Vaginal Fistulas

Diagnosis

The symptoms of vaginal fistula vary, depending on the type of fistula:

For vesicovaginal (bladder) fistula:

• Watery vaginal discharge
• Urinary incontinence
• Leakage of urine through the vagina
• Vaginal irritation
• Recurrent episodes of cystitis or vaginitis

For ureterovaginal (ureter) fistula:

• Watery vaginal discharge
• Urinary incontinence
• Leakage of urine through the vagina
• vaginal irritation

For uterovaginal (urethral) fistula:

• Urine leaking into vagina during urination
• Urinary incontinence
• Vaginal irritation

For rectovaginal (rectal) fistula:

• Fecal incontinence
• Leakage of feces into the vagina
• Vaginal irritation

The sudden onset of incontinence after pelvic surgery could signal a vaginal fistula. Radiation-induced fistula may signal the recurrence of cancer; however, fistulas can occur from one month to many years after an initial radiation treatment. Many patients with Crohn's disease develop vaginal fistulas, usually rectovaginal fistulas.

A cystoscopy exam.

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Vaginal fistulas may be detected during a visual exam. Other tests that help to determine if surgery is necessary include:

Dye test — The bladder is filled with a dyed solution and the patient is asked to cough and bear down as the physician looks for signs of leakage in the vagina. Leakage may also be detected on a tampon after physical exercise.

Cytoscopy — The doctor uses a scope to inspect the vagina, ureters and bladder.

Retrograde pyelogram — This X-ray test is used to determine the presence of a ureterovinal fistula. Dye is injected through the bladder and into the ureters, watching for leakage between the ureter and vagina.

Fistulagram — This X-ray of the patient's fistula may help detect if the fistula communicates with other organs or if multiple fistulas are present.

Anoscopy/flexible sigmoidoscopy — The doctor uses a scope to inspect the anus and rectum.