Vaginal bladder fistula: Difficult disease

This article is expertly consulted by a doctor Urologist - Department of General Surgery & Anesthesia - Vinmec Hai Phong International General Hospital.

Vaginal fistula is a difficult disease to say because it often manifests as urinary incontinence, causing many inconveniences in patients' daily activities. Therefore, the disease needs to be treated early.

Vaginal bladder fistula is the presence of an opening between the bladder and the vagina. The size of the hole can be very small, it can be seen with a toothpick or it can be as large as the tip of a finger.
In less developed countries, birth trauma due to prolonged labor is a common cause, while in developed countries, the most common cause is hysterectomy
Common causes, specifically are:
Congenital; Complications after a long difficult delivery: The fetal head presses the bladder-vaginal septum to the back of the pubic bone, causing ischemia, creating plaque and leading to bladder-vaginal perforation; Complications in caesarean section; Complications after surgery to remove fibroids; Bladder cancer and rectal cancer (cancer in situ or metastasized from elsewhere) invade the bladder-rectum-vaginal septum, causing perforation; Due to the placement of radioactive needles to treat cancer cells in the pelvis. The radiation destroys cancer cells and ruptures the wall between the bladder, rectum, and vagina.

Vaginal fistula is a difficult disease to say because the symptoms of the disease make patients quite shy to mention or go to the doctor. Symptoms depend on the size and location of the fistula.
The patient's always-present sign is urine from the bladder following the bladder fistula - the vagina continuously wets the patient's clothes. In the beginning, sometimes the patient does not notice because part of the urine will exit the normal way, partly through the fistula or mixed with the postpartum fluid.
Bladder-vaginal fistulas are easily confused with urinary incontinence because of the symptoms of leaking urine. However, unlike urinary incontinence, which only leaks during coughing or vigorous activity, vesico-vaginal fistula causes the patient to leak urine even at rest.
Patients with vesico-vaginal fistula often come to the hospital after a period of illness. At that time, their clothes often smell of urine, there may be signs of infection, red papules, itching on the thighs and vulva.

Symptoms of vesico-vaginal fistula usually appear after delivery or about 2-14 days after surgery. The amount of urine that comes out more or less depends on the size and location of the fistula; Color test: The doctor injects methylene blue solution into the bladder through a urethral catheter. Then, put 3 tampons into the vagina after the bladder is filled with water, if the tampon is soaked in blue, it can be determined that there is a bladder-vaginal fistula; Cystoscopy: Assess the number, size, location of the fistula and the degree of inflammation of the bladder to have the most appropriate treatment; Contrast urography: Detecting ureteral-vaginal fistula or accompanying vesico-vaginal fistula after perineal surgery.

In the case of small fistulas, the method of fistula electrocautery can be used, combined with bladder drainage to make the fistula scarify, and no more urine leakage.
Other cases will require surgery. It is best for patients to have surgery early when the bladder-vaginal parts adjacent to the fistula are still soft and have not been hardened due to prolonged inflammation. From the fistula, the surgeon will separate the bladder tissue from the vaginal tissue over an area large enough to close the bladder fistula, followed by suturing the vaginal fistula.

Pregnant women need to have regular antenatal check-ups to be closely monitored for pregnancy and prenatal prognosis; Pregnant women need to have scientific knowledge of food and drink to ensure safe reproduction, labor to avoid loss of strength, and avoid intervention in procedures with the risk of causing bladder - rectal - vaginal fistula after birth; Should give birth at reputable medical facilities, need to monitor postpartum signs, especially for pregnant women with prolonged labor; Women should go for regular health check-ups to promptly detect diseases such as uterine fibroids, bladder and rectal cancers, so that they can have early treatment plans to avoid complications of bladder-vaginal fistula. Although it is a difficult disease to say, but when having a bladder-vaginal fistula, the patient should not hide the disease but should go to the doctor soon to receive timely and effective treatment, to avoid adversely affecting the quality of life.