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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.
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.
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.
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.