Overview
A rectovaginal fistula is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina. Bowel contents can leak through the fistula, allowing gas or stool to pass through your 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 following surgery in the pelvic area
The condition may cause emotional distress and physical discomfort, which can impact self-esteem and intimacy.
Talk with your doctor if you have signs and symptoms of a rectovaginal fistula, even if it's embarrassing. Some rectovaginal fistulas may close on their own, but most need surgical repair.
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Symptoms
Depending on the fistula's size and location, you may have minor symptoms or significant problems with continence and hygiene. Signs and symptoms of a rectovaginal fistula may include:
- Passage of gas, stool or pus from your vagina
- Foul-smelling vaginal discharge
- Recurrent vaginal or urinary tract infections
- Irritation or pain in the vulva, vagina and the area between your vagina and anus (perineum)
- Pain during sexual intercourse
When to see a doctor
See your doctor if you experience any signs or symptoms of a rectovaginal fistula. A fistula may be the first warning of a more serious problem, such as an infected, pus-filled area (abscess) or cancer. Identifying the cause of the fistula can help your doctor determine a treatment plan.
Causes
A rectovaginal fistula may form as a result of:
- Injuries during childbirth. Delivery-related injuries are the most common cause of rectovaginal fistulas. This includes tears in the perineum that extend to the bowel, or an infection of an episiotomy — a surgical incision to enlarge the perineum during vaginal delivery. These may happen following a long, difficult, or obstructed labor. These types of fistulas may also involve injury to your anal sphincter, the rings of muscle at the end of the rectum that help you hold in stool.
- Crohn's disease. The second most common cause of rectovaginal fistulas, Crohn's disease is an inflammatory bowel disease in which the digestive tract lining is inflamed. Most women 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 your pelvic area. A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. Radiation therapy for cancers in these areas can also put you at risk. A fistula caused by radiation usually forms within six months to two years after treatment.
- Surgery involving your vagina, perineum, rectum or anus. Prior surgery in your lower pelvic region, such as removal of your uterus (hysterectomy), in rare cases can lead to development of a fistula. The fistula may develop as a result of an injury during surgery or a leak or infection that develops afterward.
- Other causes. Rarely, a rectovaginal fistula may be caused by infections in your anus or rectum; infections of small, bulging pouches in your digestive tract (diverticulitis); long-term inflammation of your colon and rectum (ulcerative colitis); dry, hard stool that gets stuck in the rectum (fecal impaction); or vaginal injury unrelated to childbirth.
Complications
Physical complications of a rectovaginal fistula may include:
- Uncontrolled loss of stool (fecal incontinence)
- Hygiene problems
- Recurrent vaginal or urinary tract infections
- Irritation or inflammation of your vagina, perineum or the skin around your anus
- An infected fistula that forms an abscess, a problem that can become life-threatening if not treated
- Fistula recurrence
Among women with Crohn's disease who develop a fistula, the chances of complications are high. These can include poor healing, or another fistula forming later.
Dec. 05, 2020
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