Rectovaginal Fistula

What is a rectovaginal fistula?

A rectovaginal fistula is a tunnel-like opening that develops between your vagina and rectum. Your vagina is a tube that connects your uterus to your vulva (genitals outside your body). Your rectum is the part of your digestive system that connects your large intestine (colon) to your anus. It holds stool and gas until your body releases them.

In a rectovaginal fistula, damage to vaginal tissue causes the tissue to die and a hole (fistula) to form. This opening lets stool and gas enter your vagina. A rectovaginal fistula is a type of vaginal fistula.

What is a vaginal fistula?

Vaginal fistulas are holes that develop between your vagina or uterus (parts of the female reproductive system) and digestive system or urinary system organs.

In addition to the rectum, you may develop other digestive system fistulas, such as:

• Colovaginal fistulas: Openings between your vagina and large intestine (colon).
• Enterovaginal fistulas: Openings between your vagina and small intestine.

How common are rectovaginal fistulas?

As many as 100,000 people worldwide develop vaginal fistulas every year. People in countries with limited medical resources are more likely to develop rectovaginal fistulas.

These fistulas can occur after prolonged vaginal labors that last for days. Pressure from your baby pushing against your vaginal wall can reduce blood flow, causing tissue death.

The World Health Organization (WHO) estimates that 2 million people designated female at birth (DFAB) in Asia and sub-Saharan Africa have some type of untreated vaginal fistula.

What causes rectovaginal fistulas?

Trauma to vaginal tissue stops blood flow, causing the tissue to die and creating a fistula. Rectovaginal fistulas can develop in a matter of days. Or they may form over several years. A person rarely has a congenital rectovaginal fistula, which means the opening is present at birth.

Causes of rectovaginal fistulas include:

• Prolonged labor, vaginal tears during childbirth or if your healthcare provider made a cut (incision) to help you deliver your baby (episiotomy).
• Abdominal or pelvic surgery, including C-section and hysterectomy.
• Cancer in your pelvic area, such as cervical cancer or colorectal (colon) cancer.
• Inflammatory bowel diseases (IBD) like Crohn’s disease and ulcerative colitis.
• Colon infections like diverticulitis.
• Radiation therapy to your pelvic region.

What are rectovaginal fistula symptoms?

Symptoms of a rectovaginal fistula include:

• Abdominal pain.
• Foul-smelling vaginal discharge.
• Gas, pus or stool that leaks out of your vagina (fecal incontinence).
• Nausea and vomiting or diarrhea.
• Painful intercourse (dyspareunia).
• Recurrent urinary tract infections (UTIs) or vaginitis (vaginal infections).
• Rectal bleeding or vaginal bleeding.
• Skin irritation in your vagina, vulva (entrance to the vagina) or perineum (area between your vagina and anus).
• Unexplained weight loss.

How is a rectovaginal fistula diagnosed?

Your healthcare provider will perform a physical exam and pelvic exam. They’ll also ask about your symptoms.

Diagnostic tests for rectovaginal fistulas include:

• Complete blood count and urinalysis to look for infections.
• Dye test using dye in your rectum to check for signs of leakage between your vagina and rectum.
• Fistulogram X-ray to determine the number and size of fistulas.
• Pelvic MRI or CT scan to take images of your vagina and rectum.
• Flexible sigmoidoscopy to view your rectum and the lower part of your large intestine (colon).
• Colonoscopy to examine the inside of your rectum and all of your large intestine.

What are rectovaginal fistula treatments?

Small rectovaginal fistulas may heal on their own over time. You may need antibiotics for infections or medications for IBD.

Most people with rectovaginal fistulas need surgery to close the opening. Your healthcare provider may use your tissue or lab-made tissue to repair a rectovaginal fistula. As many as 9 in 10 people recover completely after surgery.

If the opening is large, you may need a temporary colostomy. This procedure diverts poop (stool) away from your large intestine and rectum until the fistula heals. Stool leaves your body through a surgical opening in your abdomen called a stoma. It collects in a bag that you change regularly. You’ll need another surgery later to reconnect your intestine and close the stoma.

What happens after rectovaginal fistula repair?

These steps can aid your recovery after rectovaginal fistula repair surgery:

• Take antibiotics as prescribed to lower infection risk.
• Don’t have sex, use tampons or douche until your healthcare provider gives the OK.
• Prevent constipation and diarrhea (which can cause infection) by eating a healthy, high-fiber diet and drinking plenty of water. Use laxatives or stool softeners as directed by your healthcare provider.

What is the outlook for people with rectovaginal fistulas?

Most people who have rectovaginal fistula repair recover fully. They no longer have symptoms.

Rarely, a fistula doesn’t heal properly, or it opens up again after treatment. This is most likely to happen if you have colon cancer or Crohn’s disease or other risk factors like poorly controlled diabetes or if you smoke.

Appropriate care is critical. Living with symptoms of an untreated rectovaginal fistula can lead to depression or anxiety.

What should I ask my provider?

You may want to ask your healthcare provider:

• What caused the rectovaginal fistula?
• What are my treatment options?
• What complications could occur from surgery?
• Can I take steps to prevent getting another rectovaginal fistula?
• Am I at risk for other types of vaginal fistulas?

How can you detect a fistula?

Rectovaginal fistulas rarely cause pain or discomfort, and you can’t feel the opening with your fingers. But you may notice other problems like gas or stool leakage, increased infections and painful sex.

What doctors treat rectovaginal fistulas?

You may receive treatment from these doctors:

• Gynecologist and gynecologic surgeon (female reproductive health specialists).
• Colorectal surgeon (digestive system specialist).

A note from Cleveland Clinic

People who have prolonged labors or undergo pelvic surgery are more likely to develop rectovaginal fistulas. These openings form between your vagina and rectum, allowing gas and stool to leak out through your vagina. These symptoms can be embarrassing. Don’t hesitate to talk to your healthcare provider. Rectovaginal fistula repair surgery is highly successful at closing the fistula and putting an end to uncomfortable symptoms.