Rectovaginal fistulas, or holes, develop between your vagina and rectum. Vaginal tears in childbirth, as well as pelvic surgeries, can cause this type of vaginal fistula. Gas or stool may leak out of your vagina. Most women have a complete recovery after rectovaginal fistula repair surgery to close the 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.
In addition to the rectum, you may develop other digestive system fistulas, such as:
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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.
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:
Symptoms of a rectovaginal fistula include:
Diagnostic tests for rectovaginal fistulas include:
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.
These steps can aid your recovery after rectovaginal fistula repair surgery:
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.
You may want to ask your healthcare provider:
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.
You may receive treatment from these doctors:
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.
Last reviewed by a Cleveland Clinic medical professional on 01/13/2022.
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