Rectovaginal Fistula Treatment, Symptoms, Causes

Rectovaginal fistula refers to the abnormal connection in between the vagina and rectum. This is a devastating medical condition wherein if the aperture between the vagina and rectum is wide enough, bowel contents can escape through the vagina. So, you will be passing gas or stool from the vagina. Childbirth trauma is seen to be the number one cause of rectovaginal fistula due to insufficient health care like in some developing lands. In fact, studies show that this medical condition rarely happens in Western Countries where there is adequate health care. Still, there are some other causes of rectovaginal fistula. And one must not just be aware of its causes but it is also important to know the symptoms, complications once ignored and treatment methods used for this condition. Read further.

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Rectovaginal fistula symptoms

Manifestations of symptoms differ according the fistula location and size, of which the symptoms may range from minor symptoms to significant problems associated with hygiene and fecal incontinence. These symptoms may include stinking vaginal discharge, recurring infections on the urinary tract and vagina; pain during sexual intercourse and passage of pus or gas at the vagina; pain or irritation in the vagina, vulva as well as the part in between the anus and vagina. If you have experienced any of these symptoms, do not delay seeing your doctor. There could be underlying serious health problems and the doctor will be able to figure out the fistula cause and decide for immediate repair. To some extent, the doctor may recommend you to see a gynecologic or colorectal specialist.

Causes of Rectovaginal Fistula

• Childbirth injury – This often includes infection and episiotomy tear, a surgical cut to expand the perineum during delivery as well as perineum tear that goes beyond to the bowel. These may occur after a long and difficult labor.

• Surgical procedures involving the anus, rectum, perineum or vagina. It rarely happens though that fistula develops before any surgery done on the lower pelvic area like hysterectomy. In most cases, it develops after surgery is done.

• Cancer – A cancerous growth in your cervix, anal canal, uterus, rectum and vagina can also lead to rectovaginal fistula development. Besides, radiation treatment on these areas will make you susceptible to developing fistula usually two years after the treatment is done.

• Crohn’s disease – This is also a common cause to the development of fistula. An inflammatory bowel disease wherein the digestive tract lining has become inflamed. Although majority of women suffering from Crohn’s disease have never developed any fistula, still, they are more susceptible to developing the condition.

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• Other causes – Although it rarely happens, but there are chances of developing fistula from rectum infection, vaginal trauma or diverticulitis.


Rectovaginal fistula complications are physically obvious including hygiene problems, vaginal inflammation or irritation, fecal incontinence and perineum inflammation. For some, the rectovaginal fistula could be infected, forming an abscess which is more dangerous if treatment is delayed. Women suffering from Crohn’s disease have greater chances of developing another fistula.

Rectovaginal treatment, repair

Treatment primarily depends on the fistula’s cause, location, size and its influence on the surrounding tissues. Sometimes, fistula heals even without treatment but majority requires surgery to repair the unusual connection or shut it up completely. Prior to surgery, however, the skin surrounding the fistula should be healthy without any signs of inflammation or infection. Physicians usually observe the condition up to three months to make sure that fistula’s surrounding tissue is really healthy. There are two treatment options for rectovaginal fistula- medications and surgery.

Medications – If the area surrounding the fistula has become infected, antibiotics are first taken prior to surgery. Crohn’s disease patients with fistula may also take antibiotics. Infliximab may also be taken to help Crohn’s disease sufferers as this obstructs the activity of TNF-alpha which causes swelling. Adverse effects include chills, fever, hives, difficulty in breathing, flushing, and itching and chest pain.

Surgery – This is undertaken with the purpose of completely closing the fistula, performed either by colorectal surgeon or gynecologist. Meanwhile, fistula repair may need to use tissue graft, taken from another part of the body. Complicated surgical procedure might be needed for severely damaged anal sphincter muscles or tissue damage due to radiation or because of Crohn’s disease.

Prior the operation, you may be advised to take laxatives and follow a special liquid diet as well as take antibiotic medicine prior the surgery. For more complex cases, however, colostomy may be done prior to doing a fistula repair. Colostomy, for instance, refers to the surgical procedure that redirects the stool via an abdominal opening. It may take up to 12 weeks before the surgeon may resume fistula repair after colostomy


Rectovaginal fistula may sound unfamiliar to you, but the symptoms and causes are hardly unfamiliar. That is why when you figure out that you’ve experienced the aforementioned symptoms, never delay consulting your physician as it is the only way to confirm that the symptoms are really connected to rectovaginal fistula proper action may be taken right away.

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