A fistula is an abnormal hole or tunnel-shaped opening that develops between two separate organs. Fistulas may occur between organs anywhere in the body.
Normally, the urinary system is blocked from the gastrointestinal system. A bladder fistula occurs when a connection forms between the bladder and another organ, most often the bowel or the vagina. The bladder then leaks through the opening and out the other organ.
Bladder fistulas do not heal on their own; however, they are preventable and treatable.
Types of bladder fistula
There are many types of fistulas. The most common bladder fistulas include the following:
- Colovesical fistulas (colon-bladder fistula) occur between the bladder and bowel and is the most common type of fistula between the bladder and bowel. This type of fistula is more common in males, with an occurrence rate of three to one.
- Enterovesical fistulas occur between the bowel and vagina. Other names for this type of fistula are vesicoenteric fistula or intestinovesical fistula.
- Ureterovaginal fistulas occur between the ureter and vagina. This type of fistula occurs only in women.
- Vesicovaginal fistulas occur between the bladder and vagina. This type of fistula occurs only in women.
Classification of fistulas includes:
- Blind – the tunnel connects two structures but is open on only one end
- Complete – the tunnel is open on both ends
- Horseshoe – the tunnel connects the anus to the surface of the skin
- Incomplete – tunnel connection is formed, but does not connect to another internal structure
Symptoms
Bladder fistula symptoms vary by type and severity of the fistula. They may include any of the following:
- Abdominal pain
- Dysuria (painful urination)
- Foul-smelling urine (urine smells like sulphur)
- Incontinence
- Sore or infected genital area
- Pain during intercourse
- Pyelonephritis (urinary tract infection where both kidneys become infected)
- Recurrent sepsis
- Urinary obstruction (inability to completely void urine)
- Unusual vaginal discharge
- Problematic urinary tract infections (recurrent cystitis)
- Urine that looks like stool
- Gas that escapes through the urethra when urinating
Causes and risk factors
- Diverticulitis — accounts for 50 to 70 percent of cases
- Crohn’s disease — accounts for 10 percent of cases
- Other inflammatory conditions
- Cancer
- Trauma
- Foreign body
- Prolonged childbirth
- Post-surgical complication
- Urinary or other infections
- Congenital defect (incomplete separation of the two body systems during embryonic development) – rare
- Injury during hysterectomy surgery – most common cause in the U.S.
- Pelvic fractures
- Abortion
- Prolonged childbirth
- Infected episiotomies after childbirth
- Cancer of the pelvic area
- Radiation treatment of the pelvic area
- Abscess of glands near rectum
- Sexual abuse
- Rape
- Surgery complication to treat bladder or vaginal problems — common cause
- Gynecological cancer or canter treatment, such as radiation
- Recurrent, severe urinary tract infections — rare
Diagnosis
Sometimes bladder fistulas are found during an annual gynecologic exam. More often, uncomfortable symptoms prompt patients to call a doctor. The doctor will perform a physical exam and often order imaging tests to visualize the internal organs.
The most commonly ordered tests are an X-ray of the pelvis or a CT scan with contrast or dye. The contrast is injected through a vein or catheter in the bladder and makes it easier for the doctor to see the fistula’s source. Blood tests and a test for a urinary tract infection may also be performed.
Treatment options
Surgery is the only treatment option for fistulas, except in the rare case of a small fistula detected very early. In those cases, catheter drainage may successfully treat the fistula, but not always.
Bladder fistula surgery closes off the fistula opening by removing the damaged part of the bladder and moving healthy tissue between the bladder and other organs. Fistula surgery is normally very successful. However, if the fistula is caused by cancer or cancer treatment, outcomes tend to be less successful.
Any additional problems that are discovered during surgery are also corrected, such as organ damage, infection, edema (swelling), scar tissue, and impaired blood supply. After the surgery, a catheter in the bladder is left in for a few weeks while the surgical area heals. Antibiotics or other medications may be prescribed.
If you have symptoms of a bladder fistula or suspect you may have a fistula, contact one of our associates today for a consultation or to set up an appointment.
