A rectovaginal fistula is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina. Contents of your bowel can leak from the fistula, meaning you might pass gas or stool through your vagina.
A rectovaginal fistula may result from an injury during childbirth, a complication following surgery, cancer or inflammatory bowel disease, such as Crohn's disease. However, in Western countries rectovaginal fistulas occur only rarely.
The symptoms of a rectovaginal fistula often cause emotional distress as well as physical discomfort. Though bringing up the subject with your doctor may be difficult, it's important to have a rectovaginal fistula evaluated. Some rectovaginal fistulas may close on their own, but most need to be repaired surgically.
Depending on the size and location of the fistula, you may have very minor symptoms or significant problems with continence and hygiene. Signs and symptoms of a rectovaginal fistula may include:
When to see a doctor
A rectovaginal fistula may form as a result of:
Physical complications of rectovaginal fistula may include incontinence, problems with hygiene, and irritation or inflammation of your vagina, perineum or the skin around your anus. In some cases, a fistula may become infected and form an abscess, a problem that can become life-threatening if not treated. Among women with Crohn's disease who develop a fistula, the chance of another fistula forming later is high.
Preparing for your appointment
You're likely to start by seeing your family doctor or primary care provider. However, in some cases when you call to set up an appointment you may be referred immediately to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist).
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
For rectovaginal fistula, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment if you don't understand something.
What to expect from your doctor
Tests and diagnosis
Unless the fistula is very low in the vagina and readily visible, your doctor may use a speculum to visualize the inside of the vagina. This may allow him or her to see the opening of the fistula inside your vagina. An instrument similar to a speculum, called a proctoscope, may be inserted into your anus and rectum to check the health of your rectum.
Tests for identifying fistulas
Treatments and drugs
Treatment for a rectovaginal fistula depends on its cause, size, location and effect on surrounding tissues. Sometimes fistulas heal on their own, but most people need surgery to close or repair the abnormal connection. Before an operation can be done, the skin and other tissue around the fistula must be healthy, with no signs of infection or inflammation. Your doctor may advise a waiting period of up to three months before surgery to ensure the surrounding tissue is healthy and see if the fistula closes on its own.
To clean out your bowel before the operation, you may take laxatives or follow a liquid diet prior to surgery. This may be followed by an enema shortly before surgery. You'll also be given an antibiotic medication before surgery.
In some more complex or recurrent cases, the surgeon may do a colostomy before repairing a fistula. A colostomy is an operation that diverts stool through an opening in your abdomen instead of through your rectum. This may be needed if you've had tissue damage or scarring from previous surgery or radiation treatment, an ongoing infection or significant fecal contamination, a cancerous tumor, or an abscess. If a colostomy is needed, your surgeon may wait eight to 12 weeks before repairing the fistula.
After an operation to close a fistula, you'll be on a liquid diet for about three days, followed by a low-fiber diet for several weeks. A low-fiber diet reduces the frequency and volume of stools. Your care team may recommend that you take sitz baths two to three times a day and dry off with a blow dryer to keep the area clean and dry.
Lifestyle and home remedies
Good hygiene can help ease discomfort and reduce the chance of vaginal or urinary tract infections:
Symptoms of a rectovaginal fistula can be very distressing, but treatment generally offers good results.
Last Updated: 2010-05-29
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