What Is a Bladder (Urinary) Fistula?

A fistula is an abnormal skin tract connecting two otherwise separate organs or spaces in the body, leading to leakage between the two. A bladder or urinary fistula is one that forms between the bladder or urinary tract and another organ, such as the bowel, the colon, or the vagina. This can result in the leakage of urine into those organs. Though not typically medical emergencies, bladder fistulas are unhygienic and, if left untreated, can lead to more serious complications, including infections, abscesses, and, in rare cases, cancers.

If you or a loved one have developed a bladder fistula, seek medical care. The Baptist Health urology team is ready to serve you.

Causes & Risk Factors

Bodily structures are related in genetically determined ways, so the formation of an abnormal link between two independent organs usually results from physical trauma, surgical intervention, or an unusual medical condition. Among the causes of bladder fistula are:

• Accidental injuries, including sports injuries and automobile accidents
• Extended periods of labor and delivery
• Past surgical procedures, especially hysterectomies and caesarian sections (C-sections)
• Cancers of the colon or cervix and any related radiation treatments
• Infections
• Certain diseases, including diverticulitis, Crohn’s disease, and inflammatory bowel disease (IBD).

As this list suggests, women have a greater risk of bladder fistula than men.

Symptoms & Diagnosis

The symptoms of a bladder fistula vary depending on the organ to which the fistula has formed a connection: the colon (a colovesical fistula), the bowel (an enterovesical fistula), or the vagina (a vesicovaginal fistula). Common symptoms include:

• Abdominal pain
• Altered bowel habits
• Fever
• Frequent urination
• Loose stools or diarrhea
• Nausea and vomiting
• Weakness
• Weight loss

Symptoms specific to vesicovaginal fistulas are urinary tract infections (UTIs), genital irritation, and the vaginal leakage of urine. Some fistulas enable fecal leakage into urine.

Diagnosing a fistula involves several steps. Your will physician will begin by recording your medical history, documenting symptoms, and conducting a physical exam. Additional steps may include:

• Collecting a urine sample to analyze for possible infection
• Using an imaging technology, such as magnetic resonance imaging (MRI), computerized tomography (CT), or ultrasound, to non-invasively scan your body for the fistula
• Ordering a cystogram, which utilizes an injectable dye to enhance the accuracy of the imaging process
• Ordering a fistulogram, which deploys X-ray technology to form a comprehensive picture of the fistula’s location inside the body, along with the organs being affected.

Because of the role played by surgery in leakage disorders, your physician may check you for evidence of a fistula in the aftermath of a hysterectomy, C-section, or any related obstetrical or gynecological procedure.

Treatment Options for Bladder Fistula

The treatment of a bladder fistula usually involves surgery, either open or laparoscopic. Two common procedures are:

• Fistulotomy: In mild cases, when the fistula is small and the leakage is limited, the opening can be sealed with sutures in a minor operation.
• Fistulectomy: In more serious cases, the fistula is surgically removed, along with parts of the connected organs.

On occasion, your physician might suggest a non-invasive approach for treating a fistula, possibly as an end in itself or as a preparatory step for a later surgery:

• Antibiotics for UTIs
• Electrocoagulation technology for healing damaged vaginal tissue
• Fibrin glue administered non-surgically for closing the fistula
• Standard treatments for diverticulitis or Crohn’s disease.

Medical researchers have confirmed the effectiveness of surgery as a treatment for bladder fistula. A major study documented that the great majority of patients included in the data have had no recurring symptoms since their procedure.

Recovery & Management

Most persons undergoing fistula surgery are able to return home the day of their procedure. Be prepared to:

• Use a urinary catheter for a short time following surgery
• Take a stool softener to reduce the possibility of painful bowel movements
• Follow your physician’s recovery plan, especially dietary restrictions and any temporary limits on physical activity.

Total recovery times vary, from as a few as four weeks to as many as nine.

Complications & Prevention

Bladder fistula may in some cases be preventable. Proper nutrition, tobacco avoidance, sound family planning and regular obstetrical and gynecological care can help reduce the likelihood of developing bladder fistula as the result of a pregnancy or pregnancy complication.

If you have symptoms suggestive of a bladder fistula, seek care. An untreated condition of this type carries with it serious health risks.

When to See a Urologist

A bladder fistula is a serious medical condition typically resulting from accidental injury, surgical procedures, pregnancy complications or certain diseases of the colorectal region. Early detection and treatment are critical in addressing it. If you think that you may be suffering from a bladder fistula, call a Baptist Health urologist today.