Rectovaginal Fistula

Overview

A rectovaginal fistula is an abnormal connection between the lower part of the large intestine (rectum or anus) and the vagina. It can allow bowel contents to leak through the fistula, causing gas or stool to pass through the vagina. This condition may result from injuries during childbirth, Crohn's disease, radiation treatment or cancer in the pelvic area, or complications from diverticulitis. Symptoms include gas and stool leaking from the vagina, which can lead to emotional distress and physical discomfort. If you have symptoms of a rectovaginal fistula, it is important to talk to your healthcare provider, as most cases require surgical intervention.

Understanding the disease

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 significant problems with stool and gas leakage, and keeping the area clean. It is important to talk with your healthcare provider if you have any symptoms of a rectovaginal fistula, as most of them require surgery to fix them.

Risk Factors

Risk factors for developing a rectovaginal fistula include:

1. Injuries during childbirth, which are the most common cause. Delivery-related injuries can extend to the bowel or result in an infection.
2. Inflammatory bowel disease, specifically Crohn's disease, which is the second most common cause.
3. Certain genetic or congenital conditions.
4. Older age.
5. Female sex.
6. Cardiac catheterization, especially if the procedure involves blood vessels in the groin.
7. Certain medications, including blood thinners and medications used to control bleeding.
8. High blood pressure.
9. Increased body mass index (BMI).

Development

The various rectovaginal fistulas can develop due to several causes, including:

1. Injuries during childbirth: Delivery-related injuries are the most common cause of rectovaginal fistulas. Injuries can extend to the bowel or an infection, and fistulas caused by childbirth may involve injury to the anal sphincter.
2. Inflammatory bowel disease: Crohn's disease and, less commonly, ulcerative colitis are the second most common causes of rectovaginal fistulas. These inflammatory bowel diseases cause swelling and irritation of the tissues lining the digestive tract.
3. Cancer or radiation treatment in the pelvic area: A cancerous tumor in the rectum, cervix, vagina, uterus, or anal canal can result in a rectovaginal fistula. Additionally, radiation therapy for cancers in these areas can increase the risk of fistula formation.
4. Surgery involving the vagina, perineum, rectum, or anus: In rare cases, prior surgery in the lower pelvic area, such as removing an infected Bartholin's gland, can cause a fistula to develop.
5. Complication from diverticulitis: Infection of small, bulging pouches in the digestive tract, called diverticulitis, may cause the rectum or large intestine to stick to the vagina and may lead to a fistula. It's important to consult with a healthcare provider if you have symptoms of a rectovaginal fistula, as some may close on their own, but most require surgery to fix them.

Assessment and Diagnosis

Triage

You should see a doctor if you suspect a rectovaginal fistula, as symptoms like passing gas or stool from the vagina may cause emotional distress, physical discomfort, and impact your self-esteem and intimacy. It is important to discuss your symptoms with a healthcare provider, even if they may be embarrassing, as some rectovaginal fistulas may close on their own, but most require surgery to fix them.

Diagnosis

To diagnose a rectovaginal fistula, your health care provider will likely assess your symptoms and perform a physical exam. The exam may involve inspecting the vagina, anus, and perineum with a gloved hand, or using specialized tools to locate the fistula tunnel. Additional tests, such as an MRI or a CT scan, may be recommended to help locate the fistula and determine its cause. In rare cases when cancer is suspected, a biopsy may be performed. It's important to provide your health care provider with a list of your symptoms and any other medical information, as well as to ask questions and discuss treatment options.

Management and Treatment

Complications

Potential complications of a rectovaginal fistula may include uncontrolled loss of stool (fecal incontinence), problems keeping the perineum clean, recurrent vaginal or urinary tract infections, irritation or inflammation of the vagina, perineum, or the skin around the anus, fistula recurrence, and issues with self-esteem and intimacy. Among people with Crohn's disease who develop a fistula, the chances of complications are high, with poor healing or another fistula forming later being possible.

Home Remedies

It is important to consult a healthcare provider for proper diagnosis and treatment of rectovaginal fistula. They can recommend the best course of action, which may include medical interventions or surgery.

Treatment

There are several treatment options for rectovaginal fistulas. Depending on the cause and severity of the fistula, your healthcare provider may recommend one or a combination of the following treatments:

1. Surgery: Most rectovaginal fistulas require surgery to repair the connection between the rectum and the vagina. The type of surgery will depend on the location and extent of the fistula. Surgical options include fistula repair, sphincteroplasty (for repairing the anal sphincter muscle), and colostomy (a temporary or permanent procedure to redirect the bowel).
2. Medications: In cases where the fistula is caused by inflammation, such as Crohn's disease, medications can help reduce inflammation and prevent further complications. Anti-inflammatory drugs, immunosuppressants, and biologic therapies may be prescribed by your healthcare provider.
3. Fecal management: In cases where fecal incontinence is a significant issue, your healthcare provider may recommend fecal management techniques. These can include bowel training programs, the use of fiber supplements, or the insertion of a fecal management device.
4. Self-care: Maintaining good hygiene and keeping the affected area clean is essential in managing symptoms and preventing infections. Wearing absorbent pads or cushions can help with leakage, and avoiding irritants such as harsh soaps or perfumes can help reduce discomfort and inflammation. It's essential to consult with your healthcare provider to determine the best treatment plan for your specific situation. Remember that seeking help for rectovaginal fistula is important, and discussing your symptoms with your healthcare provider is the first step towards appropriate treatment.

Preparing for medical consultation

To prepare for an appointment for a suspected rectovaginal fistula, follow these steps:

1. Make a list of your symptoms: Compile a list of all symptoms you are experiencing, including those that may seem unrelated to a rectovaginal fistula.
2. Gather medical information: Prepare a list of your key medical information, such as any other conditions you're treating, past surgeries, and the names, doses, and frequencies of any medicines, vitamins, herbs, or other supplements you are taking.
3. Prepare for diagnostic tests: Ask your health care provider about any pre-appointment restrictions or preparations needed for diagnostic tests.
4. Bring recent brain scans: Bring any recent brain scans on a CD to your appointment. If you have experienced seizures, it may be helpful to bring along someone who has witnessed them.
5. Compile questions for your health care provider: Prepare a list of questions to ask your doctor, prioritizing them in case time runs out during the appointment. Some examples include:

• Where is the fistula located?
• Will I need follow-up tests? If so, how often will I follow up with you?
• How long would you estimate I'd be in surgery?
• How long does surgery recovery usually take?
• How long should I plan to be in the hospital?
• How many rectovaginal fistulas have you seen and how many have you treated? By being well-prepared, you can make the most of your appointment and facilitate informed discussions with your health care provider.