Rectovaginal Fistula

  • Definition

    Rectovaginal fistula is an abnormal connection between the rectum and the vagina. Gas or stool may leak from the bowel into the vagina.
    Healthy Wall Between Vagina and Rectum
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  • Causes

    A rectovaginal fistula is caused by an injury to this area. It may be caused by physical trauma or a medical condition.
  • Risk Factors

    Factors that may increase your risk of rectovaginal fistula include:
    • Crohn’s disease
    • Complications following surgery to the perineum (area between vagina and rectum), vagina, rectum, or anus
    • Injuries during childbirth
    • Radiation treatment or cancer in the pelvic area
    • Perianal infection
  • Symptoms

    If you have any of these, do not assume it is due to a fistula. These symptoms may be caused by other conditions. Talk to your doctor if you have:
    • Passing stool or gas via the vagina
    • Inability to control bowel movements
    • Foul-smelling vaginal discharge
    • Recurring vaginal infections
    • Pain during sexual intercourse
    • Persistent pain in the pelvic area
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to see a colon and rectal surgeon.
    Tests may include the following:
    • Anorectal ultrasound—a small wand-like instrument provides a video image of the rectum and anus
    • Methylene enema—a tampon is placed in the vagina and methylene blue is placed into the rectum to identify movement of fluid from rectum to vagina
    • Contrast studies— barium enema may be used to view a rectovaginal fistula that cannot be seen on physical exam
    • Endoscopy—a thin, lighted tube is inserted into the rectum to examine the rectum and the lower colon (to rule out irritable bowel disease)
  • Treatment

    Talk with your doctor about the best plan for you. Treatment options include the following:
    Rectovaginal Fistula Repair Surgery
    Surgery is usually needed. It is done to close the opening between the rectum and vagina. Tissue may be taken from another part of the body as a graft. This tissue will help to close the fistula.
    Medications
    You may be given antibiotics if the area around the fistula is infected.
  • Prevention

    There are no steps to prevent rectovaginal fistula.
  • RESOURCES

    The American Congress of Obstetricians and Gynecologists http://www.acog.org/

    American Society of Colon and Rectal Surgeons http://www.fascrs.org/

    CANADIAN RESOURCES

    Canadian Society of Colon and Rectal Surgeons http://www.cscrs.ca/

    Women's Health Matters http://www.womenshealthmatters.ca/

    References

    Rectovaginal fistula. Mayo Clinic. http://www.mayoclinic.com/. Accessed February 2, 2010.

    Wheeless CR, Roenneburg ML. Rectovaginal fistula repair. Atlas of Pelvic Surgery website. Available at: http://www.atlasofpelvicsurgery.com/2VaginalandUrethra/14RectovaginalFistulaRepair/chap2sec14.html. Accessed February 2, 2010.

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