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Rectovaginal Fistula

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A Rectovaginal Fistula is a condition in which there is an unusual and abnormal connection between the rectum and the vagina.

A Rectovaginal Fistula results in bowel contents like gas and stool to leak via the fistula into the vagina. This condition might cause a lot of discomforts physically and emotionally. These fistulas are not permanent and can be treated via surgery. A rectovaginal fistula can embarrass the patient and lead to mental distress.

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What are the Causes of Rectovaginal Fistula?

There are various causes which might cause a Rectovaginal Fistula. These include:

  • Trauma or injuries during childbirth: Delivery related injuries such as a tear in the perineum or the doctor making a surgical incision or cut in the perineum, also known as episiotomy, may cause a fistula. Long and difficult labour causes these difficulties due to which there is an injury to the anal sphincter, the muscles of which hold the stool.
  • Inflammatory Bowel Disease (IBD): IBD’s such as Crohn’s disease is the second most common cause of a rectovaginal fistula in which the lining of the digestive tract has inflammation. Having an IBD increases the risk of developing Rectovaginal Fistula.
  • Cancer or radiation therapy to the pelvis: Radiation used to treat cancers in and around the pelvic region like rectum, cervix, vagina, uterus or anus, can increase the risk of developing a fistula.
  • Previous surgeries: Having had previous surgeries in the lower pelvic region involving the vagina, uterus, rectum or anus, increases the risk of developing a fistula.
  • ● Stool getting stuck in the rectum
  • ● Infections in the rectum or anus
  • ● Pockets or sacs in the intestines
  • ● Ulcerative colitis

What are the Symptoms of Rectovaginal Fistula?

Based on the size and location of the Rectovaginal Fistula, the symptoms vary. The most common signs and symptoms include:

  • ● Trouble in controlling the bowel movements
  • ● Passing of stool, pus or gas from the vagina
  • ● Foul-smelling discharge from the vagina
  • ● Recurring urinary tract infections
  • ● Pain or irritation in the rectum, vagina or the anus region
  • ● Pain during sex

How is Rectovaginal Fistula Diagnosed?

The doctor first asks about the signs and symptoms experienced by the patient and checks the medical history of the patient. Then, there is a physical exam conducted.

In the physical exam, the doctor tries to locate the fistula by using a gloved hand to inspect the rectum, vagina and anus and the area in between in order to check for a possible mass or infection. A proctoscope is used to see into the rectum and a speculum is used to see the inside of the vagina clearly.

Following diagnostic tests are done to confirm a Rectovaginal Fistula:

  • Barium enema or contrast tests: This uses a contrast dye to show the vagina or rectum using X-rays to find the location of the fistula.
  • Blue dye test: In this, a tampon is inserted in the vagina and then a blue dye is injected in the rectum. If the tampons have any stains, it shows a fistula.
  • Magnetic Resonance Imaging (MRI) and Computerised Tomography (CT) scans: These are used to locate a fistula and determine the cause if present.
  • Anorectal Ultrasound: This test uses sound waves to produce images of the rectum and vagina. This helps to inspect the structure of the anal sphincter.
  • Colonoscopy: To check for inflammatory bowel disease.

How is Rectovaginal Fistula Treated?

Most Rectovaginal Fistula need surgery. Surgical treatments for these fistulas are very effective. However, medications can also be used in the treatment or to prepare the patient before the surgery. The doctor might first suggest waiting for 3 to 6 months to check if the fistula closes on its own or for an infection to heal. Medications like antibiotics are used to treat infections if and infliximab is prescribed to reduce the inflammation.

Surgical options include:

  • ● Repairing the anal sphincter muscles if it has damaged them.
  • ● Using a tissue graft from a nearby body part and making a flap or plug to close the opening.
  • ● Making a circular incision around the fistula. Using circumferential dissection, the vagina is separated from the rectum and the entire fistula is incised. The rectal wall is then closed.
  • ● Performing a colostomy before repairing a fistula which creates an opening in the abdomen in order to divert the stool.

What is the Results of Rectovaginal Fistula Treatment?

Surgical treatment is the best and effective treatment. While there might be some complications or side effects, it is safe to opt for surgery. Abdominal surgeries have a higher success rate than rectum or vaginal ones.

What are the Risks Associated with Rectovaginal Fistula treatments?

Potential risks arising due to the surgery include:

  • ● Bleeding
  • ● Bowel blockage
  • ● Repeating urinary tract or vaginal infections.
  • ● Damage to the uterus, bowel or the bladder
  • ● Inflammation of the vagina or perineum
  • ● Faecal incontinence

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What are Some Home Remedies for People Having these Fistulas?

Maintaining good hygiene helps ease discomfort and avoids infections before the surgery. Washing the genital area with warm water, avoiding irritants, use of wet wipes instead of dry toilet paper and wearing cotton underwear and loose clothing so there is no restriction in airflow.

What if Rectovaginal Fistulas are Left Untreated?

Untreated Fistulas result in several complications along with continuous discomfort.

Do Rectovaginal Fistulas Smell?

Patients with such Fistulas experience foul-smelling vaginal discharge.

What is the Best Treatment for Rectovaginal Fistula?

If the Fistula does not close by itself, surgery is the best and effective treatment option that a patient can choose.

Does a Patient With These Fistulas Experience Pain During Sexual Intercourse?

Yes. Patients having a Rectovaginal Fistula do experience pain while engaging in sexual intercourse.


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