Rectovaginal fistula

Overview

A rectovaginal fistula is a connection that should not exist between the lower part of the large intestine — the rectum or anus — and the vagina. Bowel contents can leak through the fistula, allowing gas or stool to pass through the vagina.

A rectovaginal fistula may result from:

• Injury during childbirth.
• Crohn's disease or other inflammatory bowel disease.
• Radiation treatment or cancer in the pelvic area.
• Complication after surgery in the pelvic area.
• Complication from diverticulitis, an infection of small, bulging pouches in the digestive tract.

The condition may cause gas and stool to leak out of the vagina. This may lead to emotional distress and physical discomfort for you, which may impact your self-esteem and intimacy.

Talk with your health care provider if you have symptoms of a rectovaginal fistula, even if it's embarrassing. Some rectovaginal fistulas may close on their own, but most need surgery to fix them.

Symptoms

The most common symptom of a rectovaginal fistula is passing gas or stool from the vagina. Depending on the fistula's size and location, you may have only minor symptoms. Or you may have significant problems with stool and gas leakage and keeping the area clean.

When to see a doctor

See your health care provider if you have any symptoms of a rectovaginal fistula.

Causes

A rectovaginal fistula may form as a result of:

• Injuries during childbirth. Delivery-related injuries are the most common cause of rectovaginal fistulas. Injuries include tears in the perineum ⸺ the skin between the vagina and the anus ⸺ that extend to the bowel or an infection. Fistulas caused by injuries during childbirth may involve injury to the anal sphincter ⸺ the rings of muscle at the end of the rectum that help hold in stool.
• Inflammatory bowel disease. The second most common cause of rectovaginal fistulas is Crohn's disease and, more rarely, ulcerative colitis. These inflammatory bowel diseases cause swelling and irritation of the tissues lining the digestive tract. Most people with Crohn's disease never develop a rectovaginal fistula, but having Crohn's disease does increase your risk of the condition.
• Cancer or radiation treatment in the pelvic area. A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. Also, radiation therapy for cancers in these areas can put you at risk. A fistula caused by radiation can form at any time following radiation treatment, but most commonly forms within the first two years.
• Surgery involving the vagina, perineum, rectum or anus. In rare cases, prior surgery in your lower pelvic area, such as removing an infected Bartholin's gland, can cause a fistula to develop. Bartholin's glands are found on each side of the vaginal opening and help keep the vagina moist. The fistula may develop as a result of an injury during surgery or a leak or infection that develops afterward.
• Complication from diverticulitis. Infection of small, bulging pouches in your digestive tract, called diverticulitis, may cause the rectum or large intestine to stick to the vagina and may lead to a fistula.
• Other causes. Rarely, a rectovaginal fistula may develop following infections in the skin around the anus or vagina.

Complications

Complications of a rectovaginal fistula may include:

• Uncontrolled loss of stool, called fecal incontinence.
• Problems keeping the perineum clean.
• Recurrent vaginal or urinary tract infections.
• Irritation or inflammation of your vagina, perineum or the skin around your anus.
• Fistula recurrence.
• Issues with self-esteem and intimacy.

Among people with Crohn's disease who develop a fistula, the chances of complications are high. These can include poor healing, or another fistula forming later.