What is the Colovesical Fistula?
A colovesical fistula is an abnormal connection between the colon and the bladder. It may occur due to gastrointestinal conditions such as diverticulitis and Crohn’s disease.
Enterovesical fistula is classified as:
- Colovesical: Fistula between colon and bladder
- Rectovesical: Fistula between rectum and bladder
- Ileovesical: Fistula between ileum and bladder
- Appendicovesical: Fistula appendix and bladder
The colon is the largest part of the intestine and is responsible for removing water and nutrients from the food that is partially digested.(1)
The bladder is an organ that stores urine.
A colovesical fistula, on average, develops between the age of 55-75 years and is more common in males.(2)
Causes of Colovesical Fistula
Diverticulitis is the most common cause of colovesical fistula and accounts for two-thirds of all cases. (2) It may lead to the formation of abscesses around the colon that may extend or rupture into the adjacent organ.
Other causes of colovesical fistula include:
- Crohn’s disease
- Surgery of the bladder or colon
- Colorectal cancers
- Radiation therapies
Symptoms of Colovesical Fistula
A person with a colovesical fistula may develop the following symptoms.
- Fecaluria: It is stool in the urinary system, which leads to the appearance of fecal matter in the urine giving it brown cloudiness. It is known to occur in 50-70% of people.
- Pneumaturia: It is the presence of air in the bladder. This occurs due to the production of gas in the colon which mixes with the urine. It can lead to bubbles in the urine. It is known to occur in 70-90% of people with this condition.
- Dysuria: It is also known as painful urination. It is the burning sensation during urination from the urinary tract infection.
- Hematuria: It is the presence of traces of blood in the urine. It is a less common condition.
If a person has recurrent abdominal pain and urinary tract infection, there may be a possibility of the presence of a colovesical fistula.
How to Diagnose Colovesical Fistula?
There are various methods to diagnose the colovesical fistula.
CT scans: These can be helpful to the doctor in seeing the abnormal walls between the organs.
Colonoscopy: In this procedure, the doctor inserts a microscope camera into the colon. It is less accurate than a CT scan but can be helpful in eliminating any cancerous cause of the fistula.
Cystoscopy: In this procedure, a camera is placed into the bladder to see whether a fistula is present or not.
Barium Enema: It can be helpful in identifying any problem with the colon. In it, water containing barium coats the inside of the rectum. This allows the doctor to see details better than standard imaging.
Assessment of these tests and a physical examination can be helpful in determining the presence of a colovesical fistula.
Treatment and Management of Colovesical Fistula
Surgery or more conservative treatments are used by doctors to treat colovesical fistula.
Conservative treatments can be helpful in allowing the fistula to heal. These include antibiotic treatment to reduce the infection. The medication may also be helpful in treating diverticulosis or Crohn’s disease, which may be causing a fistula.
A doctor recommends eating more dietary fiber to soften the stool and relieve the symptoms of diverticulitis.
Crohn’s disease may be treated with medications, dietary changes, and supplements. The aim of the treatment is to relieve inflammation, reduce the occurrence of flares and improve nutrition and food absorption.
Surgical methods are needed if, conservative methods fail to relieve symptoms.
The surgeon may remove the fistula and repair the damage caused between the organs to stop the fluid exchange.
The treatment of colovesical fistula involves:
- Removal of the fistula
- Closure of the bladder wall
- Resection of colic with or without temporary colostomy
Surgery is determined on the basis of the location of the fistula, the most common being between the sigmoid colon and bladder. Therefore, the most common procedure is sigmoid colectomy. It involves the removal of all or a part of the sigmoid colon. This may be performed as an open surgery or laparoscopic surgery. In research, it is observed that the doctor reserve laparoscopic option for select cases.(3)
A person may recover from fistula removal surgery in 7-10 days, 8 days being an average.(4)
Colovesical fistula is a rare abnormality that may develop due to other conditions or surgical procedures. There are various diagnostic methods to determine why a person is experiencing it. The treatment depends on the type of fistula and its cause.