Vesicovaginal fistula (VVF) is an uncomfortable and potentially distressing condition that causes continuous urinary leakage from your vagina. There are effective treatment options; but in parts of the world where women have limited access to healthcare, this condition can be debilitating and humiliating.

VVF is a tale of two worlds. One in which women have access to healthcare when they deliver babies, and one in which they have little to no access. In high income countries, VVF is a preventable and highly treatable condition. In low and middle income countries, VVF can be a life changing, stigmatizing catastrophe for millions of women.

VVF is an abnormal opening between your bladder and vagina. This opening causes continuous urinary incontinence — continuous leaking of urine through your vagina.

While this condition is rare in countries in which women have access to reproductive healthcare, it’s more common in areas with limited access to this care.

In many areas of the world, unrepaired VVF is a significant health problem. It’s estimated that at least three million women worldwide live with unrepaired VVFs, and between 30,000 and 130,00 women receive a diagnosis each year.

The primary symptom of VVF is continuous vaginal discharge and pain with vaginal intercourse. But if the fistula is small, watery discharge after urination may be the only symptom.

Other symptoms of VVF may include:

VVF can be congenital, meaning you were born with it. More often though, it’s acquired, meaning it’s a result of another medical event or injury.

Congenital VVF is a rare condition. In the United States and other high income countries, the most common cause of VVF is an injury to your bladder during gynecologic or other pelvic surgery. It can also occur because of gynecologic cancer or as a result of radiation therapy.

In many low and middle income countries, the most common cause of VVF that’s acquired is prolonged or obstructed labor. Labor is considered obstructed when the fetus can’t enter the birth canal even when uterine contractions are strong. When this happens, parts of the fetus such as the head or shoulder press against the pelvis and can cause injury to the tissues of the surrounding area.

Additional causes can include:

  • trauma during labor and delivery (such as assisted vaginal deliveries that involve instruments)
  • infections and inflammatory diseases
  • foreign objects (such as pessaries)
  • sexual trauma and violence
  • vaginal laser procedures

In the United States and other high income countries, the main cause of VVF is pelvic surgeries, and it may not be related to pregnancy.

In most of the world, specifically low and middle income countries, prolonged labor is the main cause of VVF. If left untreated, VVF can cause shame, other health problems, and social isolation.

Risk factors for VVF resulting from pregnancy include:

  • lack of access to skilled care during delivery
  • duration of labor
  • lack of pregnancy care
  • early marriage and young age at birthing
  • older age

After repair of VVF, it is possible to resume sexual intercourse and have pregnancies that result in live births.

Properly diagnosing VVF and getting as much information as possible about it prior to surgery is important. While self-reports are helpful, there are tests as well.

The following exams and tests may be performed to help diagnose VVF:

  • Physical exam. The area where the fistula is will be examined for inflammation or other abnormalities. This can help determine the best surgical approach for repair.
  • Imaging tests. A doctor or healthcare professional may order imaging tests such as pelvic X-ray, CT scan, and CT scan with contrast in order to see how your bladder and uterus look and exactly where the fistula or hole has developed.
  • Double dye test. In this test, your bladder is filled with a solution that’s dyed blue and then a tampon is inserted into your vagina. If the tampon turns blue, a VVF is present.
  • Cystourethroscopy. A cystoscopy can also help clarify exactly where the VVF is. This can help further aid in treatment planning.

Questions to ask your doctor or healthcare professional

When you see your doctor or healthcare professional for your VVF, it’s always a good idea to ask questions. This can help lower any anxiety, provide answers you might be wondering about, and allow you to be an active part of your care. Questions you might want to ask can include:

  • What can I expect from the surgery?
  • What’s the recovery time?
  • How many VVFs have you repaired?
  • How long have you been repairing fistulas?
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For VVFs that have been found early, that are small, and that are noncancerous, conservative treatments may be up to almost 93 percent effective. These can also help with the spontaneous closure of the fistula. These treatments may include:

  • Catheter. To help with your symptoms, a catheter may be placed for 2 to 8 weeks along with medications called anticholinergics that help stop some involuntary muscle movement.
  • Electrocoagulation. No longer considered a first line treatment, this procedure uses heat from an electrical current to remove the innermost layer of tissue, called the mucosal layer, around the VVF. Next, a catheter will be inserted and left in place for 2 to 4 weeks as you heal.

If conservative treatment fails or isn’t an option, surgical repair may be performed. Surgical repair of VVF is greater than 97 percent effective. And several types of surgery may be used, such as:

  • Laparoscopic. Laparoscopic surgery is an alternative to open surgery. Using a small camera and small tube called a catheter, surgery is performed through a small incision or cut opening.
  • Robotic. In robotic surgery, the doctor is assisted but a robotic tool.
  • Transvaginal. During transvaginal surgery, surgery is performed by going through the vagina. One common type of this surgery is called the Latzko repair.
  • Open transabdominal. This surgery involves an open incision in the abdominal area.
  • Transurethral endoscopic. This surgery involves going through the urethral to repair the fistula.

During fistula repair surgery, the opening where urine is leaking into your vagina is closed to stop the incontinence. If there’s any damage to your bladder, additional procedures may be needed.

In high income countries, VVF is typically prevented, but when it does occur is generally successfully treated and managed.

In countries with limited access to healthcare, steps need to be taken to address the risk factors for VVF. This can include delaying first pregnancy, increasing access to obstetric care, and stopping any traditional practices that may further raise the risk of VVF. Some forms of female genital mutilation can increase the risk of fistula as well.

How you can help

The Fistula Foundation provides fistula treatment, delivering life-transforming surgeries at more than 150 sites in 33 countries across Africa and Asia.

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VVF can be a distressing condition, but it is manageable and treatable.

If you have a VVF, talk with a doctor. They’ll be able to examine your fistula and work with you to create a treatment plan that’s best for your situation.