What is a Vaginal Fistula?

J.L. Drede

A vaginal fistula, sometimes also known as an obstetrical fistula, is essentially a hole or tear somewhere along the inner wall of the vagina. In most cases these holes create an opening or passageway to some other part of the body, particularly the bowels, colon, or urinary tract. As a result many women with this condition experience an essentially uncontrollable leakage of waste out of their vaginas, which can be embarrassing as well as harmful. Fistulas can be caused by a number of internal problems, but difficult childbirth is usually one of the most common. Women who receive medical care during labor and delivery usually have these sorts of problems identified right away. In most cases diagnosis and treatment is straightforward, but it does require medical intervention. Many experts consider obstetrical fistulas to be a symptom of poverty, and they do tend to be most common — and most extreme — in very poor communities where women have little or no access to post-natal care.

A vaginal fistula is a hole in the wall of the vagina.
A vaginal fistula is a hole in the wall of the vagina.

Four Main Types

There are generally four kinds of vaginal fistula: vesicovaginal, colovaginal, rectovaginal and enterovaginal. The main difference between these is where they are located. Vesicovaginal fistulas happen between the vaginal wall and the urinary tract, for instance, while those in the colovaginal category abut the colon; a rectovaginal fistula connects the vagina and the rectum, and holes classed as enterovaginal happen where the vagina presses against the small bowel.

X-rays may be used to search for vaginal fistulas.
X-rays may be used to search for vaginal fistulas.

Main Causes

Traumatic or difficult childbirth is the primary cause of all four of these types. A fetus that is awkwardly angled, a pelvis that is too small, or a mother who goes into medical distress during delivery can all cause abnormal pressure on the vaginal walls, which can and often does lead to tearing and tissue death. The tissues of the vagina are generally sensitive to start with, but prolonged pressure and pushing by a misaligned baby often exacerbates the situation. Most of the time babies are stillborn when labor has been traumatic enough to cause fistulas, but not always.

A rectovaginal fistula allows the contents of the rectum to spill into the vagina.
A rectovaginal fistula allows the contents of the rectum to spill into the vagina.

There are also instances in which vaginal fistulas happen independent of labor and delivery. Inflammatory bowel disease is sometimes a cause if pressure from the bowels or rectum is intense enough and prolonged enough to aggravate the outer vagina to the point of tearing; pelvic surgery mishaps or healing problems can also be to blame. Radiation treatment for cervical or ovarian cancer has sometimes been shown to lead to fistulas, as well. In these cases, the hole may not manifest itself for days, weeks, or even years after the original damage was done.

Women may experience an uncontrollable leakage of waste from the vagina as a result of a vaginal fistula.
Women may experience an uncontrollable leakage of waste from the vagina as a result of a vaginal fistula.


Holes anywhere in bodily tissue tend to be quite painful, and this almost always holds where the vagina is concerned. One of the first signs a woman may notice when she has a fistula is intense, searing pain. This can be difficult to distinguish from the pain normally associated with childbirth, though, which is how the condition is often undetected in women who lack medical care.

It is rare for these sorts of holes to heal on their own. Most of the time they only get worse, and commonly grow infected from constant exposure to moisture and bacteria. One of the most noticeable signs of this sort of fistula is a sour, rancid smell coming from the vagina, and regular leakage of feces and urine out of that orifice. In most cases there is nothing a woman suffering from this can do to better her situation outside of seeking medical attention.

Diagnosis Basics

Even if the symptoms seem obvious, medical professionals usually need a precise diagnosis in order to begin treatment. A dye test is frequently given first. In this test, the bladder is filled with a dyed solution. The patient then passes the fluid while the healthcare professional examines the vagina, looking for leakage. The medical professional will also usually use various scopes to inspect the vagina, ureters, bladder, anus and rectum. X-rays may also be taken to see if multiple fistulas are present.

Treatment Options

Surgery is almost always required to repair the damage. In the case of severe tearing or extensive dead tissue, the surgeon may introduce new tissue to help aide the recovery. More complicated procedures may also be needed if a bowel disease caused the fistula. In these cases, a partial proctectomy — a surgical removal of a portion of the rectum — may be needed to prevent further complications. Additional treatment to help prevent further fistulas and help promote healing can include changes in diet and the addition of fiber supplements to improve bowel regularity.

Radiation treatment for ovarian cancer may cause vaginal fistulas.
Radiation treatment for ovarian cancer may cause vaginal fistulas.

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Discussion Comments


I had a hysterectomy 25 years ago and have had no problems with my bladder. That is, until I fell and injured my hip and groin areas. Since then, I have leakage and feel the passing of air through my urethra and pelvic pain.

I have seen a hip surgeon who said it was my back, so I saw my back surgeon and he said it was my hip. So I went back to the hip surgeon who said it was my back so I again went to see my back surgeon. I saw a third surgeon who was upset that the other two doctors claimed it was my hip or back and this third one said that it was my hip *and* my back, but not one of the three has given me any advice on who to see. Now I am finding this can be a serious problem.

About 90 percent of my day is consumed with thinking about the leakage and pain. Are doctors just shining me on because I am on Medicare and our state's health plan and they only get reimbursed about $280 on a $1,200 medical bill? I need help. I do not want to live this way and will not live the rest of my life like this.


My mother's sister developed pelvic complications after a partial hysterectomy about six months ago. She had what they called a vesicovaginal fistula that had something to do with a uterine prolapse.

It wasn't until about three weeks ago before she said anything to her gynecologist about the problems she was having with vaginal discharge and urinary incontinence.

After a few tests they discovered it was a vaginal bladder fistula and now she is scheduled for surgery next week.


@babylove - Recto-Vaginal fistual really does exist but the good news is, is that it's not that common to acquire one from childbirth, even for those who have had an episiotomy.

That's not to say however that it could not happen because it does. If your gynecologist does the repair correctly, there should be no cause for concern.

If, on the other hand you start experiencing rectal vaginal fistula symptoms you should see your physician right away. A reconstructive surgery called sphincteroplasty should be performed by a urogynecologist, rather than your OB-GYN.

Don't worry though your baby doesn't need you to stress over something that has no certainty to it. I'm sure everything is going to be just fine and congratulations!


Hi. I'm twenty-four years old and almost eighteen weeks pregnant with my first child. A co-worker of mine told me this horrific story about her relative who developed rectovaginal fistula after childbirth.

Apparently she had an episiotomy during labor that wasn't repaired properly and now she lives with rectal gas and feces discharging from her vagina.

I couldn't believe it and I didn't believe it for awhile until curiosity got the best of me and I ran across this article. I''m really frightened now. I'm a small woman and the chances of me getting an episiotomy during labor are probably very high.

Is recto vaginal fistula that common after a vaginal delivery?

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