Rectovaginal fistula

DEFINITION

A rectovaginal fistula is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina. Contents of your bowel can leak through the fistula, meaning you might pass gas or stool through your vagina.

A rectovaginal fistula may result from an injury during childbirth, Crohn’s disease or other inflammatory bowel disease, radiation treatment or cancer in the pelvic area, or a complication following surgery in the pelvic area.

The symptoms of a rectovaginal fistula often cause emotional distress as well as physical discomfort, which can impact self-esteem and intimate relationships. Though bringing up the subject with your doctor may be difficult, it’s important to have a rectovaginal fistula evaluated. Some rectovaginal fistulas may close on their own, but most need to be repaired surgically.

CAUSES

A rectovaginal fistula may form as a result of:

• Injuries during childbirth. Injuries during delivery are the most common cause of rectovaginal fistulas. Such injuries include tears in the perineum that extend to the bowel or an infection or tear of an episiotomy — a surgical incision to enlarge the perineum during vaginal delivery. These may happen following a long, difficult labor. Fistulas occurring from childbirth 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 a type of inflammatory bowel disease in which the lining of your digestive tract becomes 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 lead to development of a rectovaginal fistula. Radiation therapy for cancers in these areas can also put you at risk of developing a fistula. A fistula caused by radiation usually forms within two years following the 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.
• 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); or vaginal injury other than during childbirth.

SYMPTOMS

Depending on the size and location of the fistula, 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
• A 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

If you experience any signs or symptoms of rectovaginal fistula, make an appointment to see your doctor. A fistula may be the first indication of a more serious problem, such as an area of infection where pus has collected (abscess) or cancer. It’s important that your doctor identify the cause of the fistula and determine whether and when it should be repaired. Depending on the cause, your doctor may refer you to a colorectal or gynecologic surgeon.