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Rectovaginal Fistula: Causes, Symptoms and Treatment Options
Written by Medicover Team and Medically Reviewed by Dr Jyotsna T , Gynecologists
A rectovaginal fistula is an unusual opening between the rectum and the vagina. It allows stool, gas, or pus to pass into the vagina, causing discharge, bad smell, and infections.
Many women experience emotional distress, embarrassment, and difficulties in personal relationships due to the persistent hygiene challenges and discomfort they cause.
Though rare, rectovaginal fistulas are often linked to surgical complications, inflammatory bowel diseases, or pelvic radiation.
What is Rectovaginal Fistula?
A rectovaginal fistula is an abnormal connection between the rectum and the vagina. This passage allows stool, gas, or even mucus to pass into the vaginal canal something that should never occur under normal circumstances.
It's often the result of tissue damage due to childbirth trauma, surgery, or chronic conditions and can significantly affect a woman's physical and emotional well-being.
What Increases the Risk/Causes of Developing a Rectovaginal Fistula?
Certain factors make a woman more likely to develop this condition.
These include
- Difficult vaginal deliveries, especially with large babies or prolonged labor
- Obstetric tears, particularly third- and fourth-degree perineal lacerations
- Previous pelvic surgeries, like hysterectomies or bowel operations
- Inflammatory bowel diseases like Crohn's disease
- Radiation therapy to treat pelvic cancers
- Pelvic infections or abscesses that erode nearby tissue
- Cancer of the rectum, cervix, or vagina
Women who have had multiple deliveries or lack access to quality maternal healthcare are especially vulnerable in some cases.
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Get Second OpinionWhat Symptoms Should You Watch for in Rectovaginal Fistula?
The most telling sign is the leakage of stool or gas from the vagina, which often comes as a shock to patients. Other symptoms may include:
- Persistent or foul-smelling vaginal discharge
- Pain or discomfort during intercourse (dyspareunia)
- Itching or irritation in the vaginal or perineal area
- Recurrent vaginal or urinary tract infections
- Bleeding from the vagina or rectum
- Social embarrassment, anxiety, or emotional distress due to symptoms
These signs should never be ignored and must be evaluated by a medical professional.
How is Rectovaginal Fistula Diagnosed?
Diagnosis begins with a detailed health history and a physical examination. If a fistula is suspected, doctors may recommend:
- Pelvic examination to check for openings or inflammation
- Dye tests, where a colored liquid is introduced into the rectum to see if it leaks into the vagina
- Endoscopy (colonoscopy or sigmoidoscopy) to examine the lower intestines
- Imaging tests like CT scan, MRI, or contrast X-rays to confirm the fistula and evaluate the surrounding organs
- Biopsy, if cancer is suspected, to determine if malignant cells are involved
Early and accurate diagnosis is crucial to plan appropriate treatment.
How is a Rectovaginal Fistula Treated?
Treatment depends on the size, location, cause, and how long the fistula has been present. It also considers your overall health and any underlying diseases.
Medical Management
In mild cases or when surgery isn't immediately possible, doctors may try:
- Antibiotics for infection
- Nutritional support to promote tissue healing
- Medications to manage conditions like Crohn's disease
- Fibrin glue or plugs to seal the tract (less common and not always successful)
Surgical Repair
Surgery is the most reliable way to correct the condition. Options include:
- Local tissue flap repair, often used for small, low-lying fistulas
- Gracilis muscle flap surgery for complex or recurrent fistulas
- Abdominal surgery is needed in high or deep fistulas
- Colostomy, sometimes used temporarily to divert stool and allow healing
The goal is to remove the damaged tissue and rebuild a healthy barrier between the rectum and vagina.
When Should You See a Doctor for a Rectovaginal Fistula?
You should see a doctor as soon as possible if you notice any signs that may suggest a rectovaginal fistula, especially if symptoms are new, persistent, or affecting your daily life.
A rectovaginal fistula is an abnormal connection between the rectum and vagina. This can allow stool or gas to pass through the vagina, which should never happen under normal conditions.
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What Complications Can Arise if Rectovaginal Fistula is Left Untreated?
If ignored or poorly managed, rectovaginal fistulas can lead to:
- Chronic infections of the vagina or urinary tract
- Fecal incontinence, resulting in hygiene issues and skin irritation
- Perineal abscesses or severe pelvic infections
- Sexual dysfunction and relationship strain
- Psychological distress, including depression or social withdrawal
- Recurrence, especially if the underlying cause isn't fully addressed
Timely treatment is essential to prevent these long-term complications.
What Should You Expect During Recovery and Healing of Rectovaginal Fistula?
Healing after surgery depends on the size of the anal fistula and the type of repair performed. Recovery can take several weeks to months.
Tips for Better Healing Include
- Keeping the area clean and dry to avoid infections
- Avoiding heavy lifting or strenuous activity for a few weeks
- Following a fiber-rich diet to prevent constipation and straining
- Wearing loose cotton underwear to reduce irritation
- Using non-scented products and avoiding douches or tampons
- Attending follow-up appointments for wound checks and recovery progress
Most patients can return to normal life activities gradually, though complete healing may require patience.
Our Experience in Treating Rectovaginal Fistulas
At Medicover Hospitals, we understand how sensitive and life-disrupting rectovaginal fistulas can be. Our team of expert gynecologists, colorectal surgeons, gastroenterologists, and pelvic floor specialists work together to offer precise diagnosis, modern treatment options, and compassionate aftercare.
We use the latest technology and surgical techniques to ensure safe recovery and long-term results, restoring your health, comfort, and quality of life.
