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Colovesical fistula is a rare condition that occurs when there’s a connection between the colon and the bladder, allowing fecal matter to enter the bladder.

Treatment generally involves surgery. WakeMed’s team of colorectal surgeons are experienced with treating this uncommon and painful condition.

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What Are the Symptoms and Risk Factors of Colovesical Fistula?

Colovesical fistula is usually caused by surgery or other trauma to the area. Conditions that can lead to colovesical fistula include diverticulitis, colon and rectal cancer, Crohn’s disease, and cancer that involves nearby organs.

Symptoms usually involve changes to the urine, including:

  • Bubbles in the urine, which occurs because gas from the colon is mixing with the urine
  • Brownish or cloudy urine
  • Blood in the urine
  • Painful and burning urination
  • Recurrent urinary tract infection and, sometimes, sepsis

Other symptoms include abdominal pain and diarrhea.

How Is Colovesical Fistula Diagnosed?

To diagnose a colovesical fistula, the doctor will perform a computed tomography (CT) scan. To confirm the diagnosis, a test called a cystography, which involves inserting a thin, flexible tube with a camera into the bladder, may be performed. The doctor can use this test to determine if there’s a fistula present.

A barium enema is also sometimes used to get a detailed look at the colon. In this test, the doctor inserts barium liquid into the patient’s rectum, and then looks at the colon using an X-ray camera. 

How Is Colovesical Fistula Treated?

Non-surgical methods of treatment like antibiotics and intravenous feeding may be tried first, however, surgery is typically needed for effective treatment.

Our colorectal surgeons can use either robotic, laparoscopic, or open surgical methods to repair or remove the colovesical fistula. In either approach, the patient will be put under general anesthesia. After the surgeon makes the incision, the colon and bladder are separated, and the diseased part of the colon is resected. The hole in the bladder is closed. The surgeon will repair any other issues with either the colon or the bladder, and place a patch between the colon and bladder to prevent fistulas from forming again.

After surgery, many patients are able to return to normal activities within a couple of weeks.

Learn more about what to expect from colorectal surgery.