Your Mayo Clinic care team
Mayo Clinic doctors trained in female reproductive systems (gynecologists and urogynecologists), urinary systems (urologists) and intestinal systems (colorectal surgeons) treat vaginal fistulas.
Having all this expertise in a single place, focused on you, means that you're not just getting one opinion — your care is discussed among the team, your test results are available quickly, appointments are scheduled in coordination and the most highly specialized experts in the world are all working together for you.
Advanced diagnosis and treatment
With state-of-the-art research and laboratory facilities, Mayo Clinic doctors use advanced technology and sophisticated imaging tests to accurately diagnose vaginal fistula. Doctors at Mayo Clinic also help train new surgeons to do pelvic reconstructive surgery for women. Mayo Clinic doctors perform more than 300 fistula repairs each year.
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, including:
- 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 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 cystoscopy, flexible sigmoidoscopy, CT scan and MRI.
At Mayo Clinic, your doctor will provide you with individualized care to help you manage your condition. Doctors at Mayo will also coordinate your follow-up care with your primary doctor.
Conservative therapy. 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. He or she may also recommend 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 so that it's softer and easier to pass.
- Surgery. 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.