A rectovaginal fistula is an improper connection between your rectum and your vagina. The contents of your bowel can seep through the fistula, causing gas or feces to enter your vagina.
A rectovaginal fistula can develop as a result of:
- Injuries sustained during childbirth
- Crohn's disease or another type of inflammatory bowel disease
- Radiation therapy or cancer in the pelvic region
- Surgical complication in the pelvic area
The illness can cause emotional misery as well as physical discomfort, affecting self-esteem and intimacy.
Even if the signs and symptoms of a rectovaginal fistula are humiliating, consult your doctor. Some rectovaginal fistulas heal on their own, but the majority require surgical treatment.
WHAT ARE THE SYMPTOMS FOR RECTOVAGINAL FISTULA?
Depending on the size and location of the fistula, you may experience mild or substantial problems with continence and cleanliness. A rectovaginal fistula can cause the following symptoms:
Passage of gas, feces, or pus from your vagina
Vaginal discharge that smells bad
Infections of the vaginal or urinary tract on a regular basis
Irritation or pain in the vulva, vagina, and area between the vagina and anus (perineum)
Having a painful sexual experience
WHAT ARE THE CAUSES OF RECTOVAGINAL FISTULA?
A rectovaginal fistula can develop as a result of the following factors:
Injuries sustained during childbirth: Rectovaginal fistulas are most commonly caused by birth trauma. This includes rips in the perineum that extend to the colon or an infection of an episiotomy – a surgical cut made during vaginal delivery to widen the perineum. These can occur after a long, tough, or obstructed labor. These sorts of fistulas may also cause injury to your anal sphincter, the muscle rings at the end of the rectum that help you keep stool in place.
Crohn's disease: Crohn's disease, the second most prevalent cause of rectovaginal fistulas, is an inflammatory bowel illness in which the digestive tract lining becomes irritated. Most women with Crohn's disease do not get rectovaginal fistulas, however having Crohn's disease increases your chances of developing the disorder.
Cancer or radiation therapy in your pelvic region: A rectovaginal fistula can be caused by a malignant tumor in your rectum, cervix, vagina, uterus, or anal canal. Radiation therapy for various types of cancer can potentially put you at danger. Radiation fistulas typically emerge six months to two years following therapy.
Surgery on your vagina, perineum, rectum, or anus: In rare situations, prior surgery in the lower pelvic area, such as uterus removal (hysterectomy), might result in the formation of a fistula. A fistula can form as a consequence of an injury during surgery or as a result of a leak or infection that occurs afterwards.
Other factors: Infections in your anus or rectum; infections of tiny, bulging pouches in your digestive tract (diverticulitis); long-term inflammation of your colon and rectum (ulcerative colitis); dry, hard feces that becomes lodged in the rectum (fecal impaction); or vaginal damage unrelated to delivery may produce a rectovaginal fistula.
WHAT ARE THE COMPLICATIONS OF RECTOVAGINAL FISTULA?
A rectovaginal fistula may cause the following physical complications:
- Stool loss that is uncontrollable (fecal incontinence)
- Problems with hygiene
- Infections of the vaginal or urinary tract on a regular basis
- Irritation or inflammation of the vagina, perineum, or area surrounding the anus
- An infected fistula that develops into an abscess, a disease that can be fatal if not addressed.
- Fistula recurrence
Complications are common in women with Crohn's disease who develop a fistula. These can include poor healing or the formation of another fistula later on.
HOW IS RECTOVAGINAL FISTULA DIAGNOSED?
Depending on your demands, you can expect a physical exam and several tests.
Physical examination
A physical exam will be performed by your doctor to try to detect the rectovaginal fistula and to look for a tumor mass, infection, or abscess. With a gloved hand, the doctor inspects your vagina, anus, and the space between them (perineum).
Your doctor may use a speculum to view into your vagina unless the fistula is very low in the vagina and easily apparent. A proctoscope, which is similar to a speculum, may be put into your anus and rectum to check for issues.
During the operation, your doctor may extract a tissue sample for lab analysis (biopsy).
Tests for identifying fistulas
During the physical exam, your doctor may not detect a fistula. Other tests may be required to detect and assess a rectovaginal fistula. These tests can also help your doctor plan for surgery.
Contrast tests: A vaginogram or a barium enema can help identify an upper rectum fistula. A contrast substance is used in these tests to reveal the vagina or the bowel on an X-ray image.
Blue dye test: This test consists of inserting a tampon into your vagina and injecting blue dye into your rectum. A fistula is indicated by blue staining on the tampon.
Computerized tomography (CT) scan: A CT scan of your abdomen and pelvis delivers more information than an X-ray. A CT scan can assist in locating a fistula and determining its source.
Magnetic resonance imaging (MRI): This test generates photos of your body's soft tissues. An MRI can reveal the location of a fistula, as well as whether other pelvic organs are affected or if you have a tumor.
Anorectal ultrasound: This treatment creates a video image of your anus and rectum using sound waves. A slender, wand-like instrument is inserted into your anus and rectum by your doctor. This test can assess the structure of your anal sphincter and may reveal harm from childbirth.
Anorectal manometry: This exam assesses the sensitivity and function of your rectum, as well as the function of your rectal sphincter and your capacity to control stool flow. This test does not detect fistulas, but it may aid in the planning of fistula repair.
Other tests: If your doctor suspects you have IBD, he or she may prescribe a colonoscopy to examine your colon. During the surgery, your doctor may extract small tissue samples (biopsies) for lab analysis, which may assist confirm Crohn's disease.
WHAT ARE THE TREATMENTS FOR RECTOVAGINAL FISTULA?
Rectovaginal fistula symptoms can be upsetting, but treatment is usually beneficial. The treatment for a fistula is determined by its source, size, location, and impact on neighboring tissues.
Medications
Your doctor may prescribe one of the following medications to help treat the fistula or to prepare you for surgery:
- Antibiotics: If the region surrounding your fistula is infected, you may be given antibiotics prior to surgery. Antibiotics may also be prescribed for Crohn's disease patients who develop a fistula.
- Infliximab: In women with Crohn's disease, infliximab (Remicade) can help decrease inflammation and mend fistulas.
Surgery
The majority of people require surgery to closure or repair a rectovaginal fistula.
Before a procedure, the skin and any tissue surrounding the fistula must be healthy and free of infection or inflammation. Your doctor may advise you to wait three to six months before undergoing surgery to verify that the surrounding tissue is healthy and to see whether the fistula heals on its own.
A gynecologic surgeon, a colorectal surgeon, or both working together may perform surgery to seal a fistula. The goal is to sew healthy tissue together to seal the opening and remove the fistula tract. Surgical alternatives include:
- Sewing in an anal fistula plug or patch of biologic tissue to allow your tissue to grow into the patch and mend the fistula.
- Using a tissue graft from another part of your body or folding a flap of healthy tissue over the fistula opening
- Repairing the anal sphincter muscles that have been injured by the fistula, scarring, or tissue damage caused by radiation or Crohn's disease.
- In complex or recurring cases, performing a colostomy before healing a fistula to channel stool through a hole in your belly rather than through your rectum. Most of the time, this procedure is unnecessary. However, if you have tissue damage or scarring from earlier surgery or radiation treatment, a continuing infection or substantial fecal contamination, a malignant tumor, or an abscess, you may require this. If a colostomy is required, your surgeon may recommend waiting eight to twelve weeks before healing the fistula. The colostomy can usually be reversed and normal bowel function restored after three to six months and evidence that your fistula has healed.
HOME REMEDIES FOR RECTOVAGINAL FISTULA
While waiting for repairs, good hygiene can help alleviate discomfort and reduce the risk of vaginal or urinary tract infections. Other home cures for rectovaginal fistula patients include:
- Wash with water: Each time you have vaginal discharge or stool passage, shower or gently cleanse your outer genital area with warm water.
- Irritants should be avoided: Soap can dry and aggravate your skin, so use a soft unscented soap sparingly. Avoid using harsh or scented soap, as well as scented tampons and pads. Vaginal douches can raise your risk of infection.
- Thoroughly dry: After washing, allow the area to air dry or gently pat it dry with a clean cloth or towel.
- Do not rub with dry toilet paper: A suitable alternative are pre-moistened, alcohol-free, unscented towelettes or wipes, or moistened cotton balls.
- Apply a cream or powder: Moisture-barrier creams shield inflamed skin from liquids and feces. Nonmedicated talcum powder or cornstarch may also help ease pain. Request a product recommendation from your doctor. Before using any cream or powder, make sure the area is clean and dry.
- Dress comfortably with cotton underwear and loose garments: Tight clothing can hinder ventilation and aggravate skin conditions. Quickly change soiled underwear. If you're passing liquid or feces, products like absorbent pads, disposable underwear, or adult diapers can assist, but make sure they have an absorbent wicking layer on top.
Follow any other instructions from your health care provider for the best results.