BIO - DATA

 NAME : ALVINA PARMAR

 SUBJECT : MEDICAL SURGICAL NURSING – II
 UNIT : 4
 TOPIC : VAGINAL FISTULA
 DURATION : 45 MINUTES
 SUBMITTED TO : MANISHA MADAM
VAGINAL FISTULA

 Introduction:‐

 A fistula is an abnormal opening between internal organs

or between an organ and the exterior of the body
DEFINITION

 A vaginal fistula is an abnormal passage that connects

the vagina to other organs, such as the bladder or rectum,
resulting in leakage of urine or feces into the vagina.

Ex.
 vesicovaginal fistula

 rectovaginal fistula

 colovaginal fistula

 enterovaginal fistula
ETIOLOGY

 obstetric injury, especially in long labors and in

countries with inadequate obstetric care
 pelvic surgery–hysterectomy or vaginal reconstructive
procedures
 carcinoma–extensive disease or complication of
treatment such as radiation therapy.
 infection of an episiotomy
 rectal damage
 inflammation in the bowel
 infection in the abdomen
CLINICAL MANIFESTATIONS
 Incontinence
 Passage of gas, stool or pus from vagina
 Vaginal irritation
 A foul–smelling vaginal discharge
 Recurrent vaginal/urinary tract infections
 Irritation or pain in the vulva, vagina and the area
between vagina and anus
 Pain during sexual activity
 Urgent bowel movements/inability to control bowel
movements
 Leakage of urine into vagina
DIAGNOSTIC EVALUATION

 1. History collection
– identifies risk factors such as recent pelvic surgery, infection
or prior pelvic radiation.
 2. Visual exam

–with the use of speculum.

 3. Dye test

–doctor fills bladder with a solution dye and asks patient to

cough.
 4. Cystoscopy

–with the use of cystoscope—a hollow device equipped with a

lens to view the inside of bladder and urethra, the tube carries
urine outside of body for signs of possible damage.
 5. Retrograde pyelogram
–doctor injects dye through bladder into the tubes that
connect bladder to ureters and then takes an x-ray. it
shows whether you have leakage between a ureter and
vagina.
 6. Fistulogram

–it is an x‐ray image to determine whether you have one

or more fistulas. doctor may also be able to detect what
other pelvic organs may be involved with fistula.
 7. Flexible sigmoidoscopy
–with the use of sigmoidoscope—a thin, flexible tube
with a tiny video camera at the tip to inspect anus and
rectum.
 8. Computerized tomography (CT)scan

–it creates cross‐sectional images of vagina and

urinary tract.
 9. MRI

–it uses a magnetic field and radio waves to create

detailed images.
MANAGEMENT

 1. Conservative therapy
–for simple, small in size, no
history of cancer and never had radiation therapy.
–constant bladder drainage using a urinary catheter
–change diet and use fiber supplements to bulk stool if it
is simple rectovaginal fistula
2. Medical management
–drainage of abscesses
–antibiotic therapy for acute and traumatic origin
example, ampycillin, amoxycillin
–dietary modification and supplemental fiber.
3. Surgical management
–laparoscopic surgery, robotic surgery
4. NURSING MANAGEMENT
Preoperative care
 –clean out bowel before the operation, patient may take laxatives or
follow a liquid diet for several days.
–an enema before surgery.
 Postoperative care
 –pay attention to the patient's bowel habits.
 –counselling of patient regarding diet, copious fluid intake and use of stool
softeners.
 –use antibiotics for 3–5 days.
 –take 1 tablespoon of mineral oil orally twice daily for 2 weeks.
 –refrain from sexual activity and physical activity.
 –liquid diet
 –low fiber diet
 –take sitz bath two to three times a day
PATIENT TEACHING

 Gently wash outer genital area with warm water each

time when experience vaginal discharge or passage of
stool.
 Instruct the patient to dry the genital area thoroughly.
 Encourage to avoid irritants.
 Instruct the patient to apply a cold compression to
genital area.
 Apply a cream or powder.
 Encourage patient to avoid douche.
 Wear cotton underwear and loose clothing.
THANK YOU