Rectovaginal fistula (abnormal connection)

Pelvis | Obstetrics and Gynaecology | Rectovaginal fistula (abnormal connection) (Disease)


Rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the vagina, leading to fecal incontinence.

Fistulas can also develop in women and children who are raped; women with rectovaginal fistulae are often stigmatized in third world countries, and become outcasts. It is also associated with female genital mutilation.

Causes and Risk factors

Rectovaginal fistula can result from injuries in childbirth (Obstetric injuries are the most common cause of rectovaginal fistulas), Crohns disease (the second most common cause of rectovaginal fistulas, Crohns disease is a type of inflammatory bowel disease in which the lining of your digestive tract becomes inflamed. Most women with Crohns disease never develop a rectovaginal fistula, but having Crohns disease does increase your risk of the condition), 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), 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. Before the fistula forms, you may experience pain in your anus or rectum, bloody diarrhea, or bright red blood in your stool. If you spot these warning signs, your doctor will first rule out a return of cancer as the cause).

Other causes. Less commonly, a rectovaginal fistula may be caused by infections in your anus or rectum; infections of small, bulging pouches in your digestive tract (diverticulitis); or vaginal trauma.

Diagnosis and Treatment

There is an association with recurrent urinary and vaginal infections. This type of fistula can cause pediatricians to misdiagnose imperforate anus. Rectovaginal fistulae are often the result of trauma during childbirth (in which case it is known as obstetric fistula) in situations where there is inadequate health care, such as in some developing countries.

Treatment for a rectovaginal fistula depends on its cause, size, location and effect on surrounding tissues. Sometimes fistulas heal on their own, but most people need surgery to close or repair the abnormal connection. Before an operation can be done, the skin and other tissue around the fistula must be healthy, with no signs of infection or inflammation. Your doctor may advise a waiting period of up to three months before surgery to ensure the surrounding tissue is healthy. ...