Rectovaginal fistula is an abnormal connection between the rectum and the vagina. Gas or stool may leak from the bowel into the vagina.
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A rectovaginal fistula is caused by an injury to this area. It may be caused by physical trauma or a medical condition.
Factors that may increase your risk of rectovaginal fistula include:
- Crohn 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 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
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 bodily 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)
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.
You may be given antibiotics if the area around the fistula is infected.
There are no current guidelines to prevent rectovaginal fistula.
American Society of Colon and Rectal Surgeons
The American Congress of Obstetricians and Gynecologists
Canadian Society of Colon and Rectal Surgeons
Women's Health Matters—Women's College Hospital
Anorectal malformations. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114926/Anorectal-malformations. Updated February 18, 2017. Accessed January 9, 2018.
Wheeless CR, Roenneburg ML. Rectovaginal fistula repair. Atlas of Pelvic Surgery website. Available at: http://www.atlasofpelvicsurgery.com/2VaginalandUrethra/14RectovaginalFistulaRepair/chap2sec14.html. Accessed January 9, 2018.
Last reviewed November 2018 by EBSCO Medical Review Board Daus Mahnke, MD Last Updated: 12/20/2014