A rectovaginal fistula is an abnormal connection between the lower part of the large intestine and the vagina. Contents from the intestine can leak from the fistula, which means that gas or stool might pass through the vagina.
A rectovaginal fistula can result from an injury during childbirth, a complication after surgery, cancer, or inflammatory bowel diseases, such as Crohn's disease. However, in Western countries, rectovaginal fistulas occur rarely.
The symptoms of a rectovaginal fistula often lead to emotional stress and physical discomfort. Some rectovaginal fistulas may close on their own, but most need to be surgically repaired.
Symptoms
Depending on the size and location of the fistula, symptoms can range from very mild to significant issues with incontinence and hygiene. Signs and symptoms of a rectovaginal fistula may include:
• Passage of gas, stool, or pus from the vagina
• Foul-smelling vaginal discharge
• Recurrent urinary or vaginal infections
• Irritation or pain
• Pain during sexual activity
If signs or symptoms of a rectovaginal fistula occur, schedule an appointment with a doctor. A fistula can be the first indication of a more serious problem, such as an infection site or cancer. It is important for the doctor to identify the cause of the fistula and determine if and when it should be repaired. Depending on the cause of the fistula, the doctor may refer you to a colorectal or gynecological surgeon.
Causes
A rectovaginal fistula can form as a result of:
• Injuries during childbirth. Obstetric injuries are the most common cause of rectovaginal fistulas. These can occur after difficult labor. Fistulas resulting from childbirth may also involve injuries to the anal sphincter.
• Crohn's disease. The second most common cause of rectovaginal fistula is Crohn's disease. However, most women with Crohn's disease never develop a rectovaginal fistula.
• Surgery involving the vagina, perineum, rectum, or anus. Surgery in the lower pelvic region, such as hysterectomy, can, in rare cases, lead to the development of a fistula.
• Cancer or radiation therapy in the pelvic area. A cancerous tumor in the rectum, cervix, vagina, uterus, or anus can lead to the development of a rectovaginal fistula. Radiation therapy for tumors in these areas can increase the risk of developing a fistula. A radiation-induced fistula typically forms within two years following treatment.
• Other causes. Less commonly, a rectovaginal fistula can be caused by infections in the anus or rectum, infections in the digestive tract (diverticulitis), or vaginal trauma.