A rectovaginal fistula is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina. Contents of your bowel can leak through the fistula, meaning you might pass gas or stool through your vagina.

A rectovaginal fistula may result from an injury during childbirth, Crohn's disease or other inflammatory bowel disease, radiation treatment or cancer in the pelvic area, or a complication following surgery in the pelvic area.

The symptoms of a rectovaginal fistula often cause emotional distress as well as physical discomfort, which can impact self-esteem and intimate relationships. Though bringing up the subject with your doctor may be difficult, it's important to have a rectovaginal fistula evaluated. Some rectovaginal fistulas may close on their own, but most need to be repaired surgically.

Source: http://www.mayoclinic.com

Depending on the size and location of the fistula, 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
• A 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

If you experience any signs or symptoms of rectovaginal fistula, make an appointment to see your doctor. A fistula may be the first indication of a more serious problem, such as an area of infection where pus has collected (abscess) or cancer. It's important that your doctor identify the cause of the fistula and determine whether and when it should be repaired. Depending on the cause, your doctor may refer you to a colorectal or gynecologic surgeon.

Source: http://www.mayoclinic.com

A rectovaginal fistula may form as a result of:

• Injuries during childbirth. Injuries during delivery are the most common cause of rectovaginal fistulas. Such injuries include tears in the perineum that extend to the bowel or an infection or tear of an episiotomy — a surgical incision to enlarge the perineum during vaginal delivery. These may happen following a long, difficult labor. Fistulas occurring from childbirth 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 a type of inflammatory bowel disease in which the lining of your digestive tract becomes 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 lead to development of a rectovaginal fistula. Radiation therapy for cancers in these areas can also put you at risk of developing a fistula. A fistula caused by radiation usually forms within two years following the 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.
• 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); or vaginal injury other than during childbirth.

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You can expect a physical exam and certain tests, explained below, 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 the inside of 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

Often a fistula isn't found during the physical exam. Your doctor may recommend other tests, such as those below, 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 either 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 shows the presence of a fistula.
• Computerized tomography (CT) scan. A CT scan of your abdomen and pelvis provides more detail than a standard X-ray does. 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, as well as involvement of pelvic organs or the presence of 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. Anorectal ultrasound can evaluate the structure of your anal sphincter and may show injury caused during childbirth.
• Anorectal manometry. This test measures the sensitivity and function of your rectum and can provide useful information about your rectal sphincter and your ability to control stool passage. This test does not locate fistulas, but it can help in planning to repair the fistula.
• 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 the diagnosis of Crohn's disease.

Source: http://www.mayoclinic.com

Physical complications of rectovaginal fistula may include:

• Incontinence
• Problems with hygiene
• Recurrent vaginal or urinary tract infections
• Irritation or inflammation of your vagina, perineum or the skin around your anus
• 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 chance of another fistula forming later is high.

Source: http://www.mayoclinic.com

Good hygiene can help ease discomfort and reduce the chance of vaginal or urinary tract infections while waiting for repair.

• Wash with water. Gently wash your outer genital area with warm water each time you experience vaginal discharge or passage of stool. A shower is a good option.
• Avoid irritants. Soap can dry and irritate your skin, but a gentle unscented soap may be necessary 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 toilet paper or a clean washcloth.
• Avoid rubbing with dry toilet paper. Pre-moistened, alcohol-free, unscented towelettes or wipes or moistened cotton balls may be a good alternative for cleaning the area.
• Use a cold compress. Apply a cold compress, such as a washcloth, to the folds at the opening of the vagina (labia).
• Apply a cream or powder. Moisture-barrier creams help keep irritated skin from having direct contact with 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, making skin problems worse. 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