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What is a Rectovaginal Fistula?

A rectovaginal fistula is an abnormal connection between the rectum and vagina, leading to distressing symptoms like leakage of stool into the vaginal area. This condition can profoundly affect quality of life, but understanding its causes, treatments, and management strategies is the first step toward healing. How might this condition be impacting lives more than we realize? Continue exploring with us.
A. Pasbjerg
A. Pasbjerg

A rectovaginal fistula is an abnormal opening that creates a connection between the vagina and the rectum. This can allow the contents of the bowel to spill over into the vagina. The size of the passageway can vary, so the impacts of the condition can range from relatively minor to extremely debilitating.

Patients with rectovaginal fistulas may pass feces, gas or pus from their vaginas, as well as a foul-smelling discharge. The condition can lead to discomfort or pain in the area, especially during sexual intercourse. Because stool may be entering the vagina, infections can occur and reoccur. Incontinence may be an issue as well. If the fistula becomes infected, it may form an abscess.

A rectovaginal fistula allows the contents of the rectum to spill into the vagina.
A rectovaginal fistula allows the contents of the rectum to spill into the vagina.

Injuries that occur during childbirth are the most frequent cause of rectovaginal fistulas. During long, difficult labors, the tissue between the vagina and the anus, called the perineum, can tear. An episiotomy, where the doctor cuts the perineum, may also cause tearing that can lead to a fistula.

Several other factors can also play a role in creating a rectovaginal fistula. Women with Crohn’s disease often develop them, sometimes repeatedly. Surgery that involves the rectum, vagina or surrounding tissue is a risk factor. Cancerous tumors in that area, as well as the use of radiation to treat them, may lead to a fistula. Additional causes can include infections and vaginal trauma.

Childbirth-related injuries are the most frequent causes of rectovaginal fistulas.
Childbirth-related injuries are the most frequent causes of rectovaginal fistulas.

To determine if a woman has a rectovaginal fistula, a doctor will first discuss if she has any possible risk factors that may have caused the condition. This will typically be followed by a physical exam, where the doctor will visually examine the area, as well as possibly using gloved fingers, a speculum or a proctoscope to examine the vagina and anus internally. If the physical exam does not locate the fistula, additional tests may be ordered. Tests that show air or dye passing from the rectum to the vagina can be used. Some other options include computerized tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasound.

Rectovaginal fistula is an opening between the rectum and the vagina.
Rectovaginal fistula is an opening between the rectum and the vagina.

Although a rectovaginal fistula may resolve on its own, surgery is often necessary. Depending on the location of the fistula, surgery may be done by a gynecologic surgeon or a colorectal surgeon. Because the tissue needs to be healthy for the operation, antibiotics and anti-inflammatory medication may need to be taken prior, and in some cases the patient may need a colostomy beforehand. During the surgery, a flap of healthy tissue or a graft from another area may be used to close the opening.

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    • A rectovaginal fistula allows the contents of the rectum to spill into the vagina.
      By: Alexandr Mitiuc
      A rectovaginal fistula allows the contents of the rectum to spill into the vagina.
    • Childbirth-related injuries are the most frequent causes of rectovaginal fistulas.
      By: Andres Rodriguez
      Childbirth-related injuries are the most frequent causes of rectovaginal fistulas.
    • Rectovaginal fistula is an opening between the rectum and the vagina.
      By: isyste
      Rectovaginal fistula is an opening between the rectum and the vagina.
    • The tissue between the vagina and the anus is the perineum.
      By: isyste
      The tissue between the vagina and the anus is the perineum.
    • Performing gentle stretching and kegel exercises during pregnancy may help strengthen the perineum muscles prior to giving birth.
      By: evgenyatamanenko
      Performing gentle stretching and kegel exercises during pregnancy may help strengthen the perineum muscles prior to giving birth.
    • Rectovaginal fistula can cause pain during sexual intercourse.
      By: Artem Furman
      Rectovaginal fistula can cause pain during sexual intercourse.
    • An MRI scan may be helpful in diagnosing rectovaginal fistula.
      By: EPSTOCK
      An MRI scan may be helpful in diagnosing rectovaginal fistula.
    • Vaginal ultrasound probes may be inserted into the vagina to obtain an image of the uterus.
      By: zayacsk
      Vaginal ultrasound probes may be inserted into the vagina to obtain an image of the uterus.