Rectovaginal Fistula

A rectovaginal fistula (RVF) is a tunnel-like opening that develops between your vagina and rectum inside your body.

Your rectum is the part of your digestive system that connects your large intestine (colon) to your anus (butthole). It holds poop and gas until your body releases them out of your anus. Your vagina is right next to your rectum inside your body.

A rectovaginal fistula happens when damage to tissue between your vagina and rectum causes the tissue to die. A hole (fistula) then forms, connecting your rectum to your vagina. This opening lets poop and gas enter your vagina. RVFs can range in size and shape.

RVFs can cause pain and other symptoms that disrupt your daily life. But they’re usually treatable, often with surgery. Your healthcare team will help you get the treatments and resources you need.

Symptoms of rectovaginal fistula

The most common symptoms of a rectovaginal fistula include:

• Foul-smelling vaginal discharge
• Gas or poop that leaks out of your vagina
• Painful intercourse (dyspareunia)
• Pelvic pain
• Rectal bleeding or vaginal bleeding

It’s important to see your healthcare provider if you have these symptoms. RVFs require treatment to avoid complications.

Rectovaginal fistula causes

In general, a rectovaginal fistula forms when there’s damage to tissue between your vagina and rectum that results in the death of that tissue. This forms a hole, or a fistula. Rectovaginal fistulas can develop in a matter of days. Or they may form over several years.

Many situations can lead to the formation of a rectovaginal fistula. Specific causes include:

• Childbirth injuries. Vaginal tears and episiotomies that don’t heal properly are the most common causes of RVFs.
• Diverticulitis complications. Inflammation and abscesses of the wall of a diverticulum (a small pocket in your colon) can break it down. This can affect your vaginal wall, as well, leading to RVF.
• Inflammatory bowel diseases (IBDs). Chronic IBDs, like Crohn’s disease and ulcerative colitis, can damage rectal and vaginal tissue, resulting in RVF.
• Abdominal or pelvic surgeries. Accidental damage to your vagina or rectum during surgery or poor healing post-surgery can lead to RVF. Examples include J-pouch surgery, pelvic organ prolapse surgery and hemorrhoidectomy.
• Cancer. Cervical cancer or colorectal (colon) cancer can lead to RVF. These fistulas are also called malignant fistulas.
• Radiation therapy to your pelvic region. Radiation causes long-term tissue inflammation with poor healing, which could lead to RVF.
• Intercourse or foreign body injury. Injury to your vaginal wall and/or rectum during sex or due to an object that isn’t supposed to be there can lead to RVF.
• Infections. Anal gland or Bartholin gland infections can sometimes lead to RVF.

In very rare cases, you can be born with a rectovaginal fistula. Healthcare providers call this a congenital RVF.

Complications of a rectovaginal fistula

Complications of a rectovaginal fistula can include:

• An abscess or infection, which could become life-threatening if untreated
• Fistula recurrence (it comes back) after treatment
• Irritation in your vagina, vulva, perineum or anus
• Recurrent urinary tract infections (UTIs) or vaginitis (vaginal infections)

Living with a rectovaginal fistula can also affect your mental health and decrease your quality of life. It’s important to see a mental health specialist if RVF is causing distress or resulting in social isolation.

How doctors diagnose this condition

Your healthcare provider will ask about your symptoms and medical history. They’ll likely do a physical exam and pelvic exam.

Your healthcare provider will then recommend specific tests to diagnose a rectovaginal fistula. These tests can also find the cause (if unknown) and the extent of the RVF.

Diagnostic tests for rectovaginal fistulas may include:

• Endoscopy, like colposcopy and/or proctosigmoidoscopy, to find the fistula
• An examination while you’re under anesthesia to better evaluate the RVF
• Complete blood count (CBC) and urinalysis to check for infections
• Pelvic MRI or CT scan to take images of your vagina and rectum
• Biopsy if your provider thinks cancer may be the cause

What is the treatment for a rectovaginal fistula?

Resolving RVF involves treating:

• The cause
• The fistula itself
• Any related complications

Together, you and your healthcare provider will decide the best treatment plan for your situation.

Providers typically start with conservative, nonsurgical treatment for small RVFs. This may include:

• Antibiotics for infections
• Medications for the underlying condition, like IBD
• Stool-bulking fiber supplements
• Wound care and debridement (removing dead, damaged or infected tissue)

Most women need surgery to close the opening. There are many ways to do the surgery. For example, your provider may use your tissue or lab-made tissue to repair it. Your provider will determine the best surgical approach for your situation. They’ll explain the process in detail before surgery.

If the fistula is large or complex, you may need a temporary colostomy. This procedure diverts poop away from your large intestine and rectum until the fistula heals. Poop 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.

Recovery time

In most cases, you can return to your routine a week or two after surgery. But it can take several months for the fistula to heal completely. Your recovery will depend on certain factors, like the fistula’s size and how extensive the surgery was.

When should I see my healthcare provider?

You’ll need follow-up appointments after you start treatment or get surgery to make sure the fistula is healing. Let your healthcare provider know if your symptoms get worse or you develop new symptoms.

You may want to ask your healthcare provider:

• What complications could occur from surgery?
• How can I take care of the fistula at home?
• Can I take steps to prevent getting another rectovaginal fistula?
• Am I at risk for other types of vaginal fistulas?

What can I expect if I have this condition?

Your prognosis (outlook) depends on several factors, like:

• The size and severity of the RVF
• The cause of the RVF
• Your overall health
• The type of treatment or surgery you get

In general, complex RVFs are more difficult to treat than simple ones. You may need more than one surgery. Your healthcare provider can give you a better idea of what to expect.