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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    TOP

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

Risk Factors    TOP

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    TOP

Symptoms may include:

  • Passing stool or gas via the vagina
  • Inability to control bowel movements
  • Foul-smelling vaginal discharge
  • Pain during sexual intercourse
  • Persistent pain in the pelvic area

Diagnosis    TOP

You will be asked about your symptoms and medical history. A physical exam will be done. You may need to see a colon and rectal surgeon.

Your body structures may need to be viewed. This can be done with:

  • 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    TOP

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    TOP

There are no current guidelines to prevent rectovaginal fistula.

RESOURCES:

American Society of Colon and Rectal Surgeons
https://www.fascrs.org
The American Congress of Obstetricians and Gynecologists
http://www.acog.org

CANADIAN RESOURCES:

Canadian Society of Colon and Rectal Surgeons
http://cscrs.ca
Women's Health Matters
http://www.womenshealthmatters.ca

References:

Anorectal malformations. EBSCO DynaMed Plus website. Available at: http://www.dynamed.... Updated June 13, 2013. Accessed December 18, 2014.
Wheeless CR, Roenneburg ML. Rectovaginal fistula repair. Atlas of Pelvic Surgery website. Available at:
...(Click grey area to select URL)
Accessed February 2, 2010.
Last reviewed December 2015 by Daus Mahnke, MD
Last Updated: 12/20/2014

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