Vesicovaginal Fistula: Symptoms, Diagnosis, and Treatment

If you’ve noticed persistent leakage of urine from the vaginadespite doing everything “by the book”you’re not imagining it, and you certainly didn’t just spill your water bottle. A vesicovaginal fistula (VVF) is a real, fixable condition. This guide breaks down what it is, how it’s found, and the treatments that actually workwritten in plain English, with just enough medical detail to make your search results proud.

What Is a Vesicovaginal Fistula?

A vesicovaginal fistula is an abnormal connection (a tiny tunnel) between the bladder and the vagina. Because the bladder’s job is to hold urine and the vagina was not designed for that, the result is continuous or near-continuous leakage of urine through the vagina. In high-resource countries like the United States, VVFs usually occur as a complication after gynecologic surgery (most commonly after a hysterectomy). They can also develop after pelvic radiation, cancer involving the pelvis, complicated childbirth, or less commonly after severe pelvic infections or trauma.

Who’s most at risk?

• Recent pelvic surgery (especially hysterectomy)the leading cause in the U.S.
• Radiation therapy for pelvic cancersdamage can show up months or even years later.
• Complex pelvic disease (cancer or extensive endometriosis) requiring difficult operations.
• Obstetric traumamore common globally where obstructed labor is less treated, but still possible anywhere.

Symptoms: What It Feels Like

The hallmark symptom is involuntary leakage of urine from the vagina, typically starting days to weeks after a pelvic surgery, or later after radiation. People often describe:

• Continuous wetness (not just with cough or exercise) and the need for pads daily.
• Watery vaginal discharge with a urine odor, burning or irritation of vulvar skin.
• Recurrent urinary tract infections or pelvic discomfort.

Two commonly confused conditions are stress incontinence (leakage only with activities like coughing or running) and ureterovaginal fistula (a ureter-to-vagina connection) which can also cause vaginal leakageimportant distinctions that change management.

Diagnosis: How Clinicians Confirm a VVF

Doctors combine a careful history with targeted tests. Expect a pelvic exam and one or more of the following:

Dye “tampon” test (simple and clever)

The bladder is filled with sterile fluid mixed with a blue dye. Tampons or vaginal swabs are placedif they turn blue, urine is leaking from the bladder into the vagina, confirming a VVF. A variation uses a medicine that turns urine orange (e.g., phenazopyridine) by mouth plus blue dye in the bladder to help tell a bladder-to-vagina fistula (blue) from a ureter-to-vagina fistula (orange without blue).

Endoscopic and imaging tests

• Cystoscopy: a small camera looks inside the bladder to find the fistula opening and assess tissue quality.
• CT urogram (or MRI/retrograde pyelography): maps the urinary tract to locate the tract and check for ureter involvement.

Why the distinction matters

A Vesicovaginal fistula (bladder→vagina) and a Ureterovaginal fistula (ureter→vagina) require different repairs. The dye test plus imaging usually settles this quickly so you get the right operation the first time.

Treatment: What Actually Works

Good news: VVFs are highly treatable. The best approach depends on fistula size, location, tissue health, cause (surgery vs. radiation), and how long it’s been present.

Conservative management (select early cases)

• Continuous bladder drainage with a Foley catheter for several weeks can allow a very small, fresh fistula to close on its own, especially if diagnosed within days after surgery.
• Topical estrogen (when tissues are atrophic, e.g., after menopause) may improve tissue quality ahead of repair.
• Bladder spasm control (anticholinergics) helps keep the bladder calm so the repairor natural healingcan succeed.

Most established VVFs, however, require surgery.

Timing the repair

Surgeons often wait several weeks after the fistula appears so inflammation can settle and tissues are healthier. Many centers aim for repair around 4–12 weeks after diagnosis when infection is controlled. Radiation-associated fistulas may need a longer delay and more complex reconstruction.

Surgical approaches

Your surgeon will choose the route that offers the safest, most durable closure with the lowest downtime:

• Transvaginal repair (often first choice in non-radiated, favorable anatomy). Techniques include layered closure or a Latzko partial colpocleisiswhich closes the fistula by advancing healthy vaginal tissue without excising a large amount of bladder. Many surgeons add a tissue “interposition” to reinforce the repair.
• Transabdominal / laparoscopic / robotic repair (preferred for high, complex, recurrent, or radiation-related fistulas). Surgeons can mobilize the bladder and add tissue between the bladder and vagina to bolster healing.
• Tissue interposition flaps: a Martius labial fat pad (from the labia), a peritoneal flap (from the abdomen), or an omental flap (fatty apron in the abdomen) may be placed between the bladder and vagina to improve blood supply and reduce recurrence.

How successful is surgery?

For non-radiated fistulas repaired by experienced teams, first-attempt success is typically ~90–97%, depending on size, location, and technique. Radiation-related fistulas have lower primary success but can still be cured with staged or reinforced repairs. Minimally invasive approaches (laparoscopic or robotic) can achieve similar closure rates while reducing blood loss and length of stay in selected patients.

Recovery: What to Expect After Repair

• A bladder catheter usually stays in place for 1–3 weeks to protect the repair.
• Activity restrictions: avoid heavy lifting and intercourse for several weeks (your surgeon will give a timeline; 6–12 weeks is common).
• Medications may include antibiotics, bladder spasm medicine, stool softeners, and topical estrogen if appropriate.
• Follow-up testing (a quick dye fill or cystogram) may be used before catheter removal to confirm healing.
• Pelvic floor physical therapy can help with any residual urgency, frequency, or stress incontinence after healing.

Possible Complications (and When to Call Your Team)

• Fever, flank pain, or persistent burning (possible UTI).
• Catheter not draining or sudden bladder pain (possible blockage).
• Return of continuous vaginal leakage after an interval of dryness (possible recurrenceearly evaluation helps).
• Rarely, new stress incontinence after closureoften manageable and sometimes planned as a staged fix after the fistula heals.

Prevention & Outlook

Most VVFs in the U.S. are preventable surgical injuries recognized early and repaired definitively. Routine cystoscopy at the time of complex hysterectomy (when appropriate), tension-free surgical technique, and meticulous postoperative care reduce risk. The outlook is excellent for non-radiated fistulaswith high closure rates and a return to normal urinary control for most people. For radiation-related fistulas, success often requires specialized reconstruction and sometimes staged procedures, but many patients still achieve durable continence.

FAQs

Will this go away on its own?

Small, very recent fistulas may close with catheter drainage, but most established VVFs need surgical closure.

Is surgery always done vaginally?

Not always. Surgeons choose the routevaginal, laparoscopic/robotic, or open abdominalbased on fistula location, tissue health, prior surgeries, and whether radiation was involved.

How long until I can get back to normal life?

Desk work is often possible within 1–2 weeks after minimally invasive repair; strenuous activity and intercourse typically wait 6–12 weeks, depending on surgeon guidance.

Could I still leak after the repair?

Some patients have temporary urgency or stress leakage that improves with time and pelvic floor therapy. If leakage persists, evaluation can sort out treatable causes.

Putting It All Together

VVF is frustratingbut fixable. Quick recognition, correct diagnosis (to distinguish bladder-from-ureter fistulas), and a tailored repair by a surgeon experienced in fistula surgery are the keys. With modern techniquesincluding transvaginal Latzko repair and minimally invasive abdominal approachesmost people regain continence and quality of life.

Conclusion & SEO Goodies

Real-World Experiences: Voices from the Clinic (≈)

“I thought it was just stress incontinence.” A 52-year-old teacher developed steady leakage after a laparoscopic hysterectomy. Pads didn’t help. Her primary clinician suspected stress incontinence, but she noticed the wetness was constanteven at night. A simple in-office dye test turned a tampon bright blue within minutes: classic VVF. After a short cooling-off period to let inflammation settle, she had a transvaginal Latzko repair with a small labial fat pad reinforcement (Martius flap). She kept a catheter for two weeks, returned for a quick cystogram, and then resumed gentle activity. At six weeks, she’d ditched pads entirely. Her biggest reflection: “I wish I’d said earlier that the leak never stoppedday or night. That detail mattered.”

“Radiation changed the playbook.” A 63-year-old rectal-cancer survivor developed leakage a year after completing pelvic radiation. Imaging showed a high fistula with brittle tissue. Her team recommended a robotic abdominal repair with an omental interposition flap and a longer catheter time. The first attempt improvedbut didn’t fully curethe leak. She needed a second-stage revision to achieve dryness. Her takeaway: “Success still camejust not in one step. I’m glad my surgeons prepared me for a staged plan.”

“Conservative care can workif the timing is right.” A 41-year-old patient noticed watery discharge five days after an otherwise straightforward hysterectomy. She was seen quickly; cystoscopy suggested a pinpoint tract near the bladder dome. Her surgeon placed a Foley catheter for continuous drainage and started a short course of anticholinergic medication for spasms. Three weeks later, repeat testing showed the tract had sealed. She avoided an operation entirely. The caveat: this strategy is most likely to succeed when the fistula is tiny, recognized early, and tissues are still healthy.

“Plan recovery like a project.” Nearly everyone emphasized that living with a catheter is easier with a plan. Stock up on leg bags and night bags, learn how to switch them, and keep barrier creams on hand to protect skin. Many found pelvic floor physical therapy useful after catheter removal to retrain the bladder and reduce urgency. Hydration, stool softeners, and avoiding heavy lifting were common themes. Two patients mentioned trying to return to high-intensity workouts too soonboth had temporary urgency that improved once they scaled back and followed their surgeon’s timeline.

“Ask who will be in the room.” Because VVFs are uncommon, it’s reasonable to ask whether your surgeon (urologist, urogynecologist, or gynecologic oncologist) routinely performs fistula repairs and whether a second specialist will be present for complex or radiation-associated cases. Patients felt more confident when they knew the team’s plan for interposition flaps, catheter duration, and imaging before catheter removal.

Bottom line: Most people with VVF get back to life without pads after a thoughtful, tailored approach. Early recognition, the right test, and the right team turn a demoralizing problem into a solvable one.

Disclaimer: This article is for educational purposes and does not replace medical advice. If you suspect a fistula, seek care from a clinician experienced in urogynecology or female urology.