Urinary or Fecal Fistula

A urinary fistula is an abnormal opening either within a urinary tract organ (such as the bladder) or an abnormal connection between a urinary tract organ and another organ (such as the colon). There are several types of urinary fistulas, including:

• Vesicovaginal fistula - fistula between the urinary tract and the vagina. The term (vesico) refers to the urinary bladder. It is the most common type of urinary tract fistula.
• Vesicouterine fistula - fistula between the bladder and the uterus.
• Urethrovaginal fistula - fistula between the urethra and the vagina. The urethra is the tube that empties urine from the bladder.
• Ureterovaginal fistula - fistula between the ureter and the vagina. The ureter is the tube that carries urine from the kidney to the bladder.
• Colovesical fistula - fistula between the colon (bowel) and the bladder.
• Rectovaginal fistula - fistula between the rectum and the vagina.

Fistulas are most often caused by injury to the organs in question, either during surgery or through trauma, such as an automobile accident. The most common type of urinary fistula results from injury to the bladder during abdominal or pelvic surgery such as a hysterectomy or a cesarean section for childbirth. Other causes of urinary fistula include: pelvic malignancy, such as cervical or colon cancer; radiation therapy; and inflammatory diseases, such as Crohn's disease. The most common cause of colovesical (between the rectum and the vagina) fistula is a disease of the large intestine (diverticulitis).

What are the symptoms of urinary fistula?

The symptoms vary depending on where the abnormal connection or opening occurs.

Symptoms related to fistulas between the urinary tract and the vagina (vesicovaginal) may include:

• Constant urine leakage from the vagina
• Irritation in the area of the vulva (external female genital organs)
• Frequent urinary tract infections

Symptoms of fistula between the rectum and the vagina (rectovaginal) may include:

• Leakage of gas and/or feces into the vagina

Other symptoms of urinary fistula could include:

• Fluid drainage from the vagina
• Diarrhea
• Abdominal pain
• Fever
• Weight loss
• Nausea
• Vomiting

There are other conditions that could also cause these symptoms so your doctor will need to examine you before making a diagnosis.

Tests and procedures

Your doctor will ask about your symptoms and make a thorough physical examination of the pelvic area. If you have a fistula between the urinary tract and the vagina, the doctor may be able to see it during the examination. Depending on where the fistula is located, the doctor may want to examine the lower colon.

Other tests to visualize the location of the fistula include:

• Magnetic Resonance Imaging (MRI) - a noninvasive procedure that uses magnetic fields and radio waves to produce images of the internal organs
• Radionuclide cystogram - a test (nuclear scan) using a radioactive material (radioisotope) that is placed into the bladder. A scanner then detects radioactivity to evaluate bladder and urinary tract functions.
• Retrograde cystogram - a test in which contrast dye is injected into the bladder and then visualized by X-ray to evaluate the bladder and urinary tract
• Computed tomography (CT or CAT) scan - a noninvasive X-ray imaging procedure that can show cross-sections or (slices) of the organs scanned
• Intravenous urography - a test that X-rays the urinary system after injection of contrast dye; used for diagnostic purposes
• Cystoscopy - an examination of the bladder and urethra using a thin, lighted instrument (cystoscope) inserted into the urethra (tube that empties urine from the bladder)
• Retrograde pyelography - a type of X-ray procedure in which contrast dye is first injected into the lower part of the urinary system to make it easier to visualize
• Ultrasound - a noninvasive imaging technique that uses high-frequency sound waves to create images of internal organs, blood vessels, and other soft tissues

Treatments

Depending on the type of fistula, some small fistulas that are detected early may be treated by catheter drainage. However, since a fistula is an unwanted connection between 2 organs, the treatment for most fistulas is surgical repair. If you have an infection associated with the fistula, your doctor may also prescribe antibiotics or other medications.