A vaginal fistula is an abnormal opening that connects your vagina to another organ, such as your bladder, colon or rectum. Your doctor might describe the condition as a hole in your vagina that allows stool or urine to pass through your vagina.
Vaginal fistulas can develop as a result of an injury, a surgery, an infection or radiation treatment. Whatever the cause of your fistula, you may need to have it closed by a surgeon to restore normal function.
There are several types of vaginal fistulas:
- Vesicovaginal fistula. Also called a bladder fistula, this opening occurs between your vagina and urinary bladder and is the type that doctors see most often.
- Ureterovaginal fistula. This type of fistula happens when the abnormal opening develops between your vagina and the ducts that carry urine from your kidneys to your bladder (ureters).
- Urethrovaginal fistula. In this type of fistula, also called a urethral fistula, the opening occurs between your vagina and the tube that carries urine out of your body (urethra).
- Rectovaginal fistula. In this type of fistula, also known as a rectal fistula, the opening is between your vagina and the lower portion of your large intestine (rectum).
- Colovaginal fistula. With a colovaginal fistula, the opening occurs between the vagina and colon.
- Enterovaginal fistula. In this type of fistula, the opening is between the small intestine and the vagina.
Read more about rectovaginal fistula.
Mayo Clinic doctors trained in female reproductive systems (gynecologists and urogynecologists), urinary systems (urologists) and intestinal systems (colorectal surgeons) treat vaginal fistulas. Advantages of care at Mayo Clinic include:
- Experience. Mayo Clinic doctors perform more than 200 fistula repairs each year.
- Expertise. Doctors at Mayo Clinic help train new surgeons to do pelvic reconstructive surgery for women.
- Team approach. Integrated teams of doctors include gynecologists, urogynecologists, urologists and colorectal surgeons.
Mayo Clinic in Rochester, Minn., ranks No. 1 for gynecology in the U.S. News & World Report Best Hospitals rankings. Mayo Clinic in Jacksonville, Fla., and Mayo Clinic in Scottsdale, Ariz., are ranked high performing for gynecology by U.S. News & World Report.
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At Mayo Clinic in Arizona, doctors trained in pelvic reconstructive surgery (urogynecology) care for women who have vaginal fistulas.
For appointments or more information, call the Central Appointment Office at 800-446-2279 (toll-free) 8 a.m. to 5 p.m. Mountain Standard Time, Monday through Friday or complete an online appointment request form.
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At Mayo Clinic in Florida, doctors trained in urogynecology and reconstructive surgery care for women who have vaginal fistulas.
For appointments or more information, call the Central Appointment Office at 904-953-0853 8 a.m. to 5 p.m. Eastern time, Monday through Friday or complete an online appointment request form.
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At Mayo Clinic in Minnesota, a team of doctors trained in urogynecology, urology, and colon and rectal surgery care for women who have vaginal fistulas.
For appointments or more information, call the Central Appointment Office at 507-538-3270 7 a.m. to 6 p.m. Central time, Monday through Friday or complete an online appointment request form.
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To diagnose a vaginal fistula, your doctor likely will perform a pelvic exam, discuss your medical history and identify possible risk factors, such as recent pelvic surgery, an infection or pelvic radiation. Your doctor may also recommend certain tests to help diagnose your condition and to determine treatment options.
Tests for vaginal fistula
Possible diagnostic tests for vaginal fistula include:
- Dye test. In this test, your doctor fills your bladder with a solution dye and asks you to cough or bear down. If you have a vaginal fistula, leakage will appear in your vagina. You may also see signs of leakage on a tampon after physical exercise.
- Cystoscopy. During this exam, your doctor uses a cystoscope — a hollow device equipped with a lens — to view the inside of your bladder and urethra, the tube that carries urine outside of your body, for signs of possible damage.
- Retrograde pyelogram. In this test, your doctor injects dye through your bladder into the tubes that connect your bladder to your kidneys (ureters) and then takes an X-ray. The X-ray image can show your doctor whether you have leakage between a ureter and your vagina.
- Fistulogram. A fistulogram is an X-ray image of your fistula. This test may help your doctor determine whether you have one or many fistulas. Your doctor may also be able to detect what other pelvic organs may be involved with your fistula.
- Flexible sigmoidoscopy. During this test, your doctor uses a sigmoidoscope — a thin, flexible tube with a tiny video camera at the tip — to inspect your anus and rectum.
- Computerized tomography (CT) urogram. During this test, your doctor injects dye into a vein and takes CT scans to create cross-sectional images of your vagina and lower urinary tract.
- Magnetic resonance imaging (MRI). MRI uses a magnetic field and radio waves to create detailed images of the organs and tissues within your body. With a pelvic MRI, your doctor can determine the path of a rectovaginal fistula.
Read more about CT scan, cystoscopy, flexible sigmoidoscopy and MRI.
For vaginal fistulas, conservative (nonsurgical) therapy is sometimes effective. However, in most cases, vaginal fistulas require surgery to close the opening.
If you have a simple vaginal fistula — for instance, your fistula is small in size, you haven't had cancer or you've never had radiation therapy — conservative measures may allow your fistula to heal on its own.
As part of your therapy, your doctor may recommend constant bladder drainage using a urinary catheter. Placing a ureteral stent — a small tube that holds the ureter open and helps urine flow from the kidneys to the bladder — soon after symptoms appear may help heal an otherwise uncomplicated ureterovaginal fistula. If you have a simple rectovaginal fistula, your doctor may ask you to change your diet and use fiber supplements to bulk your stool.
Most vaginal fistulas require surgery to repair the abnormal opening. Doctors can treat vaginal fistulas with surgery through the vagina or abdomen. Some cases can be treated with minimally invasive surgery (laparoscopic surgery), including robotic surgery. The location of your fistula determines whether your surgeon can perform the procedure through your vagina or your abdomen.
Mayo Clinic researchers seek innovative treatments for many types of gynecologic problems. The Women's Health Research Center at Mayo Clinic focuses on understanding and improving the health of women of all ages.
Read more about research at Mayo Clinic.
See a list of publications on vaginal fistula by Mayo Clinic doctors on PubMed, a service of the National Library of Medicine.
Apr. 14, 2014
- Garely AD, et al. Urogenital tract fistulas in women. http://www.uptodate.com/home. Accessed Jan. 22, 2014.
- Hoffman BL, et al. Williams Gynecology. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://accessmedicine.com/resourceTOC.aspx?resourceID=768. Accessed Jan. 23, 2014.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. Nov. 19, 2013.
- DiMarco CS, et al. Vesicouterine fistula: A review of eight cases. International Urogynecology Journal and Pelvic Floor Dysfunction. 2006;17:395.
- Gebhart JB (expert opinion). Mayo Clinic, Rochester, Minn. Jan. 29, 2014.