Recto-vaginal fistula

What is Recto-vaginal fistula?

A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina.Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and faeces to escape through the vagina, leading to faecal incontinence. There is an association with recurrent urinary and vaginal infections. This type of fistula can cause paediatricians to misdiagnose imperforate anus. The severity of the symptoms will depend on the size of fistula. Most often, it appears after about one week or so after delivery.

What are the causes of rectovaginal fistulas?
A rectovaginal fistula may form as a result of:

Injuries during childbirth. Delivery-related injuries are the most common cause of rectovaginal fistulas. These may happen following a long, difficult, or obstructed labor. These types of fistulas may also involve injury to your anal sphincter, the rings of muscle at the end of the rectum that help you hold in stool.

Crohn’s disease. The second most common cause of rectovaginal fistulas, Crohn’s disease is an inflammatory bowel disease in which the digestive tract lining is inflamed.

Cancer or radiation treatment in your pelvic area. A fistula caused by radiation usually forms within six months to two years after treatment.

Surgery involving your vagina, perineum, rectum or anus. The fistula may develop as a result of an injury during surgery or a leak or infection that develops afterward.

Other causes- Rarely, a rectovaginal fistula may be caused by infections.

What are the symptoms of these fistulas?
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

How are these fistulas diagnosed?

  • Physical examination and correlating it with the patients symptoms.

Contrast tests- these tests use a contrast material to show the vagina or the bowel on an X-ray image.

Blue dye test- This test involves placing a tampon into your vagina, then injecting blue dye into your rectum. Blue staining on the tampon indicates a fistula.

Computerized tomography (CT) scan.

Magnetic resonance imaging (MRI).

Other tests- if your doctor suspects you have inflammatory bowel disease, he or she may order a colonoscopy to view your colon. During the procedure, your doctor can take small samples of tissue (biopsy) for lab analysis, which can help confirm Crohn’s disease.

How is rectovaginal fistula treated?
After diagnosing rectovaginal fistula, it is best to wait for around 3 months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix.
Surgery-
A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally. Most rectovaginal fistulas will need surgery to fix.Medications such as antibiotics and Infliximab might be prescribed to help close the rectovaginal fistula or prepare for surgery.

Lifestyle modifications to prevent infectionsGood hygiene can help ease discomfort and reduce the chance of vaginal or urinary tract infections while waiting for repair. Other home remedies for people living with a rectovaginal fistula include: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.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