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What is a Rectovaginal Fistula?

A rectovaginal fistula is an abnormal connection formed between the vagina and the lower part of the large intestine, or rectum and can cause stool to leak into the vagina.

Causes of Rectovaginal Fistula

The possible causes of a rectovaginal fistula include:

  • Injuries in childbirth
  • Inflammatory bowel conditions such as Crohn’s disease
  • Prior surgical treatment complications involving your rectum, vagina, anus or perineum
  • The use of radiation therapy around the pelvic region
  • Infections in your anus or rectum
  • Diverticulitis
  • Vaginal trauma

Symptoms of Rectovaginal Fistula

Signs related to rectovaginal fistula include:

  • Presence of stool or pus in your vagina
  • Gas passage through your vagina
  • Foul-smelling vaginal discharge
  • Recurrent vaginal or urinary tract infections
  • Unexplained pain or irritation around the vaginal region or the perineum region, the area between the anus and vagina. 
  • Pain during sexual intercourse
  • Trouble controlling bowel movements

Diagnosis of Rectovaginal Fistula

Your doctor will first enquire about your symptoms and perform a physical examination to check for the presence of any possible tumour mass, infection, or abscess; and to try and locate the rectovaginal fistula.

To identify the fistula your doctor may order different tests including:

  • Contrast tests: These tests include the use of a barium enema or a vaginogram to obtain contrast X-rays of your vagina and rectum to check for the presence of a fistula in the upper region of the rectum.
  • Blue dye test: In this test, a tampon will be placed in your vagina and a blue dye injected into your rectum. The tampon is removed after some time and checked for blue staining, which indicates the presence of a rectovaginal fistula.
  • Anorectal ultrasound: This procedure involves the use of ultrasonic waves to create video images of your anus and rectum to check for the fistula.
  • Anorectal manometry:  This procedure is used to measure the sensitivity and function of the rectum including the rectal sphincter and your ability to control stool passage. 
  • Computerized tomography (CT) scan: This study creates highly detailed images of the abdomen and pelvis.
  • Magnetic resonance imaging (MRI): A magnetic field and radio waves are used to create images of the internal soft tissue structures to help identify the fistula. 

Treatment of a Rectovaginal Fistula

Initially, you may be prescribed antibiotics or other medications to heal any infection in the area.  In some instances, your doctor might recommend waiting for a few months to see if the fistula may heal on its own, but often surgery may be necessary. Surgical options include:

  • Use of a biologic tissue patch or anal fistula plug to sew up the fistula and guide your body to heal around the patch
  • Patching up the fistula using a tissue graft obtained from an adjacent area
  • Repairing sphincter muscles which may have been damaged due to the fistula
  • In some rare or complex cases, a colostomy is also performed to divert your stool through an opening in your abdomen while your fistula heals. 
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