Rectovaginal Fistula

By:    Published: August 1, 2012

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A rectovaginal fistula, though rare, can be a serious and painful issue for a woman to deal with. In most cases, surgery is needed to repair this condition. Fortunately, most treatments for rectovaginal fistula are very successful and there are ways to ease the symptoms until treatment is complete.

Definition

A rectovaginal fistula is an abnormal connection that forms between the rectum (the lower portion of the large intestine) and the vagina. The consequences of this connection are that the contents of the bowels leak through the fistula, allowing gas or stool to pass through the vagina. The condition may be both painful and embarrassing for a woman to deal with.

Symptoms

Several symptoms may occur as a result of the formation of a rectovaginal fistula. These symptoms include:

  • Passing gas or stool through the vagina
  • Pus coming from the vagina
  • Vaginal discharge with a foul smell
  • Irritation or pain in the vulva, vagina or perineum (the area between the vagina and the anus)
  • Pain during sexual activity
  • Recurrent infections of the vagina and/or urinary tract

Causes And Risk Factors

There are several possible causes of a rectovaginal fistula, including:

  • Injury during childbirth: Obstetric trauma is the most common cause of rectovaginal fistulas. Several different types of childbirth injuries could lead to a rectovaginal fistula, including a tear in the perineum that extends to the bowel, tearing of an episiotomy (a surgical incision in the perineum to allow to easier vaginal delivery or prolonged labor during which an inadequate blood supply reaches the rectovaginal septum). Despite being the leading cause of rectovaginal fistulas, this type of injury occurs in only 0.1 percent of vaginal deliveries in Western countries, according to the Cancer Institute of New Jersey (CINJ).
  • Crohn’s disease: After obstetric trauma, the next leading cause of rectovaginal fistulas is an inflammatory bowel disease called Crohn’s disease. This condition causes the lining of the digestive tract to become inflamed, which may cause inflammation of the rectal wall. Those with more severe flare-ups of Crohn’s disease seem more likely to develop a fistula. Most women with Crohn’s disease never develop a rectovaginal fistula, but having this disease does increase a woman’s risk of developing one.
  • Surgery complications: Women who have had surgery performed on their anus, rectum, vagina or perineum or who have had a hysterectomy may develop a rectovaginal fistula as a result of surgical complications.
  • Cancerous tumors: A rectovaginal fistula may develop if you have a cancerous tumor in your cervix, vagina, uterus, anal canal or rectum.
  • Radiation therapy: Women receiving radiation therapy in the area of their cervix, vagina, uterus, anal canal or rectum may develop a rectovaginal fistula. This type of fistula may not appear for up to two years after the treatment is complete.
  • Infection: Though it’s less common than other causes, an infection in the anus, rectum or areas of the digestive tract may lead to a rectovaginal fistula.
  • Vaginal trauma: Injury to the vagina could potentially lead to a rectovaginal fistula, although this is also a rare cause of the condition.

Prevention

Some women may be able to prevent a rectovaginal fistula by looking for warning signs. If you notice any abnormalities, such as the appearance of bright red blood in the stool, bloody diarrhea or pain in the anus or rectum, seek medical treatment right away. Although there are several possible causes for these symptoms, a doctor may be able to determine the cause and prevent a fistula from forming as a result.

Treatment

Because a rectovaginal fistula could become infected and potentially become life-threatening, it’s important to seek medical attention as soon as you notice any of the symptoms of this condition. Once diagnosed, a doctor will determine whether surgery is necessary to close the connection between the vagina and the rectum. In some cases the fistula may close up on its own, but most rectovaginal fistulas require surgery. Most treatments for rectovaginal fistulas are successful and offer good results.

Meanwhile, the symptoms of a rectovaginal fistula may be eased by using the following home remedies:

  • Regular washing: Anytime you pass stool through your vagina or experience vaginal discharge, wash the outer genital area with warm water. Use soap in moderation since it may irritate the skin. Use pre-moistened, alcohol-free wipes to clean the area as opposed to dry toilet paper.
  • Always dry thoroughly: Allow the area to air-dry after washing. If this isn’t possible, gently pat the area dry with a clean washcloth or toilet paper.
  • Apply a cold compress: A cold washcloth can be applied to relieve pain.
  • Apply creams or powders: Ask your doctor about using moisture-barrier creams or non-medicated powders to keep irritated skin from direct contact with fecal matter.
  • Wear light, loose clothing: Wear cotton underwear and loose-fitting clothes to avoid restricting airflow to the area.
  • Avoid irritants: Don’t use harsh or scented soap on the area. Use unscented tampons or pads.

A rectovaginal fistula should not be ignored since it can lead to further health complications. As soon as you notice any abnormal vaginal discharge or symptoms like those described above, see your doctor. Though rectovaginal fistulas are relatively rare, it’s important to have them treated promptly.

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