What are the causes of vaginal fistula?
The most common reason in the world for the development of vaginal fistula after childbirth is prolonged labor with the baby being tightly pressed against the birth channel. The pressure of the child against the surrounding tissue of the mother cuts off the blood circulation and leads to the death of vast areas of the tissue, a process that is known as necrosis. This is common in areas of the world where obstetrics care is poor and access to a cesarean birth is not readily available. The baby almost always dies and the mother often is subsequently shunned by her family and community due to the symptoms caused by vaginal fistula.
In developed countries vaginal fistula due to prolonged labor are almost unknown. However, vaginal fistula in particular recto-vaginal fistula can develop as a complication in childbirth due to tears in the vagina that are not cared for properly or that become infected. Surgical cuts to enlarge the birth channel can also sometimes become infected and lead to the development of a vaginal fistula. Less common reasons for vaginal fistula are injuries due to rape or poorly performed abortions. A chronic inflammatory bowel disease called Crohn’s disease can also cause recto-vaginal fistula, but in this case they originate from the rectum rather then from injuries to the vagina.
What are the symptoms of vaginal fistula?
Symptoms of vaginal fistula are incontinence in the case of vesico-vaginal fistula, and leakage of feces in the case of recto-vaginal fistula. Frequently the fistula become infected and can also cause urinary tract and kidney infections that can lead to kidney failure and death if left untreated. Leakage of a smelly vaginal discharge or pus from the vagina can also be a symptom of a vaginal fistula. Irritation and / or pain around the vagina or anus can be experienced with vaginal fistula. This pain can be worse during sexual intercourse. Another symptom that is rarer is nerve damage to the nerves in the vaginal area. The nerve damage can cause incontinence and / or significant paralysis to the legs which can lead to difficulties in walking. The emotional symptom can be even worse than the actual physical symptoms. There can be a considerable social stigma associated with vaginal fistula. Affected women often feel dirty and have difficulties engaging in social life or being intimate with their partner. Sometimes vaginal fistula can lead to an inability to bear children which can also be emotionally devastating.
What are the treatment options for vaginal fistula?
The treatments of vaginal fistula depend on the size of the fistula, its cause, location and effect on the surrounding tissue. In some cases of small vaginal fistula, the lesions will heal without treatment. In other cases surgery is necessary. Surgery however is not possible, if the fistula or the surrounding tissue is inflamed and / or infected. In the case of bacterial infections of the fistula, treatments with antibiotics can be used before the surgery. Laxatives or a liquid diet for several days might also be used before the surgery in the case of recto-vaginal fistula to clean out the rectum. The surgery itself attempts to close the fistula by sewing together healthy surrounding tissue and covering the opening of the fistula. Sometimes a tissue graft from surrounding healthy tissue is necessary. In some cases a colostomy, an artificial opening of the rectum to divert the feces away from the fistula, is done eight to twelve weeks before the repair of the fistula is attempted. This is usually done if there is an infection, scarring from a previous surgery or significant fecal matter in the fistula. After the fistula repair surgery, a liquid diet is usually prescribed for a few days, followed by a low fiber diet for a few weeks. The purpose of the low fiber diet is to reduce the volume and frequency of bowel movements. Several daily sitz baths and blow drying the area with a hair dryer might also be recommended as a follow up treatment after a fistula repair surgery. Usually women are recommended to have a scheduled cesarean section, if they become pregnant after a successful fistula repair surgery.
Home remedies to help with the treatment of a vaginal fistula
While most vaginal fistula require surgery for treatment, there are several home remedies that can help alleviate the symptoms and in some cases the fistula will heal without surgical intervention. Wash the affected area often with warm water and if necessary, a gentle unscented soap. Avoid using dry toilet paper, and use moist unscented and alcohol-free towelettes or baby wipes instead. Perfumed soap or feminine pads or tampons can dry out and irritate the skin. Pad the area dry gently with toilet paper or use a hairdryer to air dry the area. Don’t use vaginal douches as they can increase your risk of infection. Cold compresses can bring pain relief and can help with inflammation and swelling. Loose cotton clothing that allows airflow will keep the area dryer. If you use pads or adult diapers for discharges makes sure they have an absorbent wicking liner and that you change them as soon as they become soiled. You can ask your treating physician to recommend a water barrier forming cream that you can apply to the dry clean skin to prevent it from coming into contact with discharges. Unscented, non-medicated talcum powder or cornstarch can also help bringing relief.