Pelvic Fistulas (Vesicovaginal & Rectovaginal)

Pelvic fistulas are abnormal connections between pelvic organs, most commonly between the bladder and vagina (vesicovaginal fistula) or rectum and vagina (rectovaginal fistula). These conditions can cause significant distress, including continuous leakage of urine or stool, recurrent infections, odor, and irritation. Fistulas may result from childbirth trauma, pelvic surgery, radiation therapy, an infection, or inflammatory bowel disease.

At The Medical Group of New Jersey, our urogynecology team provides comprehensive evaluation and advanced surgical repair for fistulas. We focus on restoring continence, comfort, and quality of life with compassionate care and highly specialized expertise.

Symptom Onset & Initial Evaluation

Fistula symptoms often begin suddenly once the abnormal opening forms. The hallmark sign is continuous leakage, which does not improve with position changes or bladder emptying.

Common symptoms include:

• Constant leakage of urine (vesicovaginal fistula)
• Passage of stool or gas through the vagina (rectovaginal fistula)
• Persistent foul vaginal odor
• Recurrent urinary tract infections
• Vaginal irritation, redness, or skin breakdown
• Pain during intercourse
• Pelvic pressure or discomfort
• Emotional distress or embarrassment

Evaluation

The evaluation focuses on confirming the presence, size, and location of the fistula and determining the safest, most effective repair approach. During your first visit at The Medical Group of New Jersey, your urogynecologist will:

• Review your symptom history and onset
• Discuss prior surgeries, deliveries, medical conditions, or radiation
• Evaluate stool and urine patterns
• Perform a gentle pelvic exam to look for visible openings or discharge
• Assess tissue health, inflammation, or signs of infection
• Determine whether specialized testing is required

A supportive environment is essential, as fistulas can be emotionally overwhelming. We ensure that patients feel heard, respected, and guided each step of the way.

Diagnosis & Testing

In addition to a pelvic exam, fistula diagnosis often involves specific tests to confirm the tract and plan surgical repair.

• Dye Testing (Methylene Blue Test): A colored dye is placed in the bladder to determine whether fluid leaks into the vagina. The dye test is useful for diagnosing vesicovaginal fistulas.
• Tampon Test: A tampon is placed in the vagina while dye is instilled into the bladder; staining confirms leakage.
• Cystoscopy: A small camera evaluates the bladder and identifies the exact fistula location.
• Vaginoscopy / Rectal Examination: Used to identify rectovaginal fistulas.
• CT or MRI Scan: Helps evaluate complex fistulas, abscesses, or surrounding tissue inflammation, especially for rectovaginal fistulas or cases related to Crohn’s disease.
• Fistula Probing or Imaging with Contrast: Occasionally used to map the tract before surgery.

All recommended imaging and testing are coordinated seamlessly through The Medical Group of New Jersey.

Treatment & Ongoing Management

Fistulas rarely close on their own and typically require surgical repair. Treatment involves managing inflammation, optimizing tissue health, and choosing the most effective surgical approach.

Initial Management Prior to Surgery

• Infection Treatment: Antibiotics or antifungals may be prescribed if infection is present.
• Tissue Healing Support: For post-menopausal patients, topical vaginal estrogen significantly improves tissue quality before repair.
• Bladder Drainage (in some vesicovaginal fistulas): A catheter may temporarily reduce leakage and help tissue heal.
• Crohn’s Disease or Inflammation Management: Rectovaginal fistulas may require GI coordination to control inflammation before repair.

Surgical Management

Surgery is the definitive treatment. Techniques vary depending on fistula type, size, cause, and tissue health.

Vesicovaginal Fistula Repair Options:

• Transvaginal Repair: The most common approach; repairs the opening from the vaginal side.
• Transabdominal or Robotic Repair: Used for high or complex fistulas, or when additional reconstruction is needed. Robotic repair offers excellent visualization and minimally invasive recovery.
• Tissue Interposition Flaps: Healthy tissue (e.g., Martius flap) is placed between the bladder and vagina to support healing.

Rectovaginal Fistula Repair Options:

• Transvaginal Repair
• Transanal Repair
• Transperineal Approach
• Advancement Flap Procedures
• Seton placement (for fistulas related to Crohn’s disease)

Complex Fistulas Repair Options:

• Combined colorectal and urogynecology surgery
• Staged repair
• Robotic-assisted reconstruction

At The Medical Group of New Jersey, repairs are performed by experienced surgeons using the most advanced, minimally invasive techniques available.

Monitoring & Follow-Up

Close follow-up is essential after fistula repair to ensure healing and prevent recurrence. Follow-up visits typically include:

• Examination of the surgical site
• Monitoring for leakage or discharge
• Assessment of vaginal tissue health
• Review of bowel and bladder function
• Imaging or cystoscopy if healing is uncertain
• Guidance on physical activity, sexual function, and postoperative care

Most patients recover gradually and experience significant improvement within weeks to months.

With expert surgical repair and proper postoperative care, pelvic fistulas generally have an excellent prognosis. Most patients experience resolution of leakage, improved daily comfort, and restored urinary and sexual function. Advanced techniques at The Medical Group of New Jersey support highly successful outcomes, even in complex cases.