About the disease

A urethral fistula is a hole that develops in the urethra or bladder area. Since it can also occur in the rectum and bowel, it is sometimes also known as a urethral-rectal fistula. Urethral fistulas are more common in women, with extremely rare incidence in men.

The most common reason for a urethral fistula to develop is as a complication after surgery. According to MedScape, 50% of all cases develop after surgery to remove uterine fibroids or other gynecological surgical procedures. Surgery to improve menstrual dysfunction or a uterine prolapse can also lead to the development of a fistula.

Many factors can put women at risk of developing a urethral fistula. Having multiple pregnancies or giving birth to twins or triplets can lead to a urethral fistula in the transvaginal area. Also, having weak abdominal and vaginal muscles can cause a urethral fistula, especially if the woman performs hard labor or strains her lower abdomen muscles on a regular basis. Obesity weakens the muscles as well and can lead to problems with the bowel and bladder. Some women are genetically predisposed to have a weak pelvic floor, which puts them at risk of developing a urethral fistula, especially if they have other medical conditions such as prolapse. When undergoing surgery on the abdomen, it is important refrain from overstraining the bowel and bladder afterwards, to avoid causing a urethral fistula to appear. The recovery period for abdominal surgery is usually several weeks. Physical therapy after the recovery period can be beneficial and helps to strengthen the pelvic floor muscles.

Symptoms

• Discomfort in the pelvic area
• Vaginal discharges
• Pain when urinating
• Pain when having intercourse
• Pain in the lower abdomen
• Bleeding, in some cases

Diagnosis

• During a general examination, the gynecologist will examine the patient’s pelvic floor.
• The doctor will ask the patient about any diseases or infections they have had and will inquire about their hormonal balance and menstrual cycle.
• An ultrasound of the pelvic floor can indicate if there is a urethral fistula in the bowel or bladder area. The doctor will determine the extent of the hole and its exact location.
• Imaging tests, such as an MRI or CT scan, can be used to check the inner structure of the patient’s reproductive organs. This can rule out other causes for the symptoms, listed above.
• A blood test can establish whether there is any internal inflammation.

Treatment

• Operational closure is a surgical procedure whereby the fistula is repaired. This prevents blood loss and restores the functionality of the inner organs.
• The patient will need to rest for a few weeks after surgery. Regular imaging tests may be performed, to monitor the patient’s recovery.

Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed