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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 the Vagina and Rectum
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Causes

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

Risk Factors

Things that may raise the risk of this problem are:

  • Crohn disease
  • Recent surgery to the perineum (area between vagina and rectum), vagina, rectum, or anus
  • Injuries during childbirth
  • Radiation treatment or cancer in the pelvic area
  • Infection in the area around the anus

Symptoms

Problems may be:

  • Pain in the pelvic area
  • Pain during sex
  • Passing stool or gas through the vagina
  • Problems controlling stool (poop)
  • Foul-smelling vaginal discharge

Diagnosis

The doctor will ask about your symptoms and health history. A physical exam will be done. You may need to see a colon and rectal surgeon.

Images of the area may need to be taken. 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 the rectum to the 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

Treatment

The goal of treatment is to repair the connection. Options are:

Medications

You may be given antibiotics if the area around the fistula is infected.

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.

Prevention

There are no known guidelines to prevent this health problem.

RESOURCES:

The American Congress of Obstetricians and Gynecologists
https://www.acog.org

American Society of Colon and Rectal Surgeons
https://www.fascrs.org

CANADIAN RESOURCES:

Canadian Society of Colon and Rectal Surgeons
http://cscrs.ca

Women's Health Matters—Women's College Hospital
http://www.womenshealthmatters.ca

REFERENCES:

Anorectal malformations. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/anorectal-malformations. Accessed August 20, 2021.

Rectovaginal fistula repair. Atlas of Pelvic Surgery website. Available at: http://www.atlasofpelvicsurgery.com/2VaginalandUrethra/14RectovaginalFistulaRepair/chap2sec14.html. Accessed August 20, 2021.

Last reviewed July 2021 by EBSCO Medical Review Board James Cornell, MD  Last Updated: 8/20/2021