A fistula is an abnormal connection that connects either two body cavities or a body cavity to the skin. Fistulas occur when the tissue wall or a barrier between two body parts has broken down, usually due to trauma, injury, or infection.
Although many women are affected by fistulas every year, women do not always know how to recognize the symptoms or when to seek treatment. Fortunately, fistulas are both preventable and treatable.
The board-certified team of health professionals at Advanced Gynecology is well-versed in how to diagnose fistulas and can provide an array of treatment options tailored to your needs.
Causes of Fistulas
Fistulas can occur as a result of the following:
- Injury to the bladder as a result of pelvic surgery
- Infected episiotomies after childbirth
- Inflammation from inflammatory bowel diseases (IBD) such as ulcerative colitis or Crohn’s disease
- Radiation therapy or other treatments targeting the pelvic region
- Pelvic fractures
Geography and access to resources also play significant roles in the development of fistulas. In the United States, the most common causes of fistulas are:
- Injuries to the bladder as a result of pelvic surgery, especially hysterectomies
- Vaginal tearing from childbirth
- Inflammation due to Crohn’s disease
However, fistulas in developing countries often occur due to prolonged or obstructed labor labor that lasts three to five days when the unborn child can’t pass through the pelvis. The baby then cuts off blood flow to the tissues between the vagina and rectum or between the vagina and the bladder, cutting off oxygen and leading to the death of the affected tissue.
When these situations occur in developed nations, the woman receives a cesarean section. Unfortunately, these procedures and emergency obstetric facilities are not always available in countries with limited resources.
Types of Fistulas
The World Health Organization reports that between 50,000-100,000 women suffer from obstetric fistulas every year.
What Is a Vaginal Fistula?
Different types of vaginal fistulas can occur as a result of obstetric issues:
- Rectovaginal fistulas between the vagina and rectum
- Vesicovaginal fistula between the vagina and the bladder
- Urethrovaginal fistula between the vagina and the urethra
- Ureterovaginal fistula between the vagina and the kidney tubes (ureters)
What Are Other Types of Fistulas?
While they are less common than vaginal fistulas, women may also experience fistulas involving other genital organs:
- Vesicouterine fistulas between the uterus and bladder
- Cervical fistulas abnormal openings into the cervix
- Anal fistulas small tunnels between the anal canal and the skin near the anus
- Recto-uterine fistulas between the uterus and bowel
- Metroperitoneal fistulas between the uterus and the peritoneal cavity
- Intestinal fistulas between the intestine and a neighboring organ
Symptoms of Fistulas
The symptoms of a fistula can vary greatly depending on its location and severity. If you have a fistula, you may experience one or more of the following symptoms:
- Urinary incontinence
- Pain, tenderness, or itching in the affected area
- Pus or foul-smelling discharge
- Nausea or vomiting
- Painful intercourse
- Abdominal pain
- Generally feeling unwell
If left untreated, fistulas can lead to severe complications such as infections, fecal incontinence, perforation, or even sepsis.
If you suspect you may have a fistula, you should see a doctor as soon as possible. They can diagnose the issue and get you on a treatment plan.
How to Diagnose a Fistula
Doctors can diagnose a fistula in several ways:
- Physical exam
- CT scan
- Upper endoscopy
- Anorectal ultrasound
- Anorectal manometry
How your doctor diagnoses your fistula may depend on its location.
What Is a Fistulogram?
A fistulogram is an x-ray procedure that uses a special dye to look at abnormalities in the blood flow of a fistula.
Fistulograms may reveal:
- Abnormal narrowings
- Abnormal enlargements
- Blocked veins or arteries
Oftentimes, fistulograms can provide the information doctors need to develop a treatment plan without using a more invasive procedure. They also have few side effects and present a very low risk of infection.
Treatment Options for Fistulas
Fistulas usually do not heal on their own, which is why it’s critical that you seek medical care if you experience symptoms of a fistula. With the proper attention and treatment, fistulas can be easily managed.
There are two main forms of fistula treatment: surgery and wound care.
At Advanced Gynecology, our board-certified health experts will analyze your symptoms and the cause of the fistula to develop your treatment plan.
Doctors can treat some fistulas solely with antibiotics or other medications. However, if the fistula doesn’t respond to medication, the doctor may recommend surgery.
There are several approaches to fistula surgery that our team may consider when putting together a treatment plan:
- Fistulotomy: A fistulotomy repairs an anal fistula and avoids damage to the anal sphincter muscles.
- Medical glue: This is a simple procedure in which your doctor applies medical-grade glue to the fistula to close the opening so it can heal.
- Medical plug: A medical-grade plug is inserted into the fistula to close it and prompt the healing process.
- Drain insertion: Drain insertion involves the placement of a seton thin surgical cord into the fistula to drain the infection.
- Ileostomy: Some fistulas cause stools to enter the intestine. In cases like this, your doctor may perform an ileostomy which brings the small intestine up to the stomach wall. The stool then exits through the stomach and into a medical pouch that can be emptied and cleaned. An ileostomy is often used as a temporary measure while the fistula heals.
The surgeons at Advanced Gynecology specialize in minimally invasive techniques to treat fistulas, including robotic surgery and laparoscopic techniques. These procedures involve very small incisions, usually in the abdomen or vagina. The doctor checks the damaged area for edema or infection during the surgery and removes scar tissue to ensure proper blood supply.
Are You Suffering from a Fistula? Advanced Gynecology Can Help
Fistulas can cause discomfort and pain and, when left untreated, can lead to serious health complications. If you are experiencing symptoms of a potential fistula, we urge you to contact our team today.
Advanced Gynecology’s world-class team of women’s health experts can diagnose your fistula and present you with the best treatment plan for your health needs. If you have questions or wish to schedule an appointment today, call us at 678-201-1283 or request an appointment online.