A rectovaginal fistula which affects women is an abnormal connection between the lower portion of the large intestine (the rectum) and the vagina. Contents of the bowel can leak through the fistula, meaning gas or stool might pass through the 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. It is important to see a doctor and have a rectovaginal fistula evaluated.

Some rectovaginal fistulas may close on their own, but most need to be repaired surgically.

Symptoms

Depending on the size and location of the fistula, the symptoms can be minor or cause significant problems with continence and hygiene. Symptoms of a rectovaginal fistula are:

  • Passage of gas, stool or pus from the vagina,
  • A foul-smelling vaginal discharge,
  • Recurrent vaginal or urinary tract infections,
  • Irritation or pain in the vulva, vagina and the area between the vagina and anus,
  • Painful sexual intercourse

Causes

The following causes may be relevant:

  • 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.
  • Cancer or radiation treatment in the pelvic area. A cancerous tumor in the 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 the vagina, perineum, rectum or anus. Prior surgery in the lower pelvic region, such as removal of the uterus (hysterectomy), in rare cases can lead to development of a fistula.
  • Other causes. Rarely, a rectovaginal fistula may be caused by infections in the anus or rectum; infections of small, bulging pouches in the digestive tract (diverticulitis); long-term inflammation of the colon and rectum (ulcerative colitis); or vaginal injury other than during childbirth.

Risk Factors

Factors that may increase the risk of rectovaginal fistula include:

  • Crohn disease,
  • Complications following surgery to the perineum (area between vagina and rectum), vagina, rectum, or anus,
  • Injuries during childbirth,
  • Radiation treatment or cancer in the pelvic area
  • Perianal infection,

Rectovaginal fistula can also be a symptom of various diseases, including infection by lymphogranuloma, or the unintended result of surgery, such as episiotomy or sexual reassignment surgery.

Complications

Physical complications of rectovaginal fistula may include:

  • Recurrent vaginal or urinary tract infections Incontinence
  • Problems with hygiene
  • Irritation or inflammation of the vagina, perineum or the skin around the anus
  • Infected fistula that forms an abscess, a problem that can become life-threatening if not treated
  • Fistula recurrence

Prevention

There are no known methods of preventing rectovaginal fistula. Good hygiene can help ease discomfort and reduce the chance of vaginal or urinary tract infections while waiting for repair.