All visitors are required to wear masks.

For COVID-19 safety, all visitors to ChristianaCare facilities and services are required to wear masks. This includes visitors who are vaccinated. Please read our visitor guidelines before arrival.

Masks required at outpatient locations; visitors and support persons limited

All visitors at outpatient locations must be masked in alignment with the masking guidelines on our visitation policy page here. Patients at ChristianaCare’s outpatient services are advised to come to their appointments alone unless a support person is absolutely needed. If a support person is needed, such as a parent, guardian or spokesperson, we highly encourage that the support person be vaccinated. Outpatient practices are not requiring vaccination or a negative COVID test for visitors at this time.

All hospital visitors required to be vaccinated or have a negative COVID-19 test.

  • Inpatients in our Christiana, Wilmington and Union hospitals may have one visitor daily between 10 a.m. and 8 p.m. The visitor must be 16 or older.
  • Patients having outpatient surgery may have one support person accompany them. Support persons must be 16 or older.
  • All visitors and surgical support people must show proof of vaccination OR a negative COVID-19 test within the prior 72 hours.

Before visiting, click here for more details about visitation.

Visit or for local vaccination and testing sites.

Genital Fistula

Get help for Genital Fistulas
Surgery can address the embarrassing symptoms

A fistula is an opening between two organs that normally do not communicate with each other. According to the World Health Organization, more than 2 million women live with fistulas between the bladder and the vagina (vesicovaginal fistula) and the rectum and vagina (rectovaginal fistula), which are typically caused by a prolonged, obstructed labor in developing countries.

There are other causes, however, and the women all share symptoms that can be irritating, distressing and painful. In developing countries, women are often ostracized. In any area of the world, the involuntary loss of urine or fecal matter from the vagina is embarrassing.

Surgery can close the holes and help you lead a normal life.

What causes a vesicovaginal fistula?

In developing countries, the most common cause is a long labor, particularly if the mother is young and has an undeveloped pelvis. In the United States, leading causes include pelvic surgery, such as hysterectomies, and pelvic radiation.

What are the symptoms of a vesicovaginal fistula?

The leading symptom is uncontrollable urinary incontinence leaking through the vagina. You may or may not have pain. If you develop an infection, you might have a fever and nausea.

How are vesicovaginal fistulas diagnosed?

Your doctor may find the fistula during an exam. Additional diagnostic tests may include:

  • Cystoscopy.
  • Cystogram.
  • Back-filling the bladder with colored fluid to see if it leaks into the vagina.
  • Computerized tomography (CT) scan.
  • Collecting vaginal fluid for analysis.

What causes a rectovaginal fistula?

Again, a long, difficult labor and childbirth are the most frequent causes.

Others include:

  • Crohn’s disease, diverticulitis or another inflammatory bowel disease.
  • Radiation treatment or cancer in the area.
  • Complications from surgery.
  • Vaginal trauma.

What are the symptoms of rectovaginal fistula?

The most apparent symptom is a stool or gas coming from your vagina and not your rectum. Other symptoms include:

  • Pus coming from your vagina.
  • Vaginal discharge with an unpleasant smell.
  • Recurrent vaginal or urinary tract infections.
  • Irritation or pain in the vulva, vagina and perineum, which is the space between your vagina and anus.
  • Pain during sexual intercourse.

How are rectovaginal fistulas diagnosed?

Your doctor may find the fistula during an exam. Diagnostic tests may include:

  • Anorectal or transvaginal ultrasound.
  • Methylene enema. If a tampon, inserted into the vagina, turns blue when a dye is injected into the rectum, you have a fistula.
  • Barium enema. Contrast dye helps the doctor pinpoint a fistula on an X-ray.
  • Computerized tomography (CT) scan.
  • Magnetic resonance imaging (MRI).
  • Colonoscopy.

What is the treatment for genital fistulas?

Depending on the cause, the doctor can use surgery to close the holes. Before surgery, however, your doctor will treat any infection.

During the procedure, the surgeon will close the holes and then layer your own connective tissue between the holes to help prevent them from reopening. The area needs a good blood supply so that the tissue survives. When the surgery is correctly performed the first time, it has a high success rate.

For more information about vaginal fistulas, visit:

Urology Care Foundation
ChristianaCare Center for Urogynecology and Pelvic Surgery
International Urogynecological Association