What is rectovaginal fistula?
A rectovaginal fistula is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina. Bowel contents can leak through the fistula, allowing gas or stool to pass through your vagina.
A rectovaginal fistula may result from:
- Injury during childbirth
- Crohn’s disease or other inflammatory bowel disease
- Radiation treatment or cancer in the pelvic area
- Complication following surgery in the pelvic area
The condition may cause emotional distress and physical discomfort, which can impact self-esteem and intimacy.
Talk with your doctor if you have signs and symptoms of a rectovaginal fistula, even if it’s embarrassing. Some rectovaginal fistulas may close on their own, but most need surgical repair.
How common is rectovaginal fistula?
About 0.5 percent of women who have vaginal deliveries worldwide get this condition. However, it’s much less common in developed countries like the United States. Up to 10 percent of people with Crohn’s disease develop rectovaginal fistula. Please discuss with your doctor for further information.
What are the symptoms of rectovaginal fistula?
Depending on the fistula’s size and location, you may have minor symptoms or significant problems with continence and hygiene. Signs and symptoms of a rectovaginal fistula may include:
- Passage of gas, stool or pus from your vagina
- Foul-smelling vaginal discharge
- Recurrent vaginal or urinary tract infections
- Irritation or pain in the vulva, vagina and the area between your vagina and anus (perineum)
- Pain during sexual intercourse
There may be some symptoms not listed above. If you have any concerns about a symptom, please consult your doctor.
When should I see my doctor?
See your doctor if you experience any signs or symptoms of a rectovaginal fistula. A fistula may be the first warning of a more serious problem, such as an infected, pus-filled area (abscess) or cancer. Identifying the cause of the fistula can help your doctor determine a treatment plan.
What causes rectovaginal fistula?
The most common causes of a rectovaginal fistula include:
- Complications during childbirth. During a long or difficult delivery, the perineum can tear, or your doctor might make a cut in the perineum (episiotomy) to deliver the baby.
- Inflammatory bowel disease (IBD). Crohn’s disease and ulcerative colitis are types of IBD. They cause inflammation in the digestive tract. In rare cases, these conditions can increase your risk of developing a fistula.
- Cancer or radiation to the pelvis. Cancer in your vagina, cervix, rectum, uterus, or anus can cause a rectovaginal fistula. Radiation to treat these cancers can also create a fistula.
- Having surgery on your vagina, rectum, perineum, or anus can cause an injury or infection that leads to an abnormal opening.
Other possible causes include:
- An infection in your anus or rectum
- Infected pouches in your intestines (diverticulitis)
- Stool stuck in your rectum (fecal impaction)
- Infections due to hiv
- Sexual assault
What increases my risk for rectovaginal fistula?
Please discuss with your doctor for further information.
Diagnosis & treatment
The information provided is not a substitute for any medical advice. ALWAYS consult with your doctor for more information.
How is rectovaginal fistula diagnosed?
Rectovaginal fistula can be difficult to talk about. Yet it’s important to tell your doctor about your symptoms so you can get treated.
Your doctor will first ask about your symptoms and perform a physical exam. With a gloved hand, the doctor will check your vagina, anus, and perineum. A device called a speculum may be inserted into your vagina to open it up so your doctor can see the area more clearly. A proctoscope can help your doctor see into your anus and rectum.
Tests your doctor might use to help diagnose rectovaginal fistula include:
- Anorectal or transvaginal ultrasound. During this test, a wand-like instrument is inserted into your anus and rectum, or into your vagina. An ultrasound uses sound waves to create a picture from inside your pelvis.
- Methylene enema. A tampon is inserted into your vagina. Then, a blue dye is injected into your rectum. After 15 to 20 minutes, if the tampon turns blue, you have a fistula.
- Barium enema. You will get a contrast dye that helps your doctor see the fistula on an X-ray.
- Computerized tomography (CT) scan. This test uses powerful X-rays to make detailed pictures inside your pelvis.
- Magnetic resonance imaging (MRI). This test uses strong magnets and radio waves to make pictures from inside your pelvis. It can show a fistula or other problems with your organs, such as a tumor.
How is rectovaginal fistula treated?
The main treatment for a fistula is surgery to close the abnormal opening. However, you can’t have surgery if you have an infection or inflammation. The tissues around the fistula need to heal first.
Your doctor might suggest that you wait for three to six months for an infection to heal, and to see if the fistula closes on its own. You’ll get antibiotics to treat an infection or infliximab (Remicade) to bring down inflammation if you have Crohn’s disease.
Rectovaginal fistula surgery can be done through your abdomen, vagina, or perineum. During the surgery, your doctor will take a piece of tissue from somewhere else in your body and make a flap or plug to close the opening. The surgeon will also fix the anal sphincter muscles if they’re damaged.
Some women will need a colostomy. This surgery creates an opening called a stoma in your belly wall. The end of your large intestine is put through the opening. A bag collects wastes until the fistula heals.
You may be able to go home on the same day as your surgery. For some types of surgery, you’ll need to stay overnight in the hospital.
Possible risks from the surgery include:
- Damage to the bladder, ureters, or bowel
- Blood clot in the legs or lung
- Blockage in the bowel
Lifestyle changes & home remedies
What are some lifestyle changes or home remedies that can help me manage rectovaginal fistula?
The following lifestyles and home remedies might help you cope with rectovaginal fistula:
- Wash with water. Shower or gently wash your outer genital area with just warm water each time you experience vaginal discharge or passage of stool.
- Avoid irritants. Soap can dry and irritate your skin, but you may need a gentle unscented soap in moderation. Avoid harsh or scented soap and scented tampons and pads. Vaginal douches can increase your chance of infection.
- Dry thoroughly. Allow the area to air-dry after washing, or gently pat the area dry with a clean cloth or towel.
- Avoid rubbing with dry toilet paper. Pre-moistened, alcohol-free, unscented towelettes or wipes or moistened cotton balls are a good alternative.
- Apply a cream or powder. Moisture-barrier creams protect irritated skin from liquid or stool. Nonmedicated talcum powder or cornstarch also may help relieve discomfort. Ask your doctor to recommend a product. Be sure the area is clean and dry before you apply any cream or powder.
- Wear cotton underwear and loose clothing. Tight clothing can restrict airflow and worsen skin problems. Change soiled underwear quickly. Products such as absorbent pads, disposable underwear or adult diapers can help if you’re passing liquid or stool, but be sure they have an absorbent wicking layer on top.
If you have any questions, please consult with your doctor to better understand the best solution for you.
Hello Health Group does not provide medical advice, diagnosis or treatment.
Review Date: December 7, 2017 | Last Modified: December 9, 2019
Rectovaginal fistula. https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/symptoms-causes/syc-20377108. Accessed December 7, 2017.
What Is a Rectovaginal Fistula and How’s It Treated? https://www.healthline.com/health/rectovaginal-fistula. Accessed December 7, 2017.