16442 Vesicovaginal Fistula

Overview

A vesicovaginal fistula is an abnormal opening between the bladder and the vagina. This opening lets urine leak from the bladder into the vagina, causing constant or occasional leakage that you cannot control. It is not a normal part of aging and it can often be treated.

Vesicovaginal fistula is rare in countries with good access to obstetric care. However, it is much more common in parts of the world where women may not have access to skilled help during childbirth.

It affects women. Most cases occur after childbirth, pelvic surgery (such as hysterectomy), or cancer treatment in the pelvic area. In some cases, it can happen after an injury or infection.

Symptoms

Common symptoms

• Leaking urine from the vagina that you cannot control
• Urine leakage that happens all the time or when you stand, walk, or move
• Feeling wet or damp even after using the toilet
• Frequent bladder infections or urinary tract infections
• Irritation, soreness, or pain in the vaginal area
• A strong smell of urine that may be noticed by yourself or others

Symptoms in children

• This condition is very rare in children. If it happens, it may be due to an birth defect or injury, and a specialist should be consulted.

Symptoms in older adults

• In older adults, it may be confused with normal urine incontinence. Symptoms are the same, but the cause is a physical opening, not weak pelvic muscles. It is important to have a proper assessment.

Causes

Main causes

• Prolonged or obstructed childbirth, when the baby is stuck and presses against the bladder for a long time
• Pelvic surgery, especially hysterectomy (removal of the uterus) or other operations in the pelvis
• Radiation therapy for cancers in the pelvic area
• Injury to the pelvic area from trauma or an accident
• Infections or inflammatory conditions in the pelvis

Risk factors

• Lack of access to skilled care during childbirth, especially in low-resource settings
• Previous pelvic surgery or repeated pelvic operations
• Radiation treatment for pelvic cancers
• Having a very long labour without medical help
• Poor nutrition or other conditions that can weaken tissue healing

When to see a doctor

See a doctor urgently if:

• If you have just had pelvic surgery and you notice new, continuous urine leaking from your vagina, contact your surgical team or doctor right away.
• If you have signs of infection, such as fever, chills, or a strong-smelling discharge, seek medical help urgently.

Book a routine appointment if:

• If you notice any unwanted urine leakage from your vagina, make a routine appointment to see a healthcare provider. Early evaluation can help identify the cause and plan treatment.

Diagnosis

Your doctor will start by asking about your symptoms and medical history. They will do a physical exam, including a pelvic exam. To confirm the diagnosis, they may place a small amount of dye in your bladder and see if it appears in the vagina. They may also use a thin camera called a cystoscope to look inside the bladder.

Tests that may be done

• Pelvic examination
• Dye test (methylene blue test) to see if urine leaks through the fistul
• Cystoscopy – a thin tube with a camera to view the bladder
• Imaging scans, such as an ultrasound, CT scan, or MRI
• Urodynamic tests to measure how well the bladder stores and releases urine

What to expect at your appointment

The evaluation may feel uncomfortable but is usually not painful. You may be asked to come with a full bladder for part of the test. The doctor will explain each step as it happens. After the tests, your healthcare team will talk with you about the best treatment plan.

Treatment

The main treatment for a vesicovaginal fistula is surgery to close the opening. However, some small fistulas may heal on their own with a urinary catheter that drains the bladder for a few weeks. Infections must be treated before any surgery. Your healthcare team will decide the best approach based on the size, location, and cause of the fistula.

Self-care at home

• Keep the skin around the vagina and thighs clean and dry to prevent irritation.
• Use absorbent pads or special underwear to manage urine leakage and protect clothing.
• Drink plenty of water to dilute urine and reduce irritation.
• Clean around the vaginal area with warm water and a gentle, non-scented cleanser, and pat dry.
• Use a barrier cream as recommended by your doctor to protect your skin.

Medical treatments

If you have an infection, your doctor may prescribe antibiotics to treat it before any other treatment. If the fistula is small, a catheter (a thin tube to drain urine from the bladder) may be placed for several weeks to allow the opening to close on its own, especially if it was caused by recent surgery. Sometimes, a doctor can use a special glue or plug to close the fistula without surgery. Always discuss all options with your healthcare provider.

When is surgery considered?

Surgery is the most common and effective treatment for vesicovaginal fistulas. The goal is to close the opening between the bladder and vagina. Sometimes the surgery is done through the vagina, and other times through the abdomen. The timing usually depends on tissue health and whether there is any infection. Your doctor will explain the approach and what to expect.

Living with this condition

Living with a fistula can be hard, but you can take steps to stay comfortable and active. Use absorbent products that fit well, and change them often. Keep a supply nearby if you are away from home. Plan ahead for trips by carrying a small bag with pads, wipes, and a change of underwear.

Lifestyle tips

• Stay well hydrated and try to empty your bladder regularly.
• Maintain a healthy weight to reduce pressure on the pelvic area.
• Avoid heavy lifting or straining, especially while you wait for treatment.
• Wear loose clothing and breathable underwear to reduce irritation.
• Do pelvic floor exercises if recommended by a physiotherapist.

Diet and exercise

Eat a balanced diet with plenty of fibre to avoid constipation, because straining can make urine leak worse. Drink enough water to keep urine from becoming too concentrated, which can irritate your skin. Gentle exercise like walking can help you stay well, but avoid very strenuous activities until your doctor says it is safe.

Mental health and emotional wellbeing

Having a vesicovaginal fistula can lead to shame, embarrassment, and feeling isolated. It is normal to feel this way. Your worth is not affected by this condition. Talking to a trusted friend, family member, or counsellor can help. You are not alone, and effective treatment is available.

Prevention

Not all cases can be prevented, but many can. Good access to skilled care during childbirth greatly reduces the risk. If you are having pelvic surgery, choose an experienced surgeon and follow all pre- and post-operative instructions. If you are having radiation to the pelvis, your team will monitor you closely for any signs of fistula. Early treatment of bladder infections and careful management of prolonged labour are also important.

Complications

If left untreated

• Repeated bladder and kidney infections
• Skin irritation, sores, and infections in the genital area
• Damage to the bladder or kidneys from chronic infection
• Strong effects on mental health, including depression and social isolation
• Difficulty with intimate relationships and daily activities

Long-term outlook

The outlook for vesicovaginal fistula is very good. With proper treatment, most women can be completely cured. Even if surgery is needed, success rates are high, especially when performed by an experienced team. Many women feel their lives return to normal after recovery. There is every reason to be hopeful.

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