A bladder fistula happens when an irregular skin connection forms between the bladder and another organ. This is usually the vagina, bowel, or colon.

Fistulas are irregular, tunnel-like connections between two organs. They’re fairly rare, and they typically happen due to prior surgery or injury.

There are three types of bladder fistulas. These are:

  • enterovesical fistulas, which develop between the bladder and the bowel
  • vesicovaginal fistulas, which develop between the bladder and the vagina
  • colovesical fistulas, which develop between the bladder and the colon

Common symptoms of bladder fistulas include recurring infections, air that escapes from the urethra, and foul-smelling pee.

Here’s what else to know about this condition.

All types of bladder fistulas may be due to:

Colovesical fistulas normally develop due to diverticular disease, which is characterized by inflammation or infection in the walls of the colon. Less commonly, they’re due to cancer of the colon.

Enterovesical fistulas also typically happen due to diverticular disease. Less commonly, they’re due to cancer of the bladder, bowel, or intestine. Crohn’s disease and other inflammatory conditions, like inflammatory bowel disease, can also cause enterovesical fistulas. Radiation therapy can also cause them.

Vesicovaginal fistulas usually happen following obstetrical or gynecological surgery. More rarely, they may be due to gynecological cancers. Again, radiation therapy may also cause them.

Symptoms of a bladder fistula may include:

Bladder fistulas become much more common with age.

How serious is a bladder fistula?

Most of the time, fistulas are simple to treat with surgery and won’t cause lasting issues.

Without treatment, however, issues like abscesses, serious infections, or cancer may develop.

That’s why it’s best to speak with a doctor at the first sign of a fistula. The earlier the diagnosis and intervention, the lower the risk of more serious complications.

Most of the time, treatment involves getting surgery to repair the damaged area. The surgical intervention will vary depending on the affected organs and how severe your condition is.

In mild cases, a surgeon may do a fistulotomy, where they open up the irregular connection and repair it with sutures. This procedure is simple and takes about an hour. In more severe cases, they may also perform a fistulectomy, where they remove the entire fistula (as well as part or all of the affected organs).

According to 2021 research, only a simple, single-stage surgical repair of the bladder is needed in over 75% of cases of enterovesical or colovesical fistulas. This would typically mean repairing the irregular connection with dissolvable stitches.

In severe cases, such as when there’s a malignancy, more intensive intervention is necessary. For example, in the case of an enterovesical fistula due to intestinal cancer, the surgeon will need to remove the entire intestine plus part of the bladder.

In rare cases, a doctor may suggest a nonsurgical strategy to help manage the symptoms. Noninvasive and less invasive treatment options may include:

  • treating UTIs or other underlying infections with antibiotics
  • treating underlying medical conditions, like Crohn’s disease or diverticulitis
  • in mild cases, using less invasive measures like fibrin glue to close the tube, though this method is still experimental
  • in the case of a mild vesicovaginal fistula, using vaginal electrocoagulation to heal the irregular vaginal mucosal layer via an electric current

Ultimately, however, surgical measures are more common and — according to the 2021 research above — have a higher success rate.

A doctor may combine both conservative and invasive approaches with temporary catheterization to help you pee normally again.

How successful is bladder fistula surgery?

Surgical intervention for bladder fistulas is usually quite simple and successful.

The risk of a recurring fistula after surgery is low. According to the 2021 research, which was a review of 861 patients with enterocolovesical fistulas, the risk of a recurring fistula was about 4.9%.

The same review concluded that surgical intervention for enterocolovesical or colovesical fistulas generally leads to excellent results.

Bladder fistulas are often due to an infection or surgical intervention that causes an irregularity in the connection between the bladder and another organ, like the colon, bowel, or vagina.

Common symptoms of bladder fistulas include recurring UTIs, pee that looks or smells like stool, and gas that passes through the urethra. Stomach pain, unexplained weight loss, or bowel habit changes may also occur.

If you’re experiencing any of these symptoms, speak with a doctor as soon as possible.