A urinary fistula is an abnormal connection between the urinary tract and a nearby organ. It occurs most commonly in women, usually in relation to a gynaecological or obstetric procedure. Many affected patients have a history of pelvic surgery or of multiple childbirths involving caesarean sections.
There is also a higher risk of a vesicovaginal fistula (VVF) following radiotherapy for cervical cancer, particularly with older techniques. When a fistula forms, urine or other matter can pass through an opening where it should not, and this often leads to symptoms such as constant leakage or repeated infection. A connection between a urinary organ and the vagina is known as a vaginal fistula. In simple terms, a fistula is an abnormal hole in the vagina, bladder or another organ.
Urinary fistulae are often caused by trauma, surgery or certain diseases, such as damage to the bladder during pelvic or abdominal surgery. In most cases they need to be repaired surgically, and only a small number heal with conservative management.
Symptoms of a urinary fistula
A urinary fistula is usually painless, so people often become aware of it through its other symptoms. These may include:
- Constant leakage of urine from the vagina
- Leakage of faeces through the vagina, if the rectum is also involved
- Passing gas through the urethra while urinating
- Fluid leaking from the vagina
- Irritation in the vulval area
- Frequent urinary tract infections (UTIs)
- Abdominal pain
Causes of a urinary fistula
A fistula can develop when the tissues in the pelvic region, urinary tract or vagina are damaged. This damage may result from infection, surgery, an accident, injury or radiation treatment. As the affected tissue breaks down over time, the fistula may open. Other causes include:
- Vesicovaginal fistulae, which are largely caused by caesarean section and hysterectomy. A fistula may also result from surgery on the perineum, rectum, anus or the back wall of the vagina.
- Malignancy in the pelvic region, such as cervical or colon cancer.
- Diverticulitis or inflammatory bowel disease. Fistulae are relatively common in people with ulcerative colitis or Crohn's disease.
- Complications of an episiotomy incision during childbirth, including infection or deep tears.
Diagnosis of a urinary fistula
The doctor will carry out an examination to assess the fistula and will discuss your medical history to understand its possible cause. A pelvic examination is usually performed. Depending on the precise location of the fistula, additional diagnostic tests may be recommended to confirm the diagnosis and to determine the most suitable treatment.
Treatment of a urinary fistula
Some fistulae can be treated with conservative therapy, but most require surgery. A fistula may heal on its own if it is small and undamaged, and if the surrounding tissue is healthy and unaffected by cancer or radiation therapy.
The type of surgery depends on the location and type of fistula. Some procedures are performed through the abdomen and others through the vagina. In certain cases, the repair is carried out using robotic surgery, which allows very precise movements, or laparoscopic surgery, which uses small incisions. During the operation, any damaged tissue, tumour or other material affecting the fistula is removed. The surgery aims to repair the fistula by encouraging the growth of healthy tissue, closing the opening, and restoring normal function to the urinary tract and the affected organs.
Every treatment plan starts with a proper assessment, so you only get the care your condition actually needs. If you have symptoms or a question about your health, book a consultation with Dr. Anish Gupta.