Vaginal, Urinary and Anal Fistulas

Integrated Clinical Care for Vaginal, Urinary and Anal Fistulas

Loyola Medicine provides comprehensive, integrated care for the treatment of vaginal, urinary and anal fistulas. While the resulting symptoms, including urinary incontinence and fecal incontinence, can be distressing, Loyola’s specialists are highly experienced in treating these conditions.

A fistula is an abnormal connection that occurs between two neighboring parts of the body, often caused by injury, surgery, trauma or infection. Fistulas can cause urine and stool to leak, having a significant impact on health and quality of life.

Why Choose Loyola for Vaginal, Urinary and Anal Fistulas?

Loyola provides truly integrated clinical care for vaginal, urinary and anal fistulas, bringing together specialists in gynecology, female pelvic medicine and reconstructive surgery, gynecologic oncology, gynecologic surgery, urology, urogynecology and others to provide men and women with advanced care in a compassionate environment.

As part of an academic medical center, Loyola’s expert clinicians perform and teach the latest surgical techniques and medical treatments in numerous locations across the Chicago area. In addition, our nurses have earned Magnet status, which means they have been recognized for delivering the highest level of care.

Loyola’s specialists are widely acclaimed for their success in treating vaginal, urinary and anal fistulas, offering the latest in medical and surgical treatment.

Loyola was one of the first medical centers in the area to offer minimally invasive pelvic surgery to treat vaginal, urinary and anal fistulas, incontinence and other urologic and urogynecologic conditions.

What are Vaginal, Urinary and Anal Fistulas?

Fistulas are abnormal tubelike openings that connect two body parts, either two internal organs or an organ and the skin.

Pelvic fistulas cause fluid leaks that can be uncomfortable, distressing and sometimes dangerous. Fistulas start with some type of tissue damage, such as from:

• Abdominal surgery, such as from hysterectomy or cesarian section during childbirth
• Diseases such as Crohn’s disease or diverticulitis
• Infection, sometimes following an episiotomy during childbirth
• Injury or tear during childbirth
• Pelvic cancers, such as cervical or colon cancer
• Radiation treatment
• Traumatic injury, such as from an auto accident

Such tissue damage can result in a variety of fistulas, including:

• Anal fistula — An anal fistula is an abnormal connection between the anal canal and the skin near the anus; they are often caused by anal abscesses. Anal fistulas can start between the internal and external sphincter muscles and extend to the anus (intersphincteric fistula), just beyond the anus (transsphincteric fistula) or up to the puborectal muscle (suprasphincteric fistula). Anal fistulas can also occur between the rectum or sigmoid colon to the anus (extrasphincteric fistula) and are often caused by an appendiceal abscess, diverticular abscess or Crohn's disease.
• Urinary fistula — A urinary fistula is an abnormal connection between the urinary tract and another organ; this causes leakage of urine along with gas and stool. A connection may form between the colon and the uterus (colouterine fistula), urethra and the rectum (rectourethral fistula), colon and bladder (colovesical fistula), ureter and vagina (ureterovaginal fistula), bladder and vagina (vesicovaginal fistula) or bladder and uterus (vesicouterine fistula).
• Vaginal fistula — A vaginal fistula is an abnormal connection between the vagina and another organ; this causes stool or urine to pass through the vagina. A vaginal fistula may form between the vagina and the colon (colovaginal fistula), rectum (rectovaginal fistula), small intestine (enterovaginal fistula), bladder (vesicovaginal fistula), ureter (ureterovaginal fistula) or urethra (urethrovaginal fistula).

Symptoms of a fistula may include:

How are Vaginal, Urinary and Anal Fistulas Diagnosed?

Loyola’s specialists are experts at diagnosing vaginal, urinary and anal fistulas. Your doctor will take a detailed medical and family history and conduct a physical exam.

Depending on your condition, your doctor may request additional testing that may include:

• Anorectal manometry — This test measures the pressure and strength of the anal muscles in patients with constipation or fecal incontinence.
• Anoscopy — Your doctor may use an anoscope (a small lighted tube used to view the anal canal) to evaluate the anus, anal canal and lower rectum. It may be used to diagnose hemorrhoids, fissures, abscesses, inflammation, tumors, prolapse and fistulas.
• Barium enema — Your doctor may suggest a barium enema to detect changes or abnormalities in your colon. Barium is injected and coats the lining of your colon, allowing X-ray imaging to produce clear images of your colon.
• Colonoscopy — Using a thin, flexible, lighted tube, your doctor can view your colon, take tissue samples and detect ulcers, colon polyps, tumors and areas of inflammation or bleeding. Learn more about colonoscopy.
• CT scan (computed tomography) — CT images provide useful information about pelvic organs and internal structures and may help to rule out medical conditions with similar symptoms. A CT scan may help locate a fistula and determine its cause. Learn more about CT scans.
• Cystography — Contrast dye is injected into the bladder and then visualized by X-ray or fluoroscopy to evaluate bladder and urinary tract functions.
• Cystoscopy — Using a tube with a light and a camera, your doctor can evaluate urinary symptoms and anatomical abnormalities of the urethra and bladder.
• Endoscopic ultrasound (EUS) — EUS can be used to evaluate and diagnose gastrointestinal conditions; it allows your doctor to view the anal sphincter muscles and check for muscle tears and other abnormalities, including fistulas.
• Intravenous pyelography — Your doctor may use this type of X-ray imaging to view your kidneys, bladder and urinary tract. Contrast dye is first injected into a vein in your arm so that your doctor can see how your urinary tract is working.
• Pelvic floor MRI (magnetic resonance imaging) — Your doctor may request an MRI of your pelvic floor in order to evaluation function of the muscles, organs and support of the pelvic floor. An MRI can show the location of a fistula, as well as organs involved and any tumors that may exist.
• Rectal dye injection — To determine if a fistula exists, a blue dye may be injected into the rectum after cotton has been inserted into the vagina. If the cotton absorbs some of the blue dye, this indicates an abnormal passageway between the rectum and the vagina.

How are Vaginal, Urinary or Anal Fistulas Treated?

Loyola’s urologists, urogynecologists and colorectal surgeons specialize in the diagnosis, treatment and management of vaginal, urinary and anal fistulas.

Loyola’s clinicians have received specialized training to diagnose complex conditions and provide the most advanced treatment options. Your doctor will discuss all appropriate options in detail and answer any questions you may have before beginning treatment.

Sometimes fistulas heal on their own or can be corrected with catheter drainage, but often they require surgery. Your doctor may prescribe antibiotics or other medications as part of medical monitoring.

Depending on your case, your surgeon may recommend a minimally invasive approach to surgery. Surgical treatment for vaginal, urinary and anal fistulas may include:

• Anal fistula plug — Your surgeon will remove infected tissue from the fistula, inject collagen or a fibrous protein to fill the space and close the connection with stitches.
• Endoanal advancement flap — Your surgeon may use a flap for complex fistulas, which uses tissue to close the opening of the fistula.
• Fistulotomy — This treatment is very effective in treating anal fistulas. Your surgeon will open the fistula and remove the infected tissue, allowing it to drain and heal. The tissue is then stitched in place.
• Ligation of the intersphincteric fistula tract (LIFT) — This two-stage surgical treatment for anal fistulas first uses a silk, nylon, rubber or plastic thread (seton) to widen the fistula. Several weeks later, the infected tissue is removed and the fistula is surgically closed.
• Minimally invasive surgery — Small vaginal fistulas may be effectively repaired with minimally invasive vaginal surgery, closing the abnormal connection and restoring proper function using laparoscopy or robotic surgery.
• Reconstructive surgery — Larger vaginal and urinary fistulas may require extensive pelvic surgery and reconstruction to close the fistula and restore proper function to the affected organs. Learn more about reconstructive surgery.
• Seton techniques — A silk, nylon, rubber or plastic thread (seton) may be passed through the fistula tract, forming a ring. This allows fluid to drain and reduces inflammation.
• Vaginal surgery — Vaginal fistulas are usually treated with surgery through the abdomen or vagina. Minimally invasive surgery may be available.

Specialized Care to Treat Vaginal, Urinary and Anal Fistulas

Loyola’s specialists provide diagnosis and treatment of vaginal, urinary and anal fistulas in outstanding, conveniently located facilities.

We have multidisciplinary facilities at the Loyola University Medical Center campus, in addition to outpatient services at other locations.

We offer the following specialized services to provide you with the most comprehensive care:

• Colon and rectal surgery — Our surgeons are highly skilled in the repair of anal fistulas and maintain seamless communication with our urogynecologists and gastrointestinal specialists.
• Female pelvic medicine and reconstructive surgery — Our widely known team of urogynecologic surgeons has vast experience with every type of female fistula.
• Gastroenterology services — Our GI specialists work closely with our urogynecology team to care for patients with anal fistulas caused by diverticulitis and other GI conditions.

Exceptional Research to Improve Future Treatment of Fistulas

Loyola’s expert clinicians and scientists are actively pursuing new research with a focus on patient-centered outcomes including studies on:

• Aging and pelvic floor function
• Birth trauma and incontinence
• Botox® injections and urinary incontinence
• Pelvic floor dysfunction
• Surgery and urinary incontinence

As an academic medical center, Loyola is dedicated to improving future treatments by conducting research on new diagnostics and treatments.

Loyola’s patients benefit from research discoveries made here; read about Loyola’s current clinical trials.