Rectovaginal fistula

Overview

A rectovaginal fistula is an abnormal opening fusion between the woman’s vagina and rectum. This occurs due to a damage in the vaginal tissue, which allows the gas and stool to enter the vagina.

A rectovaginal fistula commonly develops due to a trauma during childbirth, surgery, or cancer in the pelvic area and inflammatory bowel diseases (IBD). It is rarely present at birth.

A rectovaginal fistula may cause variety of symptoms which often requires surgical treatment. The condition may result in physical pain and emotional anxiety, which can affect relationships and self-esteem. Women who experience the signs and symptoms are advised to consult a doctor for proper diagnosis and necessary treatment.

Symptoms

The signs and symptoms of rectovaginal fistula is determined by the size and location of the fistula. Common sign and symptoms are:

• Stool, gas, or pus discharge from the vagina
• Foul-odored vaginal discharge
• Recurrent urinary tract infections and vaginitis
• Skin irritation in your vagina, vulva (entrance to the vagina) or perineum (area between your vagina and anus)
• Bleeding in the vagina and rectum
• Painful intercourse
• Difficulty controlling bowel movements
• Nausea and vomiting
• Sudden unexplained weight loss

Women who experience the signs and symptoms of a rectovaginal fistula should consult their healthcare provider for correct diagnosis and appropriate treatment.  It is important to determine the cause of a fistula because it may be the first sign of a more serious issue, such as an abscess or an infected, pus-filled area.

Causes

Several factors may contribute to the development of a rectovaginal fistula, such as:

• Trauma during childbirth: The perineum may tear during a prolonged labor, or the doctor may perform an episiotomy to deliver the baby. Rectovaginal fistulas are most frequently caused by these birth-related trauma. In some cases, the fistula may also damage the anal sphincter muscles. A Rectovaginal fistula affects about 0.5 % of women who had vaginal deliveries.
• Crohn’s disease: Having a chronic inflammatory bowel disease (IBD), especially Crohn’s disease increases the risk of developing a rectovaginal fistula. With Crohn’s, the digestive tract, particularly the small and large intestines, become inflamed and irritated. Rectovaginal fistula can occur in up to 10% of Crohn’s disease patients.
• Surgery involving the vagina, perineum, rectum, or anus: Abdominal or pelvic surgery can affect one’s risk of having a fistula. A trauma in the vaginal tissues, a leak or an infection during the surgery could all lead to the development of the fistula.
• Cancer or radiation treatment in the pelvic area: Women who receive radiation therapy for cancer treatment in certain areas of the body may be at risk of rectovaginal fistula. Radiation-induced fistulas typically develop six months to two years following treatment. A rectovaginal fistula may also develop due to malignant tumor in the rectum, cervix, vagina, uterus, or anal canal.
• Others: It is uncommon but possible that a rectovaginal fistula is caused by diverticulitis, ulcerative colitis, fecal impaction, other vaginal trauma not caused by childbirth and infections due HIV.