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Rectovaginal Fistulas symptoms, causes and treatment

What are rectovaginal fistulas?

Rectovaginal fistulas are atypical connections formed between the rectum and the vagina. These are very bothersome to the individual as well the treating surgeon given the problematic nature of their symptoms and high rates of failure post a repair surgery. These fistulas cause faecal incontinence and that in turn trigger frequent vaginal and urinary infections.

Rectovaginal Fistulas Explained

Causes

Such fistulas usually result due to

  • Childbirth trauma: Tearing, vacuum/forceps extraction or episiotomy (a surgical cut made during difficult birthing at the vaginal opening)
  • Inflammatory bowel disease or Crohn’s disease
  • Surgical complications of a pelvic surgery
  • Radiation injury
  • Rectal cancer in rare cases

Symptoms

The symptoms can include:

  • Passing of stool, gas or pus from vagina
  • Vaginal discharge with foul smell
  • Pain or irritation in the perineal area
  • Pain during sex
  • Frequent episodes of urinary tract and vaginal infections

Diagnosis

Your doctor will ask questions about your medical history. The doctor will ask about your obstetrical history, prior history of any abdominal and anorectal surgeries, history of radiation treatment and symptoms of Crohn’s disease.

A physical exam of the vagina and the anus with an anoscopy of the anal canal.

Imaging tests can include a magnetic resonance imaging (MRI), anorectal ultrasound, barium enema or a vaginogram (an imaging procedure with a contrast of vagina) to diagnose the fistula.

Colonoscopy can be performed if inflammatory bowel disease is suspected. Biopsy of the tissue can be done for diagnosing Crohn’s disease.

Treatment

The treatment can include conservative management aimed at control of diarrhoea and bowel function regulation.

Antibiotics and drugs to address Crohn’s disease can be prescribed. Surgical repair is often used to improve the individual’s quality of life. The surgical approaches aim at removing the fistula tract and closing the opening by sewing up the healthy tissues.

General tips to follow at home

  • Maintain good hygiene and gently wash your genitals
  • Do not rub your genitals with toilet paper
  • Use gentle and unscented soaps
  • Avoid douching
  • Wear loose-fitting clothing and cotton innerwear

Prevention

Seeking prompt treatment by noticing early warning signs like blood in stool, bloody diarrhoea, pain in the anus/rectum can be helpful in preventing the development of a fistula.

Complications

The complications include:

  • Hygiene issues
  • Faecal incontinence
  • Fatal infections can arise if the fistula is infected and left untreated

Next Steps

If you have been diagnosed with a rectovaginal fistula, follow your doctor’s advice and visit for follow-up check-ups.

Consult a top General Surgeon

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References

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  • deBeche-Adams TH, Bohl JL. Rectovaginal Fistulas. Clinics in Colon and Rectal Surgery. 2010;23(2):99-103.
  • Congenital Recto-Vestibular Fistula and Recto-Vaginal Fistula. Cedars-Sinai. https://www.cedars-sinai.edu/Patients/Health-Conditions/Congenital-Recto-Vestibular-Fistula-and-Recto-Vaginal-Fistula.aspx. Accessed 30 Jan. 17.
  • Rectovaginal Fistula. Pelvic Floor Center. http://www.pelvicfloorcenter.org/content/rectovaginal-fistula. Accessed 30 Jan. 17.

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