A vaginal fistula is an abnormal opening in the vagina that allows stool or urine to pass through the vagina. A colovaginal fistula means the opening is between the vagina and the colon. It is a relatively uncommon occurrence.
Colovaginal fistulas can result from an injury, trauma from childbirth, surgery, inflammatory conditions such as diverticulitis or Crohn’s disease, infection, or cancer or radiation treatment in the pelvic area. They most commonly occur among women who have undergone a total hysterectomy. When the uterus is removed, inflammatory conditions in the pelvis can find a weak point at the vaginal cuff, and a fistula can form.
Symptoms consist of passage of fecal matter or gas through the vagina. A small hole permits passage of air. A larger fistula can cause liquid or even solid stool to pass. Other symptoms include:
- Foul-smelling vaginal discharge
- Recurrent vaginal or urinary tract infections
- Pain during sexual intercourse
- Abdominal pain or pain in the vagina
- Nausea or vomiting
- Sepsis and even death
Diagnosis is determined by patient history plus a physical exam. A CT with contrast or endoscopy can help diagnose small fistulae.
A colovaginal fistula may need to be surgically closed to restore normal function. The size and location impact the treatment protocol. If diverticular disease has caused the fistula, a sigmoid colectomy may need to be done.