What is Rectovaginal Fistula?
Rectovaginal Fistula is a pathological condition in which there is an abnormal connection between the large intestine, the rectum and the vagina which results in the bowel contents to leak through the fistula and pass through the vagina instead of the rectum.
There are numerous causes for development of Rectovaginal Fistula which may include any sort of injury during childbirth, suffering from a medical condition like Crohn Disease or other diseases in which there is inflammation of the bowel. In some cases, Rectovaginal Fistula may also develop as a result of radiation treatment used for treating certain types of cancers pertaining to the pelvic region.
Rectovaginal Fistula can also occur as a complication after some sort of surgery done in the pelvic region. Rectovaginal Fistula is not a condition which may require emergent medical treatment but it can be very distressing for the patient. The ability for the individual to get intimate with partner also tends to get affected due to Rectovaginal Fistula. Sometimes, a Rectovaginal Fistula may close on its own but in majority of cases surgical correction is required for treatment of Rectovaginal Fistula.
What are the Causes of Rectovaginal Fistula?
As stated above, Rectovaginal Fistula may result due to numerous causes. Some of the causes of Rectovaginal Fistula are:
Rectovaginal Fistula Caused as a Result of Injury During Childbirth
This is perhaps the most common cause of Rectovaginal Fistula. Some of the injuries that may occur at the time of delivery of the child which may cause Rectovaginal Fistula are tears in the perineum which may extend to the bowel. An infection when an incision is made to enlarge the perineum during delivery can also result in Rectovaginal Fistula. All these things tend to happen mostly in females who have prolonged and difficult labor. Also, any type of injury to the anal sphincter may also result in Rectovaginal Fistula.
Crohn's disease is also one of the common causes of Rectovaginal Fistula. This condition arises due to inflammation of the linings of the digestive tract. It is not necessary that all females with Crohn Disease go on to develop Rectovaginal Fistula but this condition definitely increases the risk of developing rectovaginal fistula later.
Radiation in the Pelvic Region
Radiation done to treat certain types of cancer in the pelvic region is also one of the causes for Rectovaginal Fistula. The cancers for which radiation is done in the pelvic areas are cancer of the cervix, rectum, vagina, and uterus. When radiation is done to treat cancers in these regions, it increases the risk of the individual developing Rectovaginal Fistula within a year or two years out of treatment.
Any surgical procedure which involves the vagina, perineum, rectum or anus increases the risk for the individual developing Rectovaginal Fistula. Also surgical procedure in the lower pelvic region such as one to remove the uterus also potentially increases the risk of an individual developing Rectovaginal Fistula.
What are the Symptoms of Rectovaginal Fistula?
The symptoms of Rectovaginal Fistula depend on the size and the exact location of the fistula. If the fistula is very small then the symptoms caused by it are generally mild and is of no concern but if the fistula is large and extends to the bowels then the symptoms caused by it are fairly severe.
Some of the symptoms caused by Rectovaginal Fistula are:
- Passing stool or pus from the vagina
- Vaginal discharge which has a foul odor
- Recurrent UTIs or vaginal infections
- Vaginal pain
- Difficulty with sexual intercourse as a result of severe pain
How is Rectovaginal Fistula Diagnosed?
A Rectovaginal Fistula is usually diagnosed after a thorough physical examination of the patient, a detailed history taking, and certain investigational studies which have all been delineated below.
If Rectovaginal Fistula is suspected by the physician then he or she will try and locate the Rectovaginal Fistula and also look for possible infection or an abscess. The physician will closely inspect the vagina, anus, and the perineum. If the Rectovaginal Fistula is higher up in the vagina then a speculum might be used by the physician to inspect the inner portion of the vagina to look for the Rectovaginal Fistula. Once a physical examination is completed, and Rectovaginal Fistula is suspected but not found then the physician may perform the following tests to confirmatively diagnose Rectovaginal Fistula. These tests are:
Vaginogram or Barium Enema: These tests can help confirm the location of the Rectovaginal Fistula. In these tests a contrast material is used and the images of the vagina and the rectal area are seen on x-ray images.
CT and MRI Scan: Advanced radiological studies in the form of CT or MRI scan of the abdomen and pelvis will give a clear picture of the area and any presence of Rectovaginal Fistula will be clearly seen on the images.
Anorectal Ultrasound: An anorectal ultrasound uses sound waves to produce images of the anal and rectal area to look for the presence of an abnormality like a Rectovaginal Fistula.
Additionally tests like colonoscopy with biopsy may be done to see if the individual has Crohn disease which is a precursor for Rectovaginal Fistula.
All the above tests confirm the diagnosis of Rectovaginal Fistula.
How is Rectovaginal Fistula Treated?
As stated above, some Rectovaginal Fistula close on their own but in most of the cases treatment is required to treat Rectovaginal Fistula as this is quite an embarrassing condition and causes a lot of distress to the patient. The treatment for Rectovaginal Fistula depends on the size, location, and the extent of the fistula and includes conservative approach with medications as well as surgical correction.
Medications: Conservative approach in the form of medications can be given in the form of antibiotics in case the area around the Rectovaginal Fistula gets infected. This is usually done before a surgical correction so as to prevent any complications postsurgery. If Crohn Disease is responsible for development of Rectovaginal Fistula in a female, then medication known as Remicade has shown quite good efficacy in treating such cases of Rectovaginal Fistula.
Surgery: In majority of cases of Rectovaginal Fistula, surgical procedure is required to close the fistula and provide relief of symptoms and allow the patient to lead a normal life. Usually, the surgeon waits for about three months post the diagnosis and treats any type of inflammation and infection with medications prior to embarking on surgery to close or repair Rectovaginal Fistula.
The surgeon also tends to wait to see if the fistula closes on its own with conservative treatment. The surgical procedure done for Rectovaginal Fistula aims at removing the fistula tract and close the opening. The surgical options to treat rectovaginal fistula are
- The surgeon may sew a patch of biologic tissue into the fistula and allow the tissue to grow into the patch and thus close the Rectovaginal Fistula
- The surgeon may also take a part of healthy tissue flap from other area of the body and place it over the opening of the fistula to close it down and treat Rectovaginal Fistula.