阴道瘘

概述

阴道瘘是指阴道与另一器官（例如膀胱、结肠或直肠）之间形成的异常开口。医务人员可能会将阴道瘘描述为阴道中允许尿液、气体或粪便排出的孔洞。

分娩、损伤、手术、感染或放射治疗都可能导致阴道瘘。您可能需要通过手术对阴道瘘进行修复。

阴道瘘有以下几种类型，根据位置和所影响的器官而命名：

• 膀胱阴道瘘。这类开口又称膀胱瘘，位于阴道与膀胱之间。这是最常见的阴道瘘之一。
• 输卵管阴道瘘。这类阴道瘘是出现在阴道与输尿管（将尿液从肾脏输送到膀胱的导管）之间的异常开口。
• 尿道阴道瘘。开口出现在阴道与尿道（将尿液排出体外的管道）之间。这类阴道瘘又称为尿道瘘。
• 直肠阴道瘘。这类阴道瘘的开口位于阴道与直肠（大肠下部）之间。
• 结肠阴道瘘。结肠阴道瘘的开口位于阴道与结肠之间。
• 肠阴道瘘。这类阴道瘘的开口位于阴道与小肠之间。

症状

Vaginal fistula symptoms can include:

• Leaking of urine or stool, or passing of gas, through the vagina.
• Urinary tract infections that happen often.
• Urine that has an unusual odor or contains blood.
• Vaginal fluid called discharge that looks or smells unusual.
• Pain during sex.
• Pain, swelling or irritation in the area between the vagina and the anus, called the perineum.
• Repeated infections of the vagina.

The exact symptoms a person has depend in part on the location of the fistula.

When to see a doctor

Get a healthcare checkup if you think you have symptoms of a vaginal fistula. Tell your healthcare professional if you have symptoms that affect your daily life, relationships or mental health.

病因

Vaginal fistulas have many possible causes, including certain medical conditions and problems that can happen because of surgery. These causes include the following:

• Surgery complications. Surgeries that involve the vaginal wall, anus or rectum can lead to vaginal fistulas. So can surgery on the area between the vagina and anus, called the perineum. Fistulas can form for reasons such as injuries during surgery and infections after surgery. Skilled surgeons can repair injuries while operating, which lowers the risk of fistula. But complications such as fistulas are more common after surgery in people with diabetes or in people who use tobacco.

  Surgery to remove the uterus, called a hysterectomy, is an example of an operation that can raise the risk of a vaginal fistula. The risk is higher if the hysterectomy is more complex. For example, the risk rises if the surgery takes longer than five hours, or if it involves larger blood loss or the removal of more surrounding tissue.

• Childbirth injuries. A vaginal fistula could stem from tearing that sometimes happens when a baby's head comes through the opening of the vagina. Or a fistula might form due to an infection of a surgical cut made between the vagina and the anus to help deliver a baby. This cause is not common in developed countries.

  Being in labor a long time because the baby can't move into the birth canal can raise the risk of a vaginal fistula, mainly in developing countries. That's partly because access to emergency delivery measures such as C-section may be limited.

• Crohn's disease. This condition inflames tissue that lines the digestive tract. If you follow your Crohn's treatment plan, you're not likely to get a vaginal fistula. Crohn's is a type of inflammatory bowel disease (IBD). Another type of IBD called ulcerative colitis also may lead to vaginal fistulas, but the risk of that happening is even lower.
• Certain cancers and radiation therapy. Cancer of the anus, rectum, vagina or cervix can lead to a vaginal fistula. So can damage from radiation therapy for the treatment of cancer in the pelvic area.
• Diverticulitis. This condition involves small, bulging pouches in the digestive tract. Diverticulitis that leads to a vaginal fistula is more common in older people.
• A large amount of stool stuck in the rectum. This condition is known as a fecal impaction. It also is more likely to cause a vaginal fistula in an older person.

风险因素

A vaginal fistula has no clear risk factors.

并发症

Vaginal fistulas can lead to other health conditions called complications. Complications of vaginal fistulas include:

• Fistulas that keep coming back.
• Ongoing pelvic infections.
• Narrowing of the vagina, anus or rectum. This also is called stenosis.
• Trouble becoming pregnant.
• Loss of a pregnancy after 20 weeks, also called stillbirth.

预防

There are no steps you need to take to prevent a vaginal fistula.