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

The condition may cause emotional distress and physical discomfort, which can impact self-esteem and intimacy.

Talk with your doctor if you have signs and symptoms of a rectovaginal fistula, even if it's embarrassing. Some rectovaginal fistulas may close on their own, but most need surgical repair.

Source: http://www.mayoclinic.com

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

When to see a doctor

See your doctor if you experience any signs or symptoms of a rectovaginal fistula. A fistula may be the first warning of a more serious problem, such as an infected, pus-filled area (abscess) or cancer. Identifying the cause of the fistula can help your doctor determine a treatment plan.

Source: http://www.mayoclinic.com

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.

Source: http://www.mayoclinic.com

Diagnosis

You can expect a physical exam and certain tests, depending on your needs.

Physical exam

Your doctor will perform a physical exam to try to locate the rectovaginal fistula and check for a possible tumor mass, infection or abscess. The doctor's exam includes inspecting your vagina, anus and the area between them (perineum) with a gloved hand.

Unless the fistula is very low in the vagina and readily visible, your doctor may use a speculum to see inside your vagina. An instrument similar to a speculum, called a proctoscope, may be inserted into your anus and rectum to check for problems.

Your doctor may take a sample of tissue for lab analysis (biopsy) during the procedure.

Tests for identifying fistulas

Your doctor may not find a fistula during the physical exam. Other tests may be needed to locate and evaluate a rectovaginal fistula. These tests can also help your medical team in planning for surgery.

• Contrast tests. A vaginogram or a barium enema can help identify a fistula located in the upper rectum. 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. A CT scan of your abdomen and pelvis provides more detail than does a standard X-ray. The CT scan can help locate a fistula and determine its cause.
• Magnetic resonance imaging (MRI). This test creates images of soft tissues in your body. MRI can show the location of a fistula, whether other pelvic organs are involved or whether you have a tumor.
• Anorectal ultrasound. This procedure uses sound waves to produce a video image of your anus and rectum. Your doctor inserts a narrow, wand-like instrument into your anus and rectum. This test can evaluate the structure of your anal sphincter and may show childbirth-related injury.
• Anorectal manometry. This test measures the sensitivity and function of your rectum and can give information about the rectal sphincter and your ability to control stool passage. This test does not locate fistulas, but may help in planning the fistula repair.
• 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.

Source: http://www.mayoclinic.com

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

Among women with Crohn's disease who develop a fistula, the chances of complications are high. These can include poor healing, or another fistula forming later.

Lifestyle and home remedies

Good 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.
• Apply a cream or powder. Moisture-barrier creams protect irritated skin from liquid or stool. Nonmedicated talcum powder or cornstarch also may help relieve discomfort. Ask your doctor to recommend a product. Be sure the area is clean and dry before you apply any cream or powder.
• 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.

For best results, be sure to follow any other recommendations from your health care team.

Source: http://www.mayoclinic.com