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FISTULA

TYPES
1. Rectovaginal Fistula
2. Vesicovaginal Fistula
Janet Kerubo
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RECTOVAGINAL FISTULA
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• A rectovaginal fistula is an abnormal connection or

passageway that forms between the rectum and the vagina.
• This condition can lead to the passage of stool, gas, or other
rectal contents into the vaginal canal, resulting in various
symptoms and potential complications.
4 TYPES

• Low Rectovaginal Fistula: This type is closer to the

vaginal opening and is typically easier to diagnose and
repair.
• High Rectovaginal Fistula: This type is situated higher
in the vaginal canal, closer to the cervix or uterus,
making it more challenging to diagnose and treat.
5 CAUSES

• Rectovaginal fistulas can occur due to various factors,

including:
• Obstetric injuries during childbirth (e.g., tears or episiotomy
complications).
• Inflammatory bowel diseases (e.g., Crohn's disease,
ulcerative colitis).
6 CAUSES CONT…

• Surgical complications after gynecological or colorectal

surgeries.
• Radiation therapy for pelvic cancers.
• Trauma or injury to the pelvis.
7 CLINICAL FEATURES

• The clinical presentation of rectovaginal fistula may

include:
Passage of stool, gas, or foul-smelling discharge from
the vagina.
Recurrent vaginal infections.
8 CLINICAL FEATURES CONT…

Pain and discomfort in the pelvic region.

Emotional distress and embarrassment.
Fecal or urinary incontinence.
Skin irritation or breakdown in the vaginal and perianal
area.
9 DIAGNOSIS

• Diagnosing typically involves the following:

Physical Examination: A healthcare provider may perform a
pelvic examination to assess the fistula's location and
characteristics.
Imaging Studies: These may include a contrast study, such as a
barium enema or MRI, to visualize the fistula's extent.
Endoscopy: A sigmoidoscopy or colonoscopy may be performed to
evaluate the condition of the rectum and rule out other causes.
10 MANAGEMENT

• Treatment options for rectovaginal fistula depend on its

type, location, size, and underlying causes. Common
approaches include:
Conservative Management: In some cases, especially
with small, low fistulas, conservative measures like dietary
modifications, pelvic floor exercises, and medications to
reduce inflammation or infection may be attempted.
11 MANAGEMENT CONT…

Surgical Repair: Surgical intervention is often necessary and may

involve various techniques, including primary suturing, flap repair,
• or the use of a temporary colostomy to divert stool away from the
fistula site during healing.
Medical Treatment: If the fistula is related to an underlying
condition like Crohn's disease, managing the underlying disease with
medications and lifestyle changes may help prevent recurrence.
12 PREVENTION

• Prevention primarily involves reducing the risk factors:

Proper obstetric care and techniques during childbirth.

Appropriate surgical techniques during gynecological or colorectal
procedures.
Careful management of inflammatory bowel diseases to minimize
complications.
13 COMPLICATIONS

• Recurrence of the fistula.

• Infections and abscess formation.
• Chronic pain and discomfort.
14 COMPLICATIONS CONT…

• Psychological distress and reduced quality of life.

• Fecal or urinary incontinence.
• Nutritional deficiencies, especially in cases related to
inflammatory bowel diseases.
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VESICOVAGINAL FISTULA (VVF)

16 DEFINITION

• Vesicovaginal fistula (VVF) is an abnormal passage or

connection that develops between the urinary bladder
and the vagina.
• This condition can result in the involuntary passage of
urine from the bladder into the vaginal canal.
17 TYPES

• Congenital VVF: Rarely, VVFs can be present at birth, often

due to developmental abnormalities in the fetal urinary system.
• Acquired VVF: This is the more common type and typically
occurs as a result of various factors, such as surgery, trauma, or
infection.
• Acquired VVFs can be further categorized based on their size
and location, which affects their management.
18 CAUSES

• The causes of acquired vesicovaginal fistulas include:

Obstetric injuries during childbirth, particularly in cases of
prolonged labor, use of forceps, or a large fetal head.
Gynecological surgeries, such as hysterectomy or pelvic
organ prolapse repair.
19 CAUSES CONT…

Radiation therapy for pelvic cancers.

Infections, including urinary tract infections (UTIs) or
pelvic inflammatory disease (PID).
Trauma to the pelvic region, such as a severe injury or
accident.
20 CLINICAL FEATURES

• Continuous or intermittent urinary incontinence.

• Strong and unpleasant urinary odor.
• Vaginal discharge, which may be mixed with urine.
21 CLINICAL FEATURES CONT…

• Frequent UTIs.
• Skin irritation or inflammation around the vaginal area.
• Emotional distress and social embarrassment due to
urinary leakage.
22 DIAGNOSIS

• Diagnosing involves the following:

Medical History and Physical Examination: A detailed history

and pelvic examination may provide clues to the presence of a
VVF.
Urinalysis: This can help detect abnormalities in the urine, such as
infection or elevated creatinine levels.
23 DIAGNOSIS CONT…

Cystoscopy: A thin, flexible tube with a camera

(cystoscope) may be used to visualize the bladder and the
site of the fistula.
Imaging Studies: Imaging modalities like ultrasound,
MRI, or CT scans can provide additional information about
the VVF's size and location.
24 MANAGEMENT

• The management depends on various factors, including the size,

location, and underlying causes.
Surgical Repair: Most VVFs require surgical closure. This can
be done through vaginal or abdominal approaches, and the choice
depends on the specific characteristics of the fistula.
• Surgery aims to close the abnormal communication and restore
normal bladder function.
25 MANAGEMENT CONT…

Temporary Urinary Diversion: In some cases, particularly when

the VVF is large or complex, a temporary urinary diversion,
• such as a urinary catheter or ileal conduit, may be needed to allow
the bladder and vaginal tissues to heal before definitive repair.
Medical Management: Antibiotics may be prescribed to manage
or prevent urinary tract infections associated with the VVF.
26 PREVENTION

• Proper obstetric care to reduce the risk of obstetric injuries

during childbirth.
• Careful surgical techniques during gynecological
procedures.
• Early management of infections and pelvic inflammatory
conditions.
27 COMPLICATIONS

• Recurrence of the fistula after surgical repair.

• Infections and abscess formation.
• Chronic urinary tract infections.
• Urinary incontinence.
• Psychological and social distress due to constant urinary
leakage.
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Any Question??
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Thank you!