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Definition

Rectovaginal fistula is an abnormal connection between the rectum and the vagina. Gas or stool may leak from the bowel into the vagina.

Healthy Wall Between Vagina and Rectum

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Causes

A rectovaginal fistula is caused by an injury to this area. It may be caused by physical trauma or a medical condition.

Risk Factors

Factors that may increase your risk of rectovaginal fistula include:

  • Crohn’s disease
  • Complications following surgery to the perineum (area between vagina and rectum), vagina, rectum, or anus
  • Injuries during childbirth
  • Radiation treatment or cancer in the pelvic area
  • Perianal infection
Symptoms

Symptoms may include:

  • Passing stool or gas via the vagina
  • Inability to control bowel movements
  • Foul-smelling vaginal discharge
  • Pain during sexual intercourse
  • Persistent pain in the pelvic area
Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. You may need to see a colon and rectal surgeon.

Your body structures may need to be viewed. This can be done with:

  • Anorectal ultrasound—a small wand-like instrument provides a video image of the rectum and anus
  • Methylene enema—a tampon is placed in the vagina and methylene blue is placed into the rectum to identify movement of fluid from rectum to vagina
  • Contrast studies— barium enema may be used to view a rectovaginal fistula that cannot be seen on physical exam
  • Endoscopy—a thin, lighted tube is inserted into the rectum to examine the rectum and the lower colon (to rule out irritable bowel disease)
Treatment

Talk with your doctor about the best plan for you. Treatment options include the following:

Rectovaginal Fistula Repair Surgery

Surgery is usually needed. It is done to close the opening between the rectum and vagina. Tissue may be taken from another part of the body as a graft. This tissue will help to close the fistula.

Medications

You may be given antibiotics if the area around the fistula is infected.

Prevention

There are no steps to prevent rectovaginal fistula.

RESOURCES:

The American Congress of Obstetricians and Gynecologists
http://www.acog.org

American Society of Colon and Rectal Surgeons
http://www.fascrs.org

CANADIAN RESOURCES:

Canadian Society of Colon and Rectal Surgeons
http://www.cscrs.ca

Women's Health Matters
http://www.womenshealthmatters.ca/

References:

Wheeless CR, Roenneburg ML. Rectovaginal fistula repair. Atlas of Pelvic Surgery website. Available at: http://www.atlasofpelvicsurgery.com/2VaginalandUrethra/14RectovaginalFistulaRepair/chap2sec14.html. Accessed February 2, 2010.



Last reviewed December 2014 by Daus Mahnke, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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