A vesicovaginal fistula creates an unnatural connection between the female bladder and the vagina. As a result, the affected women suffer from incontinence.
What is a vesicovaginal fistula?
A vesicovaginal fistula is an abnormal connection between a woman’s urinary bladder ( vesica urinaria ) and her vagina ( vagina ). This pathological contact is also known as the bladder-vaginal fistula.
A fistula is a pathological connection between two organs. A consequence of the vesicovaginal fistula is chronic inflammation of the bladder and urinary incontinence. In most cases, the bladder-vaginal fistula opens at the bottom of the bladder or on the back wall of the bladder. For hypoalgesia explanation, please visit percomputer.com.
In industrialized countries, a vesicovaginal fistula is very rare. In contrast, it occurs much more frequently in third world countries. Central Africa is particularly affected by the disease, which can be attributed to the difficult birth processes. The very young age of the women giving birth and the inadequate medical care are classified as risk factors. According to estimates, around 500,000 to two million patients worldwide live with an untreated urinary vaginal fistula.
In western countries, vesicovaginal fistula is mostly caused by complications occurring during abdominal surgery. Such trauma occurs in Europe primarily during the removal of the uterus ( hysterectomy ). In contrast, difficult births are the main cause of cystic fistula in third world countries. It is not unusual for lengthy births to result in pressure necrosis on the walls of the bladder and vagina.
Other possible reasons for the development of a vesicovaginal fistula are pelvic radiotherapy or gynecological malignancies. In some cases it is also caused by genital mutilation or rape. The biggest problem in third world countries is less malpractice at birth, but primarily the lack of obstetrics during the birth process. So turns of the child are not registered, which leads to serious damage to the soft tissues.
Poor women in particular are affected by a vesicovaginal fistula because they receive neither medical help nor the care of a midwife. Lack of education and bias also play a key role. Subforms of the vesicovaginal fistula are the ureterovaginal fistula (ureter-vaginal fistula) and the vesicointestinal fistula (bladder-intestinal fistula), in which the bowel and ureter are also affected.
Symptoms, Ailments & Signs
If an abdominal operation is responsible for the development of a vesicovaginal fistula, the first symptoms appear after five to ten days. The affected women suffer from constant uncontrolled loss of urine. These symptoms appear both during the day and at night. In the case of a rectovaginal fistula, stool passes through the vagina.
In clinical examinations, stool remains can often be found in the vagina. A certain degree of continence is only present in small fistulas, which means that part of the urine can be retained. Sometimes the urine only runs off when lying down, while it remains in the body when standing. But it can also be the other way around.
A common accompaniment of vesicovaginal fistula is cystitis and extensive eczema. The reason for eczema is the permanent wetting of the vulva and thighs with dripping urine.
Diagnosis & course of disease
Diagnosis of a vesicovaginal fistula is usually made through a thorough examination of the vagina. The fistula can then be localized. As part of the vaginal examination, a methylene blue solution or indigo carmine solution can be introduced into the bladder. A bluish discoloration occurs with the help of a tampon inserted into the vagina.
Imaging methods such as an X-ray examination of the lower urinary sections, magnetic resonance imaging (MRT) or a cystoscopy can be considered as further diagnostic options. A vesicovaginal fistula definitely requires medical treatment. Otherwise, the affected woman will suffer from incontinence for the rest of her life.
The major complication of a vesicovaginal fistula is incontinence. In most cases, the affected women suffer from problems with urinary retention after just a few days, which worsen as the disease progresses. The loss of urine leads to bladder infections and causes eczema.
Dermatitis is associated with other symptoms, such as skin rashes or bacterial infections, which need to be treated with antibiotics. Apart from any side effects of the prescribed antibiotics, the treatment of a vesicovaginal fistula is relatively free of complications. Injuries to the urinary tract can occur during an operation.
In individual cases, infections occur or bleeding and wound healing disorders occur. In the event of scarring, further functional disorders can occur. If the patient has to be placed with an indwelling catheter, this can also lead to infections and injuries. There is also a small risk of developing a blood clot.
Local estrogen therapy, such as that used in minor operations, increases the risk of complications from the cardiovascular system. Due to the one-off application, this so-called estrogenization usually does not cause any serious complications and is generally unproblematic for the patient. In some cases, allergic reactions to the accompanying substances of the preparation used occur.
When should you go to the doctor?
Vesicovaginal fistula can only occur in women who have had recent abdominal surgery. It is a complication of surgical treatment that can occur under certain circumstances. Therefore, girls and women belong to the risk group of the disease. In the event of irregularities and abnormalities after an operation, you will need to see a doctor again, since spontaneous healing is not to be expected and the possibilities of self-help for recovery are not sufficient.
If there are irregularities when going to the toilet, involuntary wetting or a general feeling of illness in the abdomen, the observations should be discussed with the doctor treating you. The loss of control over emptying the bladder is understood as a warning signal from the organism. Therefore, in these cases, consultation with the doctor is absolutely necessary. Feelings of shame and embarrassment should be overcome and addressed openly during a visit. If there is a feeling of tightness, an unexplainable feeling of discomfort or if you can only empty your bladder while lying down, you need to see a doctor.
Sudden discomfort, vaginal discharge and disturbances in the wound healing process require further investigation and treatment. Irregularities in the cardiovascular system, emotional and psychological problems and an increased body temperature are complaints that must be clarified by a doctor.
Treatment & Therapy
Treatment of a vesicovaginal fistula can be conservative or surgical. If the fistula was found following abdominal surgery, inserting a permanent catheter for a period of three to four weeks is often sufficient to allow healing. The success rate varies between 10 and 50 percent.
The prognosis is considered favorable provided treatment begins early and the fistula is small, no larger than a centimeter. In most cases, an operation is required for the successful treatment of a bladder fistula. This is done either vaginally or abdominally. However, the procedure should be delayed for about three months in order to ensure that inflamed tissue changes have healed.
In addition, local estrogenization is recommended before the operation. In this way, the vascularization of the vaginal wall is promoted. In the case of smaller vesicovaginal fistulas, which are considered uncomplicated, the vaginal surgical technique is used. A gentler procedure is possible with the vaginal approach. As a result, the patient spends less time in the hospital.
In the case of a larger fistula that reaches more than two centimeters in circumference, an abdominal approach is required. However, this is considered to be time-consuming and burdensome. It is also used in difficult anatomical conditions, combined vaginal fistulas and relapses.
To ensure that no vesicovaginal fistula develops after childbirth, the birth process must be treated accordingly. It is important to avoid prolonged pressure from parts of the child. But a healthy lifestyle also significantly reduces the risk of incontinence. In general, to prevent incontinence, one should pay attention to a healthy diet, not smoke and fight any existing obesity.
The follow-up treatment of a successfully treated vasicovaginal fistula depends on the sequelae caused by the fistula. If there is no menstruation as a result of the vasicovaginal fistula, this must be treated gynecologically. If the fistula has caused secondary infertility that cannot be repaired, artificial insemination must be carried out if this is possible if there is a desire to have children.
However, affected patients may also have to cope with being infertile for life and not being able to have children of their own. If narrowing of the vagina and/or permanent scars have developed as a result of the fistula, its symptoms must be treated. Pain, which occurs particularly during intercourse, can be relieved by regularly applying vaginal creams to the vagina and using lubricants during intercourse.
If the personal and/or social consequences (problems during sexual intercourse, permanent infertility, recurrence of the fistula) of the vasicovaginal fistula severely burden the psyche of the affected patient, psychological and psychiatric therapy should also be carried out. Discussions with your partner and family can also help you to cope psychologically with the changed situation.
If the fistula has not led to secondary diseases, regular follow-up examinations including the use of imaging methods (MRI, CT, cystoscopy, cystography) should be carried out in order to be able to identify and treat the recurrence of a fistula and long-term consequences at an early stage.
You can do that yourself
Vesikovaginal fistulas require medical attention. Small fistulas can be healed by wearing an indwelling catheter. The most important self-help measure is to wear the catheter according to the doctor’s instructions and to practice good personal hygiene.
Larger fistulas are surgically removed. Rest and bed rest apply after an operation. Good intimate hygiene is also important to avoid inflammation or the development of further fistulas. It is important to look out for unusual symptoms and inform the doctor about them. If pain, feelings of pressure or other symptoms occur that indicate a deterioration in the general condition, the doctor must be consulted.
Physical activities can be started a few days after the procedure. Initially, however, sports should be strictly avoided, since the friction can lead to bleeding in the area of the fistula. If there are problems with urination, the doctor must also be informed. If an abdominal access has been made, it may be necessary to temporarily stop eating. Smoking and drinking alcohol should be avoided for at least 24 to 48 hours after the operation. Women with a weakened immune system or other physical complaints discuss the self-help measures with the responsible doctor.