Rectovaginal Fistula

A rectovaginal fistula is an abnormal connection between the rectum and the vagina, allowing stool or gas to pass from the rectum into the vagina. This condition can cause significant discomfort, emotional distress, and disruption of daily life for those affected.

Causes

• Childbirth: Prolonged labor, instrumental delivery (e.g., forceps or vacuum extraction), or episiotomy during childbirth can lead to the development of a rectovaginal fistula.
• Crohn's disease and other inflammatory bowel diseases (IBD): These conditions can cause inflammation and damage to the tissues surrounding the rectum and vagina, potentially leading to fistula formation.
• Radiation therapy: Pelvic radiation for cancer treatment can damage tissues and lead to the development of a rectovaginal fistula.
• Surgery: Complications from surgeries such as hysterectomy, rectal surgery, or other pelvic operations can result in the formation of a rectovaginal fistula.
• Trauma: Severe injury to the pelvic area, such as from a car accident, can cause a rectovaginal fistula.

Symptoms

• Passage of stool or gas from the vagina
• Foul-smelling vaginal discharge
• Recurring vaginal infections
• Pelvic pain or discomfort
• Difficulty controlling bowel movements

Diagnosis

Diagnosing a rectovaginal fistula typically involves a combination of physical examination, medical history review, and diagnostic tests such as:

• Physical exam: A healthcare provider will perform a pelvic exam to look for signs of the fistula.
• Anoscopy or proctoscopy: These procedures involve using a scope to visually examine the rectum and anus.
• Colonoscopy: This test allows for visualization of the entire colon.
• Imaging studies: CT scans, MRI, or ultrasound may be used to evaluate the extent of the fistula and surrounding tissues.

Treatment

Treatment options for rectovaginal fistula depend on the underlying cause, size, and location of the fistula. Possible treatments include:

• Surgery: Surgical repair is often necessary to close the fistula. The type of surgery depends on the specific case.
• Fistula plug or patch: A bioprosthetic material may be used to plug or patch the fistula.
• Biofeedback therapy: This type of therapy can help improve bowel control and reduce symptoms.
• Medications: Medications such as antibiotics, anti-inflammatory drugs, or stool softeners may be prescribed to manage symptoms and prevent complications.

Prevention

While not all cases of rectovaginal fistula can be prevented, certain measures can reduce the risk:

• Avoiding constipation: Maintaining regular bowel movements through diet and lifestyle changes.
• Kegel exercises: Strengthening pelvic floor muscles can help prevent or minimize symptoms.
• Seeking medical attention for underlying conditions: Managing conditions like Crohn's disease or undergoing proper treatment for other potential causes can reduce the risk of developing a rectovaginal fistula.