Vaginal Fistulas: Causes, Symptoms, and Treatment Options

Learning you have a vaginal fistula can be overwhelming, but effective treatments are available to help you regain comfort and quality of life. A vaginal fistula is a small opening between the vagina and another organ, often caused by childbirth, surgery, or certain medical conditions. While it may lead to uncomfortable symptoms like leakage or infections, effective treatments are available. 

Understanding the causes, recognising symptoms early, and knowing what to expect from treatment can help you take the next steps with confidence and clarity. Here's what you need to know.

What Is A Vaginal Fistula?

A vaginal fistula is an abnormal connection between the vagina and another organ, such as the bladder, rectum, or intestines. This connection allows fluids like urine or stool to leak through the vagina, which can be distressing. It usually results from childbirth injuries, surgery, infections, or medical conditions affecting the pelvic area. 

Though this condition can be emotionally and physically challenging, understanding what it is and knowing that support and effective care exist can help you take informed steps toward recovery.

What Are Genitourinary Vaginal Fistulas?

Genitourinary vaginal fistulas connect the vagina to parts of the urinary system. The most common type is a vesicovaginal fistula, which links the vagina to the bladder and causes urine leakage. Other types include ureterovaginal fistulas, which connect the vagina and ureters, and urethrovaginal fistulas, which link the vagina and urethra. 

These conditions often follow pelvic surgeries, childbirth injuries, or radiation. Though uncomfortable, vaginal fistula treatment is available and often effective in restoring normal function and improving your well-being.

What Are Other Types Of Vaginal Fistulas?

Vaginal fistulas can also affect the digestive system. These fistulas form between the vagina and parts of the bowel or rectum. These types can cause gas or stool to pass through the vagina, leading to significant physical and emotional distress.

Other types include:

• Rectovaginal fistulas: These form between the rectum and vagina. You may notice stool or gas leaking from your vagina. This type is commonly caused by childbirth trauma, inflammatory bowel disease, or surgery. It is also the most common form of vaginal rectal fistula.
• Colovaginal fistulas: These connect the colon to the vagina. Symptoms may include a constant flow of gas or faeces, frequent vaginal infections, and a strong odour. These are often related to diverticulitis or colorectal surgery complications.
• Enterovaginal fistulas: These link the small intestine to the vagina. Though less common, they can be caused by Crohn’s disease or post-surgical complications. Symptoms include foul-smelling discharge and digestive discomfort.

These types of fistulas can be distressing, but treatments exist to help manage and resolve the issue effectively.

Can You Feel A Vaginal Fistula?

You typically won't feel a vaginal fistula manually. The fistula itself doesn’t usually cause pain directly, but the symptoms it brings—like constant wetness, irritation, or unusual discharge—can be uncomfortable. Some people may not notice anything at first, especially if the opening is small. 

You might feel emotional discomfort or embarrassment due to leaking, but the physical sensation of the fistula itself is usually absent. If you suspect a problem, it's important to talk to your healthcare provider for a full check-up and guidance.

What Does A Vaginal Fistula Look Like?

Vaginal fistulas are usually not visible without medical examination. These are internal openings, often too small or deep to be visible from the outside. Medical professionals use specialised tools and imaging to detect them. You might notice symptoms like leaking or irritation, but the fistula itself won’t be visible to you. 

A healthcare provider might find it during a pelvic exam or through tests such as a dye test or scan. So if you're experiencing symptoms, it’s best to seek medical advice rather than trying to examine yourself.

Vaginal Fistula Symptoms

Vaginal fistulas may not always cause pain but often lead to noticeable symptoms. These can vary depending on the type and size of the fistula.

Common symptoms include:

• Leaking of urine or faeces from the vagina, especially if the fistula connects to the bladder or rectum.
• Frequent vaginal infections or urinary tract infections, due to constant moisture and bacteria.
• Vaginal discharge with a foul smell, sometimes containing stool or gas.
• Skin irritation or rashes around the vulva or perineal area due to continuous wetness.
• Painful sexual intercourse or discomfort during physical activity.
• Vaginal bleeding not linked to your menstrual cycle.

If you notice any of these signs, it’s a good idea to speak with your doctor.

Causes Of Vaginal Fistulas

Vaginal fistulas often result from tissue damage leading to an abnormal connection between the vagina and another organ. The causes vary, and some develop over time.

Main causes include:

• Prolonged or difficult childbirth, especially if access to timely medical care was limited.
• Injuries during childbirth, such as tearing or the use of forceps.
• Pelvic or abdominal surgery, including hysterectomies or C-sections.
• Radiation therapy in the pelvic region, often used to treat cancers.
• Inflammatory bowel diseases, like Crohn’s disease or ulcerative colitis, affect tissue healing.
• Pelvic cancers, including cervical or colorectal cancer.
• Pelvic infections that damage surrounding tissue and create a passage.
• Accidental trauma from injury or sexual violence.

Understanding the cause can help guide your vaginal fistula treatment plan more effectively.

Complications of Vaginal Fistulas

Untreated vaginal fistulas can lead to chronic infections, skin breakdown, and emotional distress. They may also affect intimacy and your sense of social comfort. Some people may experience narrowing of the vagina or rectum, and in a few cases, the fistula can reoccur after treatment.

What happens if a Vaginal Fistula Bursts?

A vaginal fistula does not rupture like a blister or balloon. It’s not a fluid-filled sac but rather a permanent opening between tissues. While it may widen or worsen, it won’t suddenly rupture. However, if symptoms like increased leakage or pain arise, you should see your doctor promptly to prevent further discomfort or complications.

Also Read: Vaginal Discharge: Types, Causes, and When to See a Doctor

How Is A Vaginal Fistula Diagnosed?

Diagnosis begins with a thorough medical history and physical examination A pelvic exam may reveal signs like unusual discharge or leakage. If the fistula is not obvious, imaging and dye tests help confirm the diagnosis.

Tests that may be done include:

• Dye tests, which check for leaks by using coloured fluid in the bladder or rectum.
• Blood and urine tests, to identify infections.
• Imaging scans, like CT urogram or MRI, to view internal tissues.
• Cystoscopy, which involves looking inside the bladder.
• Flexible sigmoidoscopy or colonoscopy, to check the intestines for involvement.

These steps help confirm the fistula’s location and guide the most effective treatment approach.

Tests

To confirm the presence and location of a vaginal fistula, your healthcare provider may recommend diagnostic tests. These help identify the exact type of fistula and guide the best treatment plan.

Dye Test

In this test, dye is placed into your bladder or rectum, and your doctor checks for signs of it leaking through the vagina. You may be asked to cough or move to see if any fluid escapes. If you wear a tampon during the test, it may absorb the dye. This simple method often helps confirm the presence and exact location of a fistula.

Cystoscopy

Cystoscopy uses a thin, flexible tube with a camera to look inside your bladder and urethra. This allows your doctor to see any abnormal openings or signs of irritation. The procedure is generally quick and can be done under local anaesthesia. It helps diagnose fistulas connecting to the bladder, such as vesicovaginal fistulas, by offering a clear internal view.

Retrograde Pyelogram

This test involves injecting contrast dye into the ureters—the tubes that carry urine from the kidneys to the bladder. X-rays are then taken to track the dye’s movement. If the dye appears in the vagina, it may signal a ureterovaginal fistula. This test is helpful when urine leakage is suspected to originate higher in the urinary tract and may not show in basic tests.

Fistulogram

A fistulogram is an imaging test where contrast dye is injected directly into the fistula. X-ray images are then taken to determine the number, size, and route of the fistula. This test is particularly useful for complex or multiple fistulas and helps map how deep or widespread the issue is. It also aids in surgical planning by showing how the fistula affects nearby organs.

Flexible Sigmoidoscopy

This procedure uses a thin, flexible tube with a camera to view the rectum and the lower part of the colon. It’s particularly helpful if a rectovaginal or colovaginal fistula is suspected. Your doctor can identify inflammation, infection, or openings between the bowel and vagina. The procedure usually takes just a few minutes and helps diagnose digestive system-related fistulas.

Computerized Tomography (CT) Urogram

A CT urogram uses X-rays and contrast dye to create detailed images of the urinary system. This test is especially useful for finding small or hidden fistulas and checking for related damage. It can show the bladder, ureters, and kidneys in detail. The scan is quick, and while the contrast dye may cause a warm feeling, the procedure is generally well tolerated.

Magnetic Resonance Imaging (MRI)

MRI uses magnetic fields and radio waves to create high-resolution images of the pelvic area. It’s helpful in seeing soft tissue damage and identifying complex fistulas. Unlike X-rays, MRI doesn’t use radiation. It offers a detailed view of the path of the fistula and its relation to nearby structures. This helps in planning the right vaginal fistula treatment approach.

Colonoscopy

A colonoscopy uses a long, flexible tube with a camera to examine the entire large intestine. It helps detect colovaginal or enterovaginal fistulas and checks for causes such as Crohn’s disease or diverticulitis. If a fistula is found, a biopsy may be taken for further testing. The procedure is safe and often done with light sedation to ensure your comfort.

Treatments

Treatment depends on factors such as the type, size, and location of the fistula, as well as your overall health and symptoms. Some small fistulas may heal without surgery, while others require medical or surgical intervention.

• Antibiotics or anti-inflammatory medicines may help if infection or inflammation is present. This is especially useful when the fistula is caused by Crohn’s disease or other chronic conditions.
• Catheterisation is used for bladder-related fistulas. A tube drains urine, giving the tissue time to heal and reducing pressure on the fistula.
• Ureteral stents keep the ureters open while the fistula heals. This method is minimally invasive and helps manage ureterovaginal connections.
• Surgical repair involves removing the damaged tissue and closing the opening with healthy tissue. It can be done through the vagina or abdomen, depending on the fistula’s location and size.
• Laparoscopic or robotic surgery may be an option for less invasive repair. These techniques involve smaller cuts, shorter recovery times, and less discomfort.
• Tissue grafts or mesh may be used to strengthen the repair and prevent recurrence. Your surgeon will decide the best approach based on your needs.

With proper care, most people recover well and return to normal life after vaginal fistula treatment.

What Happens After A Rectovaginal Fistula Repair?

Post-surgery, you may require temporary measures such as using a colostomy bag to allow the bowel to heal. Your doctor will guide you on how to care for the area, avoid strain, and prevent infection. 

Healing usually takes several weeks, during which you should avoid inserting anything into the vagina, including tampons. Follow-up care ensures the repair is successful and helps you regain your comfort and confidence.

Conclusion

Vaginal fistulas can be distressing, but early diagnosis and appropriate treatment can lead to recovery. Understanding the symptoms, causes, and available options helps you take control of your health with confidence. 

If you experience unusual leakage or discomfort, don’t ignore it—seek timely medical advice. For accurate testing and expert guidance, consider Metropolis Healthcare, a trusted name in diagnostic excellence and women’s health support.

Also Read: Vaginal Yeast Infection: Symptoms, Treatment, Types & Causes

FAQs

Is a fistula an STD?

No, a vaginal fistula is not a sexually transmitted disease; it develops from injury, surgery, or disease.

What are the risk factors for vaginal fistulas?

Risk factors include childbirth trauma, pelvic surgeries, cancer, radiation, Crohn’s disease, infections, and inflammatory bowel conditions.

What is recovery like after vaginal fistula repair surgery?

Recovery involves rest, avoiding vaginal insertion, managing diet, taking prescribed medications, and attending follow-up appointments as advised.

Can a vaginal fistula go away on its own?

Small fistulas may heal with non-surgical care, like catheterisation and medication, but many require surgical intervention.

What is the outlook for women with vaginal fistulas?

Most women recover fully after treatment, especially with proper care, but complex cases may need multiple surgeries.

What doctors treat vaginal fistulas?

Gynaecologists, urologists, colorectal surgeons, and urogynecologists often work together to diagnose and treat vaginal fistulas effectively.

When should I contact my healthcare provider?

Contact your provider if you notice urine or stool leakage, pain during intercourse, or persistent unusual vaginal discharge.