Rectovaginal fistula : Causes-Symptoms-Diagnosis-Treatment

 What is a rectovaginal fistula?

Rectovaginal fistulas, or holes, develop between your channel and body part. canal tears in childbearing, still as girdle surgeries, will cause this kind of canal fistula. Gas or stool could leak from your channel. Most ladies have a whole recovery once rectovaginal fistula repair surgery to shut the fistula.

A rectovaginal fistula could be a tunnel-like gap that develops between your channel and body part. Your channel could be a tube that connects your female internal reproductive organ to your female genitalia (genitals outside your body). Your body is a part of your systema digestorium that connects your intestine (colon) to your arsehole. It holds stool and gas till your body releases them.

What is a rectovaginal fistula?
rectovaginal fistula

In a rectovaginal fistula, harm to canal tissue causes the tissue to die and a hole (fistula) to create. This gap lets stool and gas enter your channel. A rectovaginal fistula could be a sort of canal fistula.

  1. Female Reproductive System

  • Internal reproductive organs

  1. Ovaries

  2. Fallopian tubes

  3. Uterus

  4. Cervix

  5. Placenta

  • External reproductive organs

  1. Vulva

  2. Clitoris

  3. Vagina

Medical terms

A rectovaginal fistula, also called a vesico-vaginal fistula, occurs when there is an abnormality in the structure of the vaginal wall. Has this abnormality in the stool of the body may find its way into the vaginal area when this happens it can cause pain during urination or passing, treatments for rectovaginal fistula include surgical repair as well as transplantation of bioengineered tissue that helps to improve

A rectovaginal fistula (RVF) occurs when there is a physical opening or tunnel between the rectum and the vagina due to this fistula. Stool is constantly leaking through the vagina and causing a foul odor. This leakage can be intermittent or constant depending on the type of RVF which can cause severe embarrassment and stigma. Social shame for some women, especially if they are not aware that it is a common condition that has a treatment option

Symptoms, treatment and prevention of fistulas Fistulas are abnormal passages that form between internal organs or between the body and the outside world, usually caused by complications during a medical procedure or from an infection in the urinary tract or digestive system

A rectovaginal fistula is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina. Bowel contents can leak through the fistula, allowing gas or stool to pass through your vagina.

A rectovaginal fistula may result from:

  • Injury during childbirth

  • Crohn's disease or other inflammatory bowel disease

  • Radiation treatment or cancer in the pelvic area

  • Complication following surgery in the pelvic area

The condition may cause emotional distress and physical discomfort, which can impact self-esteem and intimacy.

Talk with your doctor if you have signs and symptoms of a rectovaginal fistula, even if it's embarrassing. Some rectovaginal fistulas may close on their own, but most need surgical repair.

Symptoms Rectovaginal fistula

Depending on the fistula's size and site, you'll have minor symptoms or important issues with continence and hygiene. Signs and symptoms of a rectovaginal fistula could include:

  • Passage of gas, stool or pus from your vagina

  • Foul-smelling vaginal discharge

  • Recurrent vaginal or urinary tract infections

  • Irritation or pain in the vulva, vagina and the area between your vagina and anus (perineum)

  • Pain during sexual intercourse

When to see a doctor

See your doctor if you experience any signs or symptoms of a rectovaginal fistula. A fistula may be the first warning of a more serious problem, such as an infected, pus-filled area (abscess) or cancer. Identifying the cause of the fistula can help your doctor determine a treatment plan.

Causes Rectovaginal fistula

A rectovaginal fistula may form as a result of:

  • Injuries during childbirth. Delivery-related injuries are the foremost common reason for rectovaginal fistulas. This includes tears within the area that stretch to the viscus, or Associate in Nursing infection of Associate in Nursing perineotomy — a incision to enlarge the area throughout channel delivery. These might happen following an extended, difficult, or closed labor. These varieties of fistulas can also involve injury to your sphincter muscle, the rings of muscle at the tip of the body part that assist you hold in stool. 

  • Crohn's disease. The second most typical reason behind rectovaginal fistulas, malady|regional enteritis|regional ileitis|Crohn's disease|colitis|inflammatory gut disease} is associate degree inflammatory bowel disease during which the duct lining is inflamed. Most girls with colitis ne'er develop a rectovaginal fistula, however having colitis will increase your risk of the condition. 

  • Cancer or radiation treatment in your pelvic area. A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. Radiation therapy for cancers in these areas can also put you at risk. A fistula caused by radiation usually forms within six months to two years after treatment.

  • Surgery involving your vagina, perineum, rectum or anus. Prior surgery in your lower girdle region, like removal of your womb (hysterectomy), in rare cases will cause development of a fistula. The fistula might develop as a result of AN injury throughout surgery or a leak or infection that develops later on. 

  • Other causes. Rarely, a rectovaginal fistula may be caused by infections in your anus or rectum; infections of small, bulging pouches in your digestive tract (diverticulitis); long-term inflammation of your colon and rectum (ulcerative colitis); dry, hard stool that gets stuck in the rectum (fecal impaction); or vaginal injury unrelated to childbirth.

Complications Rectovaginal fistula

Physical complications of a rectovaginal fistula may include:

  • Uncontrolled loss of stool (fecal incontinence)

  • Hygiene problems

  • Recurrent vaginal or urinary tract infections

  • Irritation or inflammation of your vagina, perineum or the skin around your anus

  • An infected fistula that forms an abscess, a problem that can become life-threatening if not treated

  • Fistula recurrence

Among women with Crohn's disease who develop a fistula, the chances of complications are high. These can include poor healing, or another fistula forming later.

How do you live with a rectovaginal fistula?

A rectovaginal fistula can be devastating. You know the condition is debilitating and will likely never go away; There is no cure for it, it may cause you to lose friends as they may not understand what you are going through. The only thing you can do is find out all you can about the condition and its symptoms, so when someone asks you how to get rid of it. Flatulence that you may have an answer to, the more information people have about this situation, the less likely they are to pity someone who lives with a rectovaginal fistula every day of their lives.

Can a fistula be treated on its own?

A fistula cannot be treated on its own because a fistula is essentially an abnormal passage of the intestine from the intestinal wall to the surface of the skin or mucous membrane, and the problem with this is that it can lead to severe infection if not treated immediately. I recommend patients with these conditions to have surgery as soon as possible to prevent this condition from getting worse.

Fistulas are abnormal connections between organs or structures in the body. In some cases, fistulas occur between two chambers of the heart and are usually caused by a viral infection. Other common causes of fistulas include surgical complications and infections such as gangrene or tuberculosis. Fistulas that connect the bladder to the vagina or another organ sometimes cause urine to flow into their body instead of the toilet. Pregnancy-related fistulas can lead to kidney damage and even death if not treated promptly.

How can I treat a fistula at home without surgery?

Your doctor may recommend surgery to remove the fistula. Depending on the size and location of the fistula, you may need to use a tube in your bladder for several weeks after surgery. This is called an indwelling catheter, and your doctor will monitor you carefully for infection during this. After the fistula is removed, there are still treatments available that can help you heal at home by making lifestyle changes such as: Avoid constipation Eat more foods rich in fiber (such as fruits, vegetables, and whole grains) Drink plenty of water each day to maintain your condition . Dilute urine (usually about half.

Diagnosis Rectovaginal fistula

You can expect a physical exam and certain tests, depending on your needs.

Physical exam

Your doctor can perform a physical examination to find the rectovaginal fistula and check for a potential tumor mass, infection or symptom. The doctor's examination includes inspecting your epithelial duct, asshole and therefore the space between them (perineum) with a gloved hand.

Unless the fistula is incredibly low within the epithelial duct and pronto visible, your doctor could use a speculum to ascertain within your epithelial duct. Associate in Nursing instruments the same as a speculum, referred to as an endoscope, could also be inserted into your asshole and body part to examine for issues.

Your doctor could take a sample of tissue for science lab analysis (biopsy) throughout the procedure.

Tests for identifying fistulas

Your doctor might not notice a fistula throughout the physical communication. different tests could also be required to find and measure a rectovaginal fistula. These tests may also facilitate your medical team in coming up with surgery.

  • Contrast tests. A vaginogram or a barium enema can help identify a fistula located in the upper rectum. These tests use a contrast material to show the vagina or the bowel on an X-ray image.

  • Blue dye test. This test involves placing a tampon into your vagina, then injecting blue dye into your rectum. Blue staining on the tampon indicates a fistula.

  • Computerized tomography (CT) scan. A CT scan of your abdomen and pelvis provides more detail than does a standard X-ray. The CT scan can help locate a fistula and determine its cause.

  • Magnetic resonance imaging (MRI). This takes a look at creating pictures of soppy tissues in your body. imaging will show the placement of a fistula, whether or not different girdle organs are concerned or whether or not you have got a tumor. 

  • Anorectal ultrasound. This procedure uses sound waves to provide a video image of your porta and body part. Your doctor inserts a slender, wand-like instrument into your porta and body part. This check will judge the structure of your sphincter ani and will show childbirth-related injury. 

  • Anorectal manometry. This test measures the sensitivity and function of your rectum and can give information about the rectal sphincter and your ability to control stool passage. This test does not locate fistulas, but may help in planning the fistula repair.

  • Other tests. If your doctor suspects you've got inflammatory intestine sickness, he or she might order an endoscopy to look at your colon. Throughout the procedure, your doctor will take little samples of tissue (biopsy) for work analysis, which may facilitate regional enteritis. 

Treatment Rectovaginal fistula

Symptoms of a rectovaginal fistula will be distressing, however treatment is commonly effective. Treatment for the fistula depends on its cause, size, location and impact on close tissues.


Your doctor may recommend a medication to help treat the fistula or prepare you for surgery:

  • Antibiotics. If the realm around your fistula is infected, you'll tend a course of antibiotics before surgery. Antibiotics may additionally be counseled for girls with regional enteritis UN agency develop a fistula. 

  • Infliximab. Infliximab (Remicade) can help reduce inflammation and heal fistulas in women with Crohn's disease.


Most people want surgery to shut or repair a rectovaginal fistula.

Before AN operation will be done, the skin and different tissue round the fistula should be healthy, while not infection or inflammation. Your doctor could suggest waiting 3 to 6 months before having surgery to make sure the encompassing tissue is healthy and see if the fistula closes on its own.

Surgery to shut a fistula could also be done by a gynecological Dr., a large intestine Dr. or each operating as a team. The goal is to get rid of the fistula tract and shut the gap by stitching along healthy tissue. Surgical choices include:

  • Sewing an anal fistula plug or patch of biologic tissue into the fistula to allow your tissue to grow into the patch and heal the fistula.

  • Using a tissue graft taken from a nearby part of your body or folding a flap of healthy tissue over the fistula opening.

  • Repairing the anal sphincter muscles if they've been damaged by the fistula or by scarring or tissue damage from radiation or Crohn's disease.

  • Performing a colostomy before repairing a fistula in complex or recurrent cases to divert stool through a gap in your abdomen rather than through your body part. Most of the time, this surgery is not required. however you would like this if you've had tissue harm or scarring from previous surgery or radiation treatment, associate degree in progress infection or important soiled contamination, a cancerous tumor, or associate degree symptom. If an ostomy is required, your doc might wait eight to twelve weeks before repairing the fistula. Typically when regarding 3 to 6 months and confirmation that your fistula has well, the ostomy may be reversed and traditional internal organs operate fixed up. 

Lifestyle and home remedies

and scale back the prospect of channel or tract infections whereas looking ahead to repair. alternative home remedies for individuals living with a rectovaginal fistula include:

  • Wash with water. Shower or gently wash your outer genital area with just warm water each time you experience vaginal discharge or passage of stool.

  • Avoid irritants.Soap will dry and irritate your skin, however you would like a mild unscented soap carefully. Avoid harsh or scented soap and scented tampons and pads. canal douches will increase your likelihood of infection.

  • Dry thoroughly. Allow the area to air-dry after washing, or gently pat the area dry with a clean cloth or towel.

  • Avoid rubbing with dry toilet paper. Pre-moistened, alcohol-free, unscented towelettes or wipes or moistened cotton balls are a good alternative.

  • Apply a cream or powder. Moisture-barrier creams defend irritated skin from liquid or stool. Non Medicated bath powder or amylum additionally could relieve discomfort. raise your doctor to suggest a product. make certain the world is clean and dry before you apply any cream or powder. 

  • Wear cotton underwear and loose clothing. Tight consumer goods will limit flow of air and worsen skin issues. amendment sordid underclothing quickly. products like absorbent pads, disposable underclothing or adult diapers will facilitate if you are passing liquid or stool, however take care they need to associate absorbent wicking layers on prime.
    For best results, take care to follow the other recommendations from your health care team. 

Preparing for your appointment

Your initial appointment is also along with your general practitioner, medical aid supplier or specialist. In your initial analysis, you'll be told that a World Health Organization makes a specialty of procedures involving the feminine system (gynecologic surgeon) or one World Health Organization makes a specialty of treating conditions of the colon and body part (colorectal surgeon) to debate treatment choices.

What you can do

To prepare for your appointment:

  • Ask about any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance to prepare for diagnostic tests.

  • Make a list of symptoms you're experiencing. Include any that may seem unrelated to a rectovaginal fistula.

  • Make a list of your key medical information. Include any other conditions you're treating, all past surgeries, and the names of any medications, vitamins, herbal remedies or supplements you're taking.

  • Consider questions to ask your doctor.Make a listing, take it with you to your appointment, and build notes as your doctor answers your queries.
    For a rectovaginal fistula, some basic inquiries to raise your doctor include:

  • What's causing these symptoms?

  • Are there other possible causes for my symptoms?

  • What kinds of tests do I need? Do these tests require any special preparation?

  • Is this condition temporary or long lasting?

  • What treatments are available, and which do you recommend?

  • Are there any alternatives to your recommended treatment?

  • Will I need surgery?

  • Do you have any brochures or other printed material that I can take with me? What websites do you recommend?

Don't hesitate to ask questions during your appointment anytime you don't understand something.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • When did your symptoms begin?

  • Have your symptoms been continuous or occasional?

  • How severe are your symptoms?

  • What, if anything, seems to improve your symptoms?

  • What, if anything, appears to worsen your symptoms?

  • Are you able to have regular bowel movements?

  • Do you experience uncontrolled loss of stool, also called fecal incontinence?

  • Do you have difficulty with constipation that causes you to strain a lot during bowel movements?

  • Have you given birth vaginally? Were there any complications?

  • Have you ever had pelvic surgery?

  • Have you ever been treated for gynecologic cancer?

  • Have you had pelvic radiation therapy?

  • Do you have any other medical conditions, such as Crohn's disease?

General summary

  1. A rectovaginal fistula is a serious, life-threatening condition. If one develops, you need to see a surgeon immediately. May require additional surgery over time.

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