RECTOVAGINAL FISTULA

Overview

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

Symptoms

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

Causes

A rectovaginal fistula may form as a result of:

 Injuries during childbirth. Delivery-related injuries are the most common

cause of rectovaginal fistulas. This includes tears in the perineum that extend to
the bowel, or an infection of an episiotomy — a surgical incision to enlarge the
perineum during vaginal delivery. 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. Most women with Crohn's disease never develop a
rectovaginal fistula, but having Crohn's disease does increase your risk of the
condition.

 Cancer or radiation treatment in your pelvic area. A cancerous tumor in

your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal
fistula. Radiation therapy for cancers in these areas can also put you at risk. A
fistula caused by radiation usually forms within six months to two years after
treatment.

 Surgery involving your vagina, perineum, rectum or anus. Prior surgery in

your lower pelvic region, such as removal of your uterus (hysterectomy), in rare
cases can lead to development of a fistula. 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 in

your anus or rectum; infections of small, bulging pouches in your digestive tract
(diverticulitis); long-term inflammation of your colon and rectum (ulcerative
colitis); dry, hard stool that gets stuck in the rectum (fecal impaction); or vaginal
injury unrelated to childbirth.

Complications

Physical complications of a rectovaginal fistula may include:

 Uncontrolled loss of stool (fecal incontinence)

 Hygiene problems

 Recurrent vaginal or urinary tract infections

 Irritation or inflammation of your vagina, perineum or the skin around your

anus

 An infected fistula that forms an abscess, a problem that can become life-
threatening if not treated

 Fistula recurrence