The female anatomy is a very complex system with several organs intertwined. The reproductive system is in direct proximity with the urinary tract system, which can complicate treatment for certain conditions or illnesses, especially a hysterectomy. Complications from this procedure can include urinary tract fistulas, which require additional treatment. To better understand your circumstances, here is more information regarding urinary tract fistulas and how to treat them after a hysterectomy.
What is a Hysterectomy?
A hysterectomy is a surgical procedure that’s performed in the pelvic area of women to remove the uterus and in some cases, the cervix as well. It’s the second most common surgery performed in women aside from cesarean sections. Hysterectomies are often performed in order to treat one or more health problems that are causing issues with the reproductive tract. However, after a hysterectomy, women are no longer able to get pregnant. In most cases, the benefits of the procedure outweigh the risks but it’s important to discuss your unique circumstances with your doctor ahead of time. Some of the most common reasons that hysterectomies are performed include:
- Non-cancerous tumors (fibroids)
- Ovarian cancer
- Uterine cancer
- Cervical cancer
- Cancer of the fallopian tubes
- Heavy periods
- Long-term pelvic pain
- Uterine prolapse
- Hyperplasia or other conditions that affect uterine lining
There are several different types of hysterectomies that can be performed. The type needed will depend on the condition and its severity. For example, a total hysterectomy will remove the uterus and cervix, but the ovaries remain while a supracervical hysterectomy removes the upper part of the uterus and leaves the cervix. Your doctor will discuss which option is best for your condition and the risks involved.
What to Expect After a Hysterectomy
A hysterectomy is a major surgery, but the recovery time varies based on which type you received. Regardless, you should prepare to spend a few days to a week in the hospital for post-op monitoring. This allows for any signs of complications to be treated accordingly. You’ll be encouraged to walk around as soon as you’re able to in order to prevent clots. Once you’re cleared for discharge, you can continue recovery at home.
Following a hysterectomy, you may notice irritation at the incision site, vaginal drainage, or in some cases, an increase in urinary incontinence. It’s important to stay in communication with your doctor to address any side effects and how to treat them. Signs of incontinence could be indicative of a urinary tract fistula.
What is a Urinary Tract Fistula?
A urinary tract fistula tends to be more persistent than mild incontinence. It occurs when an abnormal opening forms between the wall of the vagina and the bladder, often following vaginal or bladder surgery. Although it occurs most commonly as a surgical complication, there are a few other potential causes as well such as gynecological cancer or in rare cases, chronic urinary tract infections. Urinary fistulas may also occur after complications during childbirth, infection, inflammation, or radiation treatment to the general area.
Different Types of Urinary Tract Fistulas
Fistulas can occur in several parts of the body and cause various symptoms. They can happen within the cervix, between the bowel and vagina, between the uterus and bladder, and more. Some of the most common types of fistulas include:
- Vesicovaginal Fistula –an opening between the vagina and the bladder, which is most common after a hysterectomy.
- Rectovaginal Fistula – an opening between the vagina and the rectum.
- Enterovesical Fistula – an opening between the bladder and the bowel and is another commonly occurring type of urinary fistula.
- Vesicouterine Fistula – an opening between the bladder and the uterus.
- Ureterovaginal Fistula – an opening between the vagina and the ureter.
- Urethrovaginal Fistula – an opening between the vagina and urethra.
- Colovesical Fistula – an opening between the bladder and the colon.
Depending on the size of the opening, the symptoms can be mild or severe. Vesicovaginal fistulas are the most common type of fistula in women, alongside a rectovaginal fistula, which results in fecal incontinence.
Symptoms of a Urinary Tract Fistula
The most notable symptom of a vesicovaginal fistula is the continuous release of urine. Although this can be mistaken for urinary incontinence, fistulas tend to be more severe and occur constantly rather than during stress or strain. They’re also not associated with urgency or frequency. You may also notice other symptoms, which include:
- Fever
- Abdominal pain
- Pain during sex
- Soreness
- Infections
- Diarrhea
- Weight loss
- Nausea
- Vomiting
If you experience any of these symptoms regardless of if you have recently undergone a hysterectomy, or other type of vaginal or bladder surgery, it’s important to see your doctor as soon as possible. There are treatment options available that can help reduce the risk of other complications developing and alleviate your symptoms.
Diagnosing Urinary Tract Fistulas
Since the symptoms are quite apparent, many instances of vesicovaginal fistulas are diagnosed through a simple physical exam. However, there are further tests that may be done to confirm the underlying cause, as mild cases of urinary fistulas may be mistaken for incontinence. A CT scan allows doctors to identify the location of the fistula and the source, but a bladder scope may also be used. Some commonly performed tests for a urinary tract fistula include:
- Urinalysis
- Blood Testing
- Dye Test
- Cystoscope
- Retrograde Pyelogram
- Fistulogram
- CT Urogram
- MRI
- Cystogram
Your doctor may perform only one or two of these tests, or a combination of several. This is done to make sure that the diagnostics are accurate and reduce the risk of unnecessary surgery. Since incontinence may present similar symptoms, try to be patient with the tests. Getting the right treatment plan from the start can help you alleviate your symptoms and reduce the risk of leakages or embarrassing accidents.
How to Treat Urinary Tract Fistulas After a Hysterectomy
Although they can be scary, fistulas after a hysterectomy are treatable. However, most fistulas do not heal on their own so it’s important to see your doctor at the first sign of any symptoms. The only time that urinary tract fistulas may heal on their own is if they’re very simple and small. To help aid in the healing process, your doctor will likely have you use a catheter to drain your bladder. This can help the skin develop and reattach.
Otherwise, the primary treatment option for fistulas is surgery, but many can be performed using a minimally invasive approach. When dealing with vesicovaginal fistulas, they can often be repaired using a laparoscopic approach, but open surgery may be required in some instances. Surgery aims to repair the fistula and help proliferate the growth of healthy tissue around the opening. This helps the organs return to normal and resume functioning as before. If there is any damaged tissue that’s proliferating the issues with the fistula (i.e., a tumor), your surgeon may remove them during the procedure. Following surgery, you’ll likely need to wear an indwelling, or Foley, catheter. This helps the skin around your bladder and the affected areas heal without any added stress. Your doctor may also recommend intermittent self-catheterization at some point.
Regardless of the type of urinary catheter you’re using, just remember that it’s meant to aid in your recovery and won’t be a permanent requirement. However, using the catheter is an important part of your treatment and can help improve the quality of your recovery while reducing the risk of serious complications.
If you are suffering from any type of urologic problem, especially a urinary tract fistula, don’t hesitate to see your urologist. To help facilitate a healthy experience with urinary catheters during your recovery, Byram Healthcare has a wide selection of high-quality urologic supplies that can be discreetly delivered to your door. Our product guide includes both indwelling catheters and various types of intermittent self-catheters to help support your lifestyle. Browse our product catalog today or call one of our representatives for more information on our catheter delivery program.
Byram Healthcare is a member of the National Association for Continence’s Trusted Partners Program, whose mission is to provide quality continence care through education, collaboration and advocacy. We continue to build partnerships in the clinical community to ensure we focus on what’s best for the patient.
