Vaginal fistulas are the formation of defective fistulas that connect the vagina with the urinary organs or intestines. Due to the formed fistula mouths, the vagina is constantly being filled with urine, feces, gases. Diagnosis of the disease takes place through gynecological examination, endoscopy and X-ray of the internal organs of the pelvis. Treatment consists in removing the defect — normalization of the condition of the vagina and decalcification of abnormal growths.
The content of the article:
Causes of vaginal fistulas
Symptoms of vaginal fistulas
Diagnosis of vaginal fistula
Treatment of vaginal fistulas
Disease prevention and prognosis after treatment
Vaginal fistulas
Fistula in the vagina is one of the serious diseases, the vaginal wall in which is in constant contact with the organs of the rectum, urinary tract. Abnormal development of the mouths forms a passage between them — a fistula defect.
A vaginal fistula can develop in various areas: the bottom of the vagina, the middle and the top. Based on this, fistulas are divided into: low, medium and high.
And in the form of a fistula in the vagina happens:
small intestine-vaginal;
colonic-vaginal;
vesicovaginal;
rectovaginal;
urethrovaginal;
ureterovaginal.
Very often, fistulas are formed during life and do not have congenital pathologies. The manifestation of the disease, symptoms and further treatment depend on a number of reasons that influenced the formation of fistulas.
Causes of vaginal fistulas
The main causes of vaginal fistulas are surgical manipulations performed, in which the vagina, intestines, and urinary tract are injured. Most often this is due to surgical interventions in gynecology, urology, proctology, less often — a defect occurs during obstetric procedures.
The causes of the formation of urogenital fistulas are postoperative complications during surgical manipulations to remove the following defects:
urinary incontinence under stress;
urethral diverticula;
vaginal cyst;
prolapse of the anterior vaginal wall;
performing a radical type hysterectomy.
The cause of rectovaginal fistulas may be injuries received during obstetric actions, delivery of an abnormal type, trophic defects. These include:
the fetus is too large, as a result of which ruptures and injuries occur during childbirth;
pelvic type fetal presentation;
surgical intervention during childbirth, which can damage the rectum together with the connective-myotic tissue, the vagina.
In addition, the following factors may be the causes of the disease:
necrosis of soft tissues during delivery with further oxygen starvation, damage to the integrity of the vaginal framework;
prolonged ischemia in complicated childbirth;
autopsy of the vaginal mouth with aposema;
discovery of diverticulitis, acute paraproctitis;
ectopia of the ureter;
gastrointestinal diseases: Crohn’s disease, atrophic forms of gastritis, cholecystitis;
the use of chemotherapy or radiation therapy of the pelvic organs;
presence of malignant/benign pelvic tumors;
burns.
Symptoms of vaginal fistulas
The symptoms of the development of the disease depends on the form of the course of the fistula. With urogenital mouths, urinary incontinence of a partial or complete nature is manifested, its outpouring into the vaginal area. Characteristic features:
vaginal hyperemia;
tissue edema;
changes in the epidermis in the buttocks, perineum — irritation, redness, ulcerative foci.
With the development of genitourinary fistulas with preserved urination function and a small outpouring of urine, a fistula is detected as high or spot. With a different localization: the middle of the vagina or the proximal region of the urethra, urine cannot be kept inside at any position of the body, the development of the disease leads to a constant pain syndrome in the vagina and urea.
Symptoms of intestinal-vaginal fistula are determined by the following signs:
independent loss of fecal masses: manifests itself with large mouth sizes;
incontinence of gases: in the presence of spot fistulas;
defecation and gas escape through the vagina;
genital itching, burning.
With rectovaginal fistulas, a scar (one or many) of the posterior vaginal wall is formed together with the perineum, a defect of the rectal sphincter, limp myotic pelvic tissues.
Vaginal fistula together with infection and the progress of the inflammatory process is characterized by:
pain in the lower abdomen;
pain syndrome of the groin area with subsequent transition to the sacral zone, rectovaginal septum;
purulent discharge from the vagina;
diarrhea with admixtures of pus, mucus;
fever.
The symptoms of the vaginal fistula are manifested in pain in the perineum, discomfort during intimate intercourse and at rest, the occurrence or exacerbation of colpitis, vulvitis. Psychoemotional disorder is also inherent on the basis of chronic pain and general discomfort.
Diagnosis of vaginal fistula
The primary diagnosis of fistulas consists in conducting a gynecological examination, collecting the patient’s anamnesis.
Examination with the help of mirrors in the presence of fistulas will show a closed scar, from which urine or feces oozes. The exact determination of the localization of the fistula, its height and diameter is diagnosed using a button probe. With vaginal fistulas , the diagnosis consists in:
urethral cystoscopy;
chromocystoscopy;
retrograde/extraneous urography;
renographies;
cystography;
individually — vaginography.
With rectovaginal fistulas, diagnosis consists in examination of the rectovaginal type. This method reveals the diameter of the fistula, its shape and density, the presence and volume of scars of adjacent tissues, the functionality of the rectal sphincter, the possibility of an abscess.
Complicated forms of the disease are examined with the help of fistulography, irrigoscopy, thanks to which it is possible to detect the expansion and swelling of the fistula mouth.
Rectomanoscopy and colonoscopy are also mandatory for the differentiation of vaginal pathology. Conducting a cytology and histology study of the surrounding tissues, their biopsy and CT scan will show a more accurate clinical picture. The sphincter and its functionality are diagnosed using electromyography, sphincterometry, and anorectal manometry.
Treatment of vaginal fistulas
Methods of treating a vaginal fistula depend on its localization, shape and size, anatomical disorders of adjacent tissues, the presence of scars, the condition of the pelvis and rectum together with the functionality of the sphincter.
Cystovaginal mouths can pass independently after treatment with medications. And fistulas of the bladder and urethra are indicated to be treated with electrocoagulation.
Genitourinary fistulas must be surgically removed. During the operation, the vaginal walls are sewn together, removing the defect. The tissues of the bladder and urethra are also sewn together. For this, patchwork plastic is used.
The operation is indicated only in case of rapid symptoms, not earlier than 4 months later.
At the urethrovaginal mouth, ureterocystoneostomy is performed.
Rectovaginal injuries should be removed as soon as possible — up to 18 hours from the beginning of the appearance of the fistula. The operation involves the incision of atrophied tissues along the circumference of the fistula and their further stitching.
Fistulas in the vagina and rectum are surgically removed in several ways:
rectal;
vaginal;
perineal;
laparotromic.
Further treatment consists in the use of levatoroplasty and sphincteroplasty. The damaged epithelium is removed and stitched along the line of the vagina and intestine.
The presence of an inflammatory process inside the fistula lengthens the treatment process. First, it is necessary to clean the area for surgery by diverting intestinal outpourings into the vaginal cavity, preventing this in the future. A colostomy is used for this. The operation is shown below — no earlier than 3 months later.
Disease prevention and prognosis after treatment
The main problems that arise after surgery in patients are:
relapse of the fistula;
dysfunction of intestinal sutures.
In this regard, the operation is performed repeatedly.
A vaginal fistula has a positive prognosis, improvements are observed in dynamics and a natural lifestyle can be led already 3-4 months after surgery. For women who want to get pregnant, it is necessary to wait a period of time up to 3 years. In the future, childbirth is carried out exclusively by caesarean section in order to avoid rupture of the scar link.
Measures are needed to prevent vaginal fistula:
treatment of chronic diseases;
treatment of diseases of the genitourinary system;
timely examination of pathologies of the vaginal area, pelvic organs;
performing operations with qualified specialists;
avoiding gynecological operations to scrape the vaginal cavity and further scarring;
timely diagnosis and treatment of infectious diseases of the vaginal mucosa;
preventive measures of the genitourinary system based on diet.
In order to avoid the occurrence of this disease, it is necessary to adhere to hygiene, visit a gynecologist at least once a year and not start treatment of diseases.
