Descripción general

Una fístula vaginal es una abertura inusual que se desarrolla entre la vagina y otro órgano, como la vejiga, el colon o el recto. El proveedor de atención médica puede describir la fístula vaginal como un orificio en la vagina que permite el paso de la orina, los gases o las heces.

Las fístulas vaginales pueden desarrollarse después del trabajo de parto, debido a una lesión, una cirugía, una infección o un tratamiento con radiación. Es posible que necesites cirugía para corregir una fístula.

Existen varios tipos de fístulas vaginales. El nombre varía según la ubicación y los órganos que afecten:

  • Fístula vesicovaginal. También denominada "fístula vesical", esta abertura se presenta entre la vagina y la vejiga urinaria y es una de las fístulas más comunes.
  • Fístula ureterovaginal. Este tipo de fístula se produce cuando la abertura inusual se desarrolla entre la vagina y los conductos que transportan la orina desde los riñones hasta la vejiga (uréteres).
  • Fístula uretrovaginal. La abertura se produce entre la vagina y el tubo que transporta la orina fuera del cuerpo (uretra). Este tipo de fístula también se conoce como fístula uretral.
  • Fístula rectovaginal. En este tipo de fístula, la abertura se produce entre la vagina y la parte inferior del intestino grueso (recto).
  • Fístula colovaginal. Con una fístula colovaginal, la abertura se produce entre la vagina y el colon.
  • Fístula enterovaginal. En este tipo de fístula, la abertura se produce entre el intestino delgado y la vagina.

Síntomas

Vaginal fistula symptoms can include:

  • Leaking of urine or stool, or passing of gas, through the vagina.
  • Urinary tract infections that happen often.
  • Urine that has an unusual odor or contains blood.
  • Vaginal fluid called discharge that looks or smells unusual.
  • Pain during sex.
  • Pain, swelling or irritation in the area between the vagina and the anus, called the perineum.
  • Repeated infections of the vagina.

The exact symptoms a person has depend in part on the location of the fistula.

When to see a doctor

Get a healthcare checkup if you think you have symptoms of a vaginal fistula. Tell your healthcare professional if you have symptoms that affect your daily life, relationships or mental health.

Causas

Vaginal fistulas have many possible causes, including certain medical conditions and problems that can happen because of surgery. These causes include the following:

  • Surgery complications. Surgeries that involve the vaginal wall, anus or rectum can lead to vaginal fistulas. So can surgery on the area between the vagina and anus, called the perineum. Fistulas can form for reasons such as injuries during surgery and infections after surgery. Skilled surgeons can repair injuries while operating, which lowers the risk of fistula. But complications such as fistulas are more common after surgery in people with diabetes or in people who use tobacco.

    Surgery to remove the uterus, called a hysterectomy, is an example of an operation that can raise the risk of a vaginal fistula. The risk is higher if the hysterectomy is more complex. For example, the risk rises if the surgery takes longer than five hours, or if it involves larger blood loss or the removal of more surrounding tissue.

  • Childbirth injuries. A vaginal fistula could stem from tearing that sometimes happens when a baby's head comes through the opening of the vagina. Or a fistula might form due to an infection of a surgical cut made between the vagina and the anus to help deliver a baby. This cause is not common in developed countries.

    Being in labor a long time because the baby can't move into the birth canal can raise the risk of a vaginal fistula, mainly in developing countries. That's partly because access to emergency delivery measures such as C-section may be limited.

  • Crohn's disease. This condition inflames tissue that lines the digestive tract. If you follow your Crohn's treatment plan, you're not likely to get a vaginal fistula. Crohn's is a type of inflammatory bowel disease (IBD). Another type of IBD called ulcerative colitis also may lead to vaginal fistulas, but the risk of that happening is even lower.
  • Certain cancers and radiation therapy. Cancer of the anus, rectum, vagina or cervix can lead to a vaginal fistula. So can damage from radiation therapy for the treatment of cancer in the pelvic area.
  • Diverticulitis. This condition involves small, bulging pouches in the digestive tract. Diverticulitis that leads to a vaginal fistula is more common in older people.
  • A large amount of stool stuck in the rectum. This condition is known as a fecal impaction. It also is more likely to cause a vaginal fistula in an older person.

Factores de riesgo

A vaginal fistula has no clear risk factors.

Complicaciones

Vaginal fistulas can lead to other health conditions called complications. Complications of vaginal fistulas include:

  • Fistulas that keep coming back.
  • Ongoing pelvic infections.
  • Narrowing of the vagina, anus or rectum. This also is called stenosis.
  • Trouble becoming pregnant.
  • Loss of a pregnancy after 20 weeks, also called stillbirth.

Prevención

There are no steps you need to take to prevent a vaginal fistula.