard, a fistula may occur due to infection or cancer and radiation therapy.
Adib Elixir, a producer of products such as Inolix urine burn ointment, Fengrix capsule (diabetes medicine), Daminest capsule (women’s sexual enhancement), Vigress capsule (men’s sexual enhancement), Silidianin fatty liver treatment capsule, Punica capsule (ovarian cyst medicine), Karodib tea, Adib Derm burn ointment (ointment for burns), Adib Derm’s acne cream and anti-stain cream, Estorest capsule (treatment of menopause problems), scar healing ointment (ointment for scars) etc. are available in Iran.