What is Rectovaginal Fistula? Symptoms, Causes, & Treatment

A rectovaginal fistula is an abnormal connection between your rectum and vagina that allows stool and gas to pass through the vaginal opening. This opening shouldn't exist, and when it does, it can feel overwhelming and isolating. You're not alone in this experience, and effective treatments are available to help restore your quality of life.

What is a rectovaginal fistula?

A rectovaginal fistula creates a tunnel-like passage between your rectum (the last part of your large intestine) and your vagina. This connection allows bowel contents to leak into your vagina instead of exiting through your anus as they normally would.

The size of these fistulas can vary greatly. Some are tiny pinhole openings, while others can be larger and more complex. The location along the rectovaginal wall also differs, which affects both symptoms and treatment approaches.

This condition impacts your daily life significantly, affecting everything from personal hygiene to intimate relationships. Understanding what's happening in your body is the first step toward getting the help you need.

What are the symptoms of rectovaginal fistula?

The most noticeable symptom is stool or gas passing through your vagina instead of your rectum. This can happen unexpectedly and may feel distressing, especially when you're trying to manage your daily activities.

Here are the main symptoms you might experience:

• Stool leaking from your vagina
• Gas passing through your vagina
• Foul-smelling vaginal discharge
• Recurrent vaginal or urinary tract infections
• Pain during bowel movements
• Irritation or burning around your vaginal area
• Pain during sexual intercourse
• Abdominal cramping or discomfort

Some women also develop skin irritation around the vaginal opening due to contact with stool. The emotional impact can be just as challenging as the physical symptoms, often leading to anxiety about social situations or intimacy.

What are the types of rectovaginal fistula?

Doctors classify rectovaginal fistulas based on their location and complexity. Understanding your specific type helps determine the best treatment approach for your situation.

The main types include:

• Low rectovaginal fistula: Located near the vaginal opening, often easier to repair
• High rectovaginal fistula: Located higher up in the vaginal canal, may require more complex surgery
• Simple fistula: Small, straightforward opening with healthy surrounding tissue
• Complex fistula: Large opening, multiple tracks, or surrounded by scarred or infected tissue

Your doctor will determine which type you have through examination and imaging studies. This classification guides both the surgical technique and your expected recovery timeline.

What causes rectovaginal fistula?

Several different situations can lead to the development of a rectovaginal fistula. The most common cause is complications during childbirth, but other medical conditions and procedures can also create these abnormal connections.

The primary causes include:

• Obstetric trauma: Severe tears during vaginal delivery, especially fourth-degree tears that extend into the rectum
• Inflammatory bowel disease: Crohn's disease can cause inflammation that breaks down tissue between organs
• Surgical complications: Complications from episiotomy repair, hemorrhoid surgery, or other pelvic procedures
• Radiation therapy: Cancer treatment in the pelvic area can weaken tissues over time
• Infections: Severe abscesses in the area between the rectum and vagina
• Cancer: Tumors in the rectum, vagina, or cervix can create openings between organs
• Pelvic trauma: Serious accidents or injuries to the pelvic region

In rare cases, some women are born with rectovaginal fistulas due to developmental abnormalities during pregnancy. Sometimes the exact cause remains unclear, which can feel frustrating but doesn't affect your treatment options.

When should you see a doctor for rectovaginal fistula?

You should contact your healthcare provider immediately if you notice stool or gas coming from your vagina. This symptom always requires medical evaluation, as it's not something that will resolve on its own.

Seek medical attention if you experience any of these signs:

• Any amount of stool passing through your vagina
• Persistent foul-smelling vaginal discharge
• Recurrent vaginal or urinary tract infections
• Severe pain during bowel movements or sexual activity
• Signs of infection like fever, chills, or worsening pelvic pain

Early treatment often leads to better outcomes and can prevent complications. Don't feel embarrassed about discussing these symptoms with your doctor – they're trained to handle these situations with sensitivity and professionalism.

What are the risk factors for rectovaginal fistula?

Certain factors can increase your likelihood of developing a rectovaginal fistula. Understanding these risk factors helps you and your healthcare team make informed decisions about prevention and treatment.

The main risk factors include:

• Difficult childbirth: Prolonged labor, forceps or vacuum delivery, or large baby size
• Previous pelvic surgery: History of procedures in the anal or vaginal area
• Inflammatory bowel disease: Particularly Crohn's disease affecting the rectum
• Previous radiation therapy: Cancer treatment targeting the pelvic region
• Advanced age during childbirth: Being over 35 during delivery
• Chronic constipation: Long-term straining during bowel movements
• Poor nutrition: Conditions that affect tissue healing
• Smoking: Impairs blood flow and tissue healing

Having risk factors doesn't mean you'll definitely develop a fistula. Many women with these risk factors never experience this condition, while others without obvious risk factors do develop fistulas.

What are the possible complications of rectovaginal fistula?

If left untreated, rectovaginal fistulas can lead to several complications that affect both your physical health and quality of life. Understanding these potential issues emphasizes why seeking treatment is so important.

Possible complications include:

• Recurrent infections: Frequent vaginal, urinary tract, or pelvic infections
• Skin breakdown: Irritation and sores around the vaginal and anal areas
• Social isolation: Difficulty maintaining normal activities due to odor and leakage
• Sexual dysfunction: Pain during intercourse and relationship strain
• Emotional distress: Depression, anxiety, and loss of self-confidence
• Electrolyte imbalance: In rare cases with large fistulas causing significant fluid loss

The good news is that with proper treatment, most of these complications are preventable or reversible. Your healthcare team will work with you to address both the physical and emotional aspects of this condition.

How is rectovaginal fistula diagnosed?

Your doctor will start with a detailed discussion about your symptoms and medical history. They'll ask about childbirth experiences, previous surgeries, and any inflammatory bowel conditions to understand potential causes.

The diagnostic process typically includes a physical examination where your doctor gently examines your vaginal and rectal areas. This examination might feel uncomfortable, but it's necessary to locate the fistula and assess its size and complexity.

Additional tests might include:

• Fistulogram: X-ray with contrast dye to map the fistula track
• CT scan or MRI: Detailed imaging to see surrounding tissues and rule out other conditions
• Colonoscopy: Camera examination of your colon to check for inflammatory bowel disease
• Anorectal manometry: Tests to measure anal sphincter function
• Endorectal ultrasound: Sound wave imaging to assess the anal sphincter muscles

Your doctor might also perform a methylene blue test, where blue dye is placed in your rectum to see if it appears in your vagina. These tests help create a complete picture of your condition and guide treatment planning.

What is the treatment for rectovaginal fistula?

Treatment depends on several factors including the size and location of your fistula, its underlying cause, and your overall health. Your doctor will develop a personalized treatment plan that gives you the best chance of successful healing.

Small, simple fistulas sometimes heal on their own with conservative management. This approach might include dietary changes, medications to reduce bowel movements, and careful hygiene practices. Your doctor will monitor your progress closely during this time.

Surgical repair is often necessary for larger or complex fistulas. The main surgical approaches include:

• Fistulotomy: Opening and cleaning the fistula track
• Advancement flap repair: Using healthy tissue to cover the opening
• Muscle interposition: Placing muscle tissue between the rectum and vagina
• Temporary colostomy: Diverting stool away from the area to allow healing

For fistulas caused by Crohn's disease, your doctor might prescribe medications to reduce inflammation before attempting surgical repair. This combination approach often improves success rates.

How can you manage symptoms at home?

While waiting for treatment or during recovery, several home care strategies can help you manage symptoms and maintain your comfort. These approaches work alongside medical treatment, not as replacements for professional care.

Helpful home management techniques include:

• Gentle hygiene: Clean the area with warm water after each bowel movement
• Barrier creams: Apply zinc oxide or petroleum jelly to protect skin from irritation
• Dietary modifications: Eat low-residue foods to reduce stool volume and frequency
• Adequate hydration: Drink plenty of water to maintain soft stools
• Comfortable clothing: Wear loose, breathable fabrics and change underwear frequently
• Sitz baths: Soak in warm water for 10-15 minutes to soothe irritated tissues

Consider keeping a symptom diary to track patterns and triggers. This information helps your healthcare team adjust your treatment plan as needed.

How should you prepare for your doctor appointment?

Preparing for your appointment helps ensure you get the most from your visit with your healthcare provider. Having organized information ready allows for more efficient diagnosis and treatment planning.

Before your appointment, gather this information:

• Symptom timeline: When symptoms started and how they've changed
• Medical history: Previous surgeries, childbirth experiences, and chronic conditions
• Current medications: Include prescription drugs, over-the-counter medications, and supplements
• Family history: Any relatives with inflammatory bowel disease or similar conditions
• Questions list: Write down concerns you want to discuss

It's helpful to bring a trusted friend or family member for emotional support. Don't hesitate to ask for clarification if you don't understand something your doctor explains. This is your health, and you deserve clear, comprehensive information.

What's the key takeaway about rectovaginal fistula?

A rectovaginal fistula is a serious but treatable condition that requires medical attention. While it can significantly impact your daily life and emotional well-being, effective treatments are available to help restore your health and quality of life.

The most important thing to remember is that you're not alone in this experience. Many women successfully overcome this condition with proper medical care and support. Early treatment generally leads to better outcomes, so don't delay seeking help if you're experiencing symptoms.

Work closely with your healthcare team to develop a treatment plan that addresses both your physical symptoms and emotional needs. With patience and proper care, most women with rectovaginal fistulas can return to their normal activities and relationships.