Pelvic Organ Prolapse · Treatment

Fistula Repair: Vesicovaginal and Rectovaginal Fistula Care

Fistula repair is surgery that closes an abnormal opening between the vagina and the bladder, urethra or rectum, which causes continuous leakage of urine or stool through the vagina. Somssi Women's Clinic in Gangnam, Seoul evaluates suspected fistulas with examination, dye testing and imaging, manages the skin, infection and timing issues that come first, and coordinates the repair itself with urogynecology or colorectal surgeons at partner hospitals.

Medically reviewed by Dr. Yoon Ho-joo, MD, PhD, OB/GYN specialist, Somssi Women's Clinic · Last updated October 2026

At a glance

Key facts

The essentials, based on how Somssi Women's Clinic performs this procedure or answers this question. Your plan is confirmed at consultation.

• Types: vesicovaginal (bladder to vagina), urethrovaginal, rectovaginal (rectum to vagina), rarely ureterovaginal
• Common causes: hysterectomy or other pelvic surgery, obstetric injury or prolonged labor, radiation, inflammatory bowel disease, infection
• Evaluation at the clinic: history, speculum exam, dye (tampon) test, pelvic ultrasound; cystoscopy, CT urography or MRI arranged with hospital partners
• Conservative measures: bladder catheter drainage for small fresh urinary fistulas, treatment of infection and skin irritation, bowel management and nutrition
• Surgical repair: layered closure through the vagina or abdomen, often with a tissue flap; performed by hospital-based specialists we coordinate with
• Typical timing: repair once inflammation has settled, often 6 to 12 weeks after the injury
• Led by: Dr. Yoon Ho-joo, MD, PhD, member of the Korean Society of Urogynecology

What is a genital fistula and what is fistula repair?

A fistula is an abnormal passage between two organs. In gynecology the most important ones connect the vagina to the bladder (vesicovaginal fistula), to the urethra (urethrovaginal fistula) or to the rectum (rectovaginal fistula). Because the vagina is now joined to the urinary or digestive tract, urine or stool and gas pass through it continuously, which is distressing, damaging to the skin and socially isolating.

Fistula repair is the operation that closes that passage and separates the two organs with healthy tissue. It is specialist surgery. Somssi Women's Clinic is a surgical gynecology clinic in Gangnam, Seoul, founded in 2000 and led by Dr. Yoon Ho-joo, MD, PhD. Our role is to recognize a fistula early, confirm where it is, manage the problems that come before surgery, and coordinate the repair with urogynecology, urology or colorectal surgeons at partner hospitals. We do not want women to spend months with a misdiagnosis of "incontinence" or "vaginitis" when the real cause is a fistula.

Who should be evaluated for a fistula?

• Continuous, painless leakage of urine from the vagina, day and night, especially within weeks of a hysterectomy, cesarean, prolapse surgery or pelvic radiation.
• Passing gas or stool through the vagina, or stool-stained discharge, especially after a difficult vaginal birth, a severe tear, or with Crohn's disease.
• Leakage that started after an obstructed or very long labor.
• Recurrent urinary or vaginal infections with watery discharge that has never been explained.
• Skin irritation, odor or ulceration of the vulva from constant wetness.

A fistula is different from ordinary stress or urge incontinence: the leakage does not depend on coughing or urgency, and it does not stop. If this describes you, say so plainly at your first visit; it changes the examination we perform. Our page on urinary incontinence treatment explains the more common forms of leakage.

How Somssi evaluates a suspected fistula

History and examination

Dr. Yoon reviews the timing of your symptoms against any births, operations or radiation, then examines the vagina with a speculum, looking for a visible opening, pooled urine, granulation tissue or stool. Small fistulas can hide in scar at the top of the vagina, so the examination is careful and sometimes repeated.

Dye test

For a suspected urinary fistula, the bladder is filled with dilute dye through a catheter and a tampon is placed in the vagina. Staining of the tampon confirms a bladder-to-vagina connection; if the tampon is wet but unstained, the leak may be coming from a ureter, which needs a different test. For a suspected rectovaginal fistula, a similar approach with a gentle rectal examination and, sometimes, a dye or air test helps locate the tract.

Imaging and endoscopy

A pelvic ultrasound checks the uterus, ovaries and residual urine. Cystoscopy (looking inside the bladder), CT urography or MRI, and for bowel fistulas a colonoscopy or endoanal ultrasound, are arranged with hospital partners. These define the size, position and number of openings and whether the ureters are involved, which decides how the repair should be done.

Treatment: what happens before and during repair

Conservative management first

A small, fresh vesicovaginal fistula, particularly one found within days of surgery, sometimes closes on its own if the bladder is kept empty with a catheter for several weeks. Infection is treated, the vulval skin is protected with barrier creams, and for bowel fistulas, stool is kept soft and the diet adjusted. Estrogen cream may be used after menopause to improve tissue quality. These measures are started here and reviewed regularly.

Timing

Repair is usually delayed until the tissue is no longer inflamed, commonly 6 to 12 weeks after the injury, so that the edges of the fistula are soft and well supplied with blood. Radiation-related fistulas need longer. Operating too early is a recognized cause of failure.

The repair itself

Surgeons close a fistula in layers after excising the scarred tract, separating the bladder or rectum from the vagina and closing each organ separately without tension. Many repairs are done through the vagina; large, high or complex fistulas, and those involving the ureters, are repaired through the abdomen. A flap of well-vascularized tissue, such as a Martius labial fat pad, is often placed between the layers to improve healing. Rectovaginal fistulas may require a temporary stoma in complex cases, and some women with inflammatory bowel disease need medical control of the disease before surgery. These operations are performed by hospital-based specialists, and we coordinate the referral, share the evaluation and remain involved in your care.

What we treat at the clinic

Alongside the pre-operative measures above, we manage the gynecologic problems that often accompany a fistula: vaginal atrophy, a scarred or shortened vagina, perineal damage from obstetric injury and pelvic floor weakness. After the fistula has healed, Dr. Yoon's native-tissue reconstruction of the perineum and posterior wall can be discussed where appropriate; see perineal scar revision and pelvic reconstructive surgery.

Anesthesia, duration and hospital stay

Evaluation, dye testing and conservative management are clinic visits with no anesthesia. Fistula repair is performed under general or regional anesthesia at the partner hospital, typically takes one to three hours depending on complexity, and involves a hospital stay with a bladder catheter for one to two weeks after a urinary fistula repair.

Recovery timeline after repair

Results and what to expect

Published series report that most simple fistulas close with a single well-timed repair, with success rates generally lower for radiation-related, recurrent or very large fistulas. Continence can be affected if the urethra or anal sphincter was damaged by the original injury, and some women need a further continence procedure later. We give you realistic expectations based on the specific findings rather than a general figure.

Risks and how we reduce them

• Failure of the repair and recurrence: reduced by correct timing, complete evaluation of all tracts and a well-vascularized flap; a second repair is possible if needed.
• Infection and wound breakdown: managed with antibiotics, drainage and bowel preparation where relevant.
• Ureteral injury or obstruction: excluded by imaging before surgery.
• Vaginal shortening or narrowing, pain with intercourse: can follow extensive scar excision; reconstruction may be offered later.
• New or persistent incontinence: addressed after the fistula has healed.
• Anesthesia and general surgical risks: explained by the hospital team at consent.

Why international patients choose Somssi

Women from abroad often come with months of unexplained leakage and conflicting opinions. We offer an unhurried English-language evaluation by an OB/GYN who treats pelvic floor problems daily, an honest statement of what the clinic can and cannot do, and a coordinated path to hospital repair when that is needed. The clinic has been registered with the Ministry of Health and Welfare for foreign patients since 2011 and is 100 meters from Gangnam Station Exit 1. See international patients or contact us with your history and any reports.

Questions patients ask

Frequently asked questions

Short, honest answers. For anything personal, a consultation is the right place to ask.

See the full FAQ →

How do I know if I have a fistula or ordinary incontinence?

Fistula leakage is continuous and painless, does not depend on coughing or urgency, and often begins within weeks of surgery, childbirth or radiation. Ordinary incontinence comes and goes with activity or urgency. Passing gas or stool through the vagina is almost always a fistula. A dye test at the clinic can usually tell the difference quickly.

Can a fistula heal without surgery?

Sometimes. A small, fresh vesicovaginal fistula may close with several weeks of continuous bladder drainage through a catheter, and some tiny rectovaginal tracts close on their own. Larger, older or radiation-related fistulas almost always need surgery. We try conservative care when the findings make it reasonable and set a clear time limit.

Does the clinic perform the fistula operation?

Fistula repair is specialist hospital surgery, and we coordinate it with urogynecology, urology or colorectal surgeons at partner hospitals rather than perform it in the clinic. Our role is diagnosis, preparation, the gynecologic problems around the fistula, and reconstruction of the perineum or vaginal wall afterward if needed.

Why is repair delayed for weeks?

Fresh fistula edges are swollen, inflamed and poorly supplied with blood, so stitches placed early tend to pull through. Waiting roughly 6 to 12 weeks lets the tissue soften and heal, which substantially improves the chance that one operation is enough. Radiation damage needs longer.

Will I be continent after repair?

Most women with a simple fistula regain normal control once it is closed. If the urethra, bladder neck or anal sphincter was damaged by the original injury, some leakage can persist and may need a separate procedure later. The pre-operative evaluation is designed to predict this honestly.

Can I have children after a rectovaginal fistula repair?

Usually yes, but a future delivery should be discussed with your obstetrician. Many surgeons advise a planned cesarean to protect the repair, particularly when the fistula followed an obstetric tear. We include this in the plan if you may want more children.

Keep reading

Related treatments and guides

• How Do I Know If I Have Pelvic Organ Prolapse? — distinguishing prolapse symptoms from other causes
• Pelvic Organ Prolapse Treatment in Korea for Foreigners: Complete Guide — arranging pelvic floor care from abroad
• Can Pelvic Organ Prolapse Be Treated Without Surgery? — conservative pelvic floor care
• Urinary Incontinence Treatment — the common causes of leakage
• Pelvic Floor Disorders — how we assess the whole pelvic floor
• Perineal Scar Revision — reconstruction after obstetric injury
• Dr. Yoon Ho-joo — the specialist coordinating your care

Sources and medical review

• Te Linde's Operative Gynecology (textbook) — chapters on vesicovaginal and rectovaginal fistula.
• American College of Obstetricians and Gynecologists (ACOG) — guidance on lower urinary tract injury and fistula after gynecologic surgery.
• International Continence Society (ICS) / International Urogynecological Association (IUGA) — terminology for female lower urinary tract and pelvic floor dysfunction.
• World Health Organization (WHO) — obstetric fistula principles of management.

Next step

A consultation first. A decision only when you are ready.

Tell us what you are experiencing and what you hope to change. Dr. Yoon examines, measures and explains the options, including when no surgery is the right answer. International patients can start with an online consultation before travelling to Seoul.