Rectovaginal Fistula is a condition where an abnormal opening or hole develops between the vagina and rectum. This usually causes bowel contents to leak through the fistula while allowing gas and stool to pass through the vaginal opening.
A rectovaginal fistula may cause emotional anguish and physical discomfort, which in turn can impact self-esteem and intimacy. But the good news is that it can be very well treated with surgery and fully recovered from within a few months.
Causes
In most cases, injury to the vaginal tissue stops the blood flow, resulting in the death of the particular tissue and creating a fistula. Although rectovaginal fistulas can develop in a matter of days, they can also gradually form over several years. An individual rarely has a congenital rectovaginal fistula, which means that this condition is usually not present at birth.
Some of the most common causes of a rectovaginal fistula include:
- Prolonged labour pain spreading for days: During a long or complicated delivery, the perineum layer can rupture, or the doctor might have to cut the perineum (episiotomy) to deliver the baby
- Inflammatory bowel disease (IBD): Different types of IBD like Crohn’s disease and ulcerative colitis often cause inflammation in the digestive tract. These inflammatory conditions can often increase the risk of developing a fistula
Also Read: Crohn’s Disease: Causes, Symptoms And Treatment
- Radiation to the pelvic region: Exposure to radiation therapy for treating cancer in the vagina, uterus, cervix, rectum, or anus can often cause a rectovaginal fistula. Even cancer of the above parts without radiation can also create a fistula
- Surgery: A surgical procedure on the rectum, vagina, perineum, or anus can result in an injury or infection that leads to an abnormal opening or fistula
Other probable causes of Rectovaginal fistula include:
- An infection in the anus or rectum
- Infected small pouches in the intestines (i.e., diverticulitis)
Also Read: Diverticulitis: Causes, Symptoms and Treatment
- Blockage in the rectum due to accumulation of stool (i.e., faecal impaction)
- Infections due to HIV or AIDS
- Sexual assault causing vaginal injury
Symptoms
The symptoms of a Rectovaginal fistula depend upon the size and location of the opening. It can either cause minor difficulties or lead to significant problems. Some of the characteristic signs and symptoms include:
- Intense abdominal pain
- Faecal incontinence ( leakage of gas, pus or stool from the vagina)
- Vaginal discharge with a foul smell
- Discharge of blood from the rectum or vagina (unrelated to menstrual flow)
- Irritation of the vaginal skin, vulva or perineum
- Nausea or vomiting
- Diarrhoea
- Dyspareunia (uncomfortable and painful intercourse)
- Recurrent urinary tract infections (UTIs)
- Recurrent vaginal infections (vaginitis)
- Unexplained weight loss
- Painful sexual intercourse
Diagnosis And Treatment
On experiencing abdominal pain or noticing any of the above-mentioned signs and symptoms, do consult a doctor right away to avoid complications. The doctor usually does a thorough physical exam to try to detect the rectovaginal fistula and look for a possible tumour mass, infection or abscess. He or she also conducts some diagnostics including:
- Complete blood count and urinalysis to detect infections
- Dye test; where a blue dye is used in the rectum to look for signs of leakage between the vagina and rectum
- Fistulogram X-ray; to deduce the number and size of fistulas.
- Pelvic MRI or CT scan; to obtain images of the rectum and vagina and the rest location of the fistula
- Anorectal ultrasound; to evaluate the structure of the anal sphincter and show images of injury related to childbirth
- Anorectal manometry; to measure the sensitivity and function of the rectum for planning the repair of the fistula
- Flexible sigmoidoscopy; to view the rectum and the lower part of your large intestine (colon)
- Colonoscopy; to examine the inside of the rectum and all of the large intestine
Treatment
While a Rectovaginal fistula can be a painful condition to live with, complete treatment and recovery are possible. Treatment for the fistula chiefly depends on its cause, the size and location of the fistula and its effect on the surrounding tissues. The treatment options primarily include:
Medications: The doctor may prescribe antibiotics before the surgery or give anti-inflammatory medicines to help decrease the inflammation and remedy fistulas in women with Crohn's disease
Surgery: Surgical option is commonly used in most cases to heal or repair the fistula. The surgical option includes:
- Stitching an anal fistula plug or patch with the patient’s biologic tissue into the fistula to allow the tissue to gradually thrive into the patch and heal the fistula
- Covering the fistula by using a tissue graft taken from a nearby part of the body or just folding a flap of healthy tissue over the abnormal opening
- Mending the anal sphincter muscles if they've been scarred by the fistula or damaged due to radiation, infection or Crohn's disease
