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Rectovaginal Fistula

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Rectovaginal fistula is the abnormal passage between the rectum and vagina. This communication allows involuntary passage of gas and stools through the vagina. The condition can lead to physical discomfort and also affect personal relationships affecting intimacy. As the condition is quite embarrassing, many women take time to visit the doctor and seek help.

What is a Rectovaginal Fistula?

Rectovaginal fistula (RVF) is a hole that occurs between the vagina and the rectum. This abnormal connection leads to fetal incontinence as well as recurrent urinary and vaginal infections.

Symptoms of Rectovaginal Fistula

Most of the symptoms of rectovaginal fistula causes emotional distress as well as physical discomfort. Depending on the size and location of the fistula the symptoms may be mild or severe. The rectovaginal fistula symptoms include:

  • Passage of gas, stool or pus from vagina
  • Recurrent vaginal infections
  • Recurrent urinary tract infections
  • Pain in vulva, vagina or the internal area between the vagina and anus
  • Pain and discomfort during intercourse
  • Foul smelling discharge from the vagina

Causes of Rectovaginal Fistula

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Rectovaginal fistula often occurs as a result of trauma during childbirth. It is very common in countries with inadequate health care. A long and painful labor leads to tears in the perineum. This can also happen due to a tear of an episiotomy done to enlarge the perineum during childbirth.

Chron’s disease is the second most common cause of rectovaginal fistula. It increases the risk of the fistula in many women. Other causes include surgery of the vagina, perineum, rectum or anus. Radiation therapy to treat cancers of the rectum, cervix, vagina, uterus and the anal canal can lead to rectovaginal fistula.

In some cases, rape injuries can lead to damage to the rectum and vaginal structures, leading to fistula.

Problems Related to Rectovaginal Fistula

The condition may lead to many physical problems like:

  • Fecal incontinence
  • Hygiene problems
  • Irritation and inflammation of the vagina, perineum and the skin around the anus
  • Abscess formation near an infected fistula can lead to life-threatening complications
  • Recurrence of corrected fistula

Diagnosis of Rectovaginal Fistula

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Diagnosis is based on a physical examination where the doctor will inspect the vagina, anus and the perineum using a gloved hand. At times, a speculum or another instrument called the proctoscope may be used to detect problems deep within the vagina.

If a physical test is not helpful in detecting the fistula, the doctor may order diagnostic tests such as:

  • Barium enema
  • Blue dye test using a tampon
  • CT scan
  • MRI
  • Anorectal ultrasound
  • Anorectal manometry
  • Tissue biospy to confirm Chron’s disease

Treatment for Rectovaginal Fistula

The treatment for rectovaginal fistula depends on the size, location of the fistula. The treatment includes:

  • Antibiotics to treat an infected fistula before a surgery to correct it.
  • Infliximab, a medication that helps reduce inflammation and heal a fistula due to Chron’s disease
  • When the fistula does not heal on its own, it requires a correctional or repair surgery. The surgery will help sew the fistula or plug the hole between the rectum and vagina.

Rectovaginal fistula causes many women to become house bound. They feel dirty all the time and think people can smell them. In many cases, rectovaginal fistula surgeries are carried out by doctors who have little experience or use incorrect surgical techniques. This leads to failed repairs and may make the incontinence worse than ever. Thus, make sure one visits only a qualified, experienced doctor for surgical treatment.

Written by: Saptakee sengupta
Date last updated: April 01, 2015