FISTULAS OF THE VAGINA

Fistulas of the vagina :- 

A fistula is an abnormal opening between two internal hol low organs or between an internal hollow organ and the exte rior of the body. The name of the fistula indicates the two areas that are connected abnormally-for example, a vesi covaginal fistula is an opening between the bladder and the vagina, and a rectovaginal fistula is an opening between the rectum and the vagina. 

CAUSES :- 

Due to damage resulting from 

1.Injury sustained  during surgery

2. Vaginal delivery 

3. Irritable bowel disease 

4. Radiation therapy 

5. Disease process such as carcinoma 

CLINICAL MANIFESTATIONS :- 

1. Vesicovaginal fistula  - urine escapes continuously into the vagina. 

2. Rectovaginal fistula - Fecal incontinence, flatus is discharged through the vagina. 

The combination of fecal discharge with leukorrhea results in malodor that is difficult to control. 

DIAGNOSTIC EVALUATION :- 

1. History taking

2. Physical examination

3. Dye test :- Methylene blue dye and through Indigo carmine is injected IV 

4. Cystoscopy

5. IV Pyelography

MANAGEMENT :-

The management goal is to eliminate the fistula and to treat infection and excoriation. 

A fistula may heal without surgical intervention, but surgery is often required.

Non surgical management :- 

1. Care is plannned to relieve discomfort 

2. Prevent infection

3. Improve the patient's self concept

4. Proper nutrition

5. Cleansing douches and enemas

6. Rest

7. Administration of prescribed intestinal antibiotic agents 

Sometimes, A fistula does not heal and cannot be surgically repaired. In this situation, care must be planned and implemented on an individual basis. 

Example :- 1 . Cleanliness

                   2 . Frequent Sitz bath

                   3. Deodarizing douches are required, as are perineal pads, and protective undergarments. 

                   4. Meticulous skin care is necessary to prevent excoriation. 

                   5. Applying bland creams or lightly dusting with cornstarch may be soothing 

Surgical management :- 

1. Sewing of anal fistula 

2. Applying patches of biological tissue into the vagina. 

3.Colostomy 

4. Tissue grafting