Vaginal Fistula

A vaginal fistula is an unusual opening that connects vagina to another organ in females like rectum, bladder, urethra, ureter and small & large intestine. We would like to limit our discussion for management of fistula connecting vagina with the rectum or the bladder

1. Rectum, the lower part of large intestine-rectovaginal fistula
2. Bladder - vesicovaginal fistula

Out of all these above-mentioned locations of fistula, Plastic surgeons contribute in the management ofrectum or difficult recurrent bladder fistulae. Fistulas at the higher locations within the abdomen region are managed by Urologists and general surgeons.

The main reason is tissue damage because of :

1. Childbirth/ labour,
2. Any Abdominal surgery (hysterectomy or caesarean section)
3. Pelvic, cervical, or colon cancer
4. Radiation treatment
5. Bowel disease like Crohn's or diverticulitis
6. Infection (including after an episiotomy or a tear while labour)
7. Traumatic injury, such as from a car accident

Symptoms of Vaginal Fistula

Vaginal fistulas arevery embarrassing to women when they leak and cause bad smells.

1. If there is an opening between vagina and bladder, urine will constantly leak from the bladder into vagina. This can make unable to control urination (incontinent).
2. If there is an opening between vagina and rectum, faecal matter or gas can constantly leak from the rectum into the vagina and this can make the patient unable to control the bowel movements also
3. Also, genital area may get infected or sore, and you can have pain during intercourse.
4. Vaginal or urinary tract infections that keep coming back
5. Hygiene problems

Diagnosis of Vaginal Fistula

A pelvic exam is a must and details about medical and surgical history to see any risk factors for fistulas, like a recent surgery, infection, or radiation.

Few investigations are advised to confirm the diagnosis of fistula, its path, numbers and extent:

1. Fistulogram - This is an X-ray image of the fistula. It can show number of fistulas and if other pelvic organs may be involved.
2. Dye test(for bladder fistulae) - Bladder is filled with a dye solution. The patient is asked to cough or bear down. If there is a vaginal fistula, the dye will leak into the vagina.
3. Cystoscopy(for bladder fistulae) - A thin device called a cystoscope is used to look inside bladder and urethra for signs of damage and opening of fistula.
4. Flexible sigmoidoscopy(for rectum fistulae) - Anal and rectal areais examined with a sigmoidoscope (a thin, flexible tube with a tiny video camera at the tip).
5. Pelvic MRI(for rectum fistulae) - Detailed pictures of rectum and vagina are done to help show the details of a rectovaginal fistula.

Treatment of Vaginal Fistula

1. Small vaginal fistulas may heal on their own. If it's a bladder fistula, a small tube called a catheter is put into your bladder to drain the urine and give the fistula time to heal by itself. An antibiotic to treat infection caused by the fistula is also started.
2. Most people who have larger fistulas need surgery. What kind of surgery you get depends on the type of fistula and where it is? It could be laparoscopic or it could be abdominal surgery done by gynecologists, general surgeons and urologist.
3. For failed fistula surgery/recurrent fistula - connecting vagina with the Bladder or rectum, addition of tissue from another place of the body can seal the fistula. This procedure is usually done by plastic surgeons.

The margins of the fistula and its surrounding area is inflamed and scarred and does not hold sutures good and tightand thus repairs are liable to give up and form fistula again. Dr Amit Agarwal bring in healthy tissues from the thigh in form of a muscle and well vascularised pedicled flap to inset between the rectum and the vagina so that the area can heal properly.

The surgery is usually done in lithotomy position only usually completed within an hour or 2 hours.

Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.

MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)

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