Summary about Disease
A vesicovaginal fistula (VVF) is an abnormal opening between the urinary bladder and the vagina. This opening allows urine to leak continuously or intermittently into the vagina. This can cause significant physical and psychological distress for the affected individual.
Symptoms
The primary symptom of a VVF is continuous or intermittent leakage of urine from the vagina. Other symptoms may include:
Foul vaginal odor
Vaginal irritation or infection
Pain during intercourse
Recurrent urinary tract infections
Causes
The most common causes of VVF include:
Prolonged obstructed labor (especially in areas with limited access to obstetric care)
Surgical injury (e.g., during hysterectomy, cesarean section, or other pelvic surgeries)
Radiation therapy for pelvic cancers
Pelvic trauma
Cancer (rarely, VVF can be caused by advanced pelvic cancers)
Infection
Medicine Used
Medications are not typically used to directly treat the fistula itself. Treatment is usually surgical. However, medications may be used to manage complications:
Antibiotics: To treat or prevent urinary tract infections.
Anticholinergics: To reduce bladder spasms.
Topical Estrogen: For postmenopausal women, if atrophy is a contributing factor.
Is Communicable
A vesicovaginal fistula is not a communicable disease. It is not infectious and cannot be spread from person to person.
Precautions
Precautions are primarily aimed at preventing the development of a VVF:
Access to Quality Obstetric Care: Ensuring access to skilled birth attendants and timely cesarean sections can prevent obstetric fistulas.
Safe Surgical Practices: Meticulous surgical technique during pelvic surgeries to minimize the risk of injury to the bladder and vagina.
Radiation Therapy Planning: Careful planning and administration of radiation therapy to minimize damage to surrounding tissues.
Pelvic Floor Exercises: Strengthening pelvic floor muscles may help some women who develop minor fistulas.
How long does an outbreak last?
A VVF is not an outbreak. It is a physical defect (hole) that persists until surgically repaired. The symptoms (urine leakage) will continue until the fistula is closed.
How is it diagnosed?
Diagnosis of a VVF typically involves:
Physical Examination: A pelvic examination to visualize the fistula.
Dye Test: Inserting dye into the bladder and observing for leakage into the vagina.
Cystoscopy: Visual examination of the bladder with a camera.
Vaginoscopy: Visual examination of the vagina with a camera.
Imaging Studies: such as CT scan or MRI.
Timeline of Symptoms
Symptoms typically begin immediately after the event that caused the fistula (e.g., childbirth, surgery, or trauma). The timeline is as follows:
Immediate Onset: Continuous or intermittent urine leakage from the vagina starts shortly after the causative event.
Progression: If left untreated, symptoms persist indefinitely. Secondary issues like vaginal infections, skin breakdown, and social isolation may develop over time.
Important Considerations
Psychological Impact: VVF can have a profound psychological impact on affected women, leading to depression, anxiety, social isolation, and loss of self-esteem. Mental health support is crucial.
Surgical Repair: Surgical repair is the primary treatment. Success rates vary depending on the size, location, and cause of the fistula.
Reconstructive Surgery: In complex cases, reconstructive surgery may be needed.
Global Health Issue: VVF is a significant public health issue in developing countries with limited access to obstetric care.
Social Stigma: Affected women often face social stigma and discrimination.