Description
Genital fistula is a condition in which the genital tract and the urinary and intestinal tract become connected (usually in the vagina) by a leak in the system. It usually occurs as a result of a difficult delivery, when the vagina and the urinary bladder may become swollen or damaged due to excessive pressure during labor.
Symptoms
Urine leaks into the vagina in amounts proportional to the size of the hole. When the urine settles in the pubic area, a very strong odor may be noticed. If the rectum and the vagina are connected by a fistula, excretion through the vagina is also possible.
Causes
The most common cause of genital fistula is childbirth complications. Other possible causes are obstetrics/gynecologic surgeries, x-rays, tumors, and necrosis due to the use of a pessary.
Diagnosis
In the case of a urethral fistula, the diagnosis can be relatively simple. If leakage continues to occur when there does not appear to be a fistula, an over relaxed sphincter muscle may be the problem. For small urethral fistulas, a color pigment can be introduced into the urinary bladder to check to see if leakage occurs into the vagina. Or, cystoscopy (urinary bladder examination) can be performed to determine the location of the fistula in relation to the ureter. Depending on the situation, delicate urologic examination, or in rare cases, intravenous or retrograde pyelography can be used for diagnosis. For rectum-vaginal fistulas, a substance called barium is introduced into the intestinal canal, and an x-ray is taken to determine the whereabouts of the fistula.
Complications
Psychological problems, such as an avoidance of social contact, oversensitivity, insomnia, and depression may limit social activity.
Treatment
Most small fissures that are not a result of major diseases (i.e., cancer) heal themselves, and, thus, surgery may not be necessary. However, most people tend to prefer the immediate results of surgery. The standard treatment is to undergo reconstructive surgery after 4-6 months the injury. The waiting period is necessary in order to allow the swelling and hardening to subside before operating.
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