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Rectovaginal Fistula (RVF)

WHAT IS A RECTOVAGINAL FISTULA?

A rectovaginal fistula (RVF) is an abnormal connection between the rectum and vagina that can result in the passage of gas and/or stool through a tract. This can be a very bothersome condition for the female patient.

From the moment you contact Loma Linda University Health, we do everything we can to make sure your RVF treatment runs smoothly. Our goal is to make your experience as convenient, comfortable and stress-free as possible.

WHAT ARE THE SYMPTOMS OF A RECTOVAGINAL FISTULA?

Symptoms of a rectovaginal fistula include:

  • Passage of gas or stool from the vagina
  • Foul-smelling vaginal discharge
  • Chronic vaginal infection
  • Pain during intercourse
  • Incontinence

WHAT CAUSES RECTOVAGINAL FISTULA?

The most common causes of rectovaginal fistula are:

  • Trauma or tearing of the perineum (the area between the anus and the vulva) during childbirth
  • Crohn’s disease or inflammatory bowel disease
  • Prior pelvic surgery
  • An infection
  • Cancer

HOW IS RECTOVAGINAL FISTULA DIAGNOSED?

The diagnosis of a rectovaginal fistula is typically made by the history of the passage of stool and/or gas from the vagina, in addition to a physical exam. A vaginal exam with a speculum and a rectal exam should be performed. If the fistula cannot be identified, imaging studies such as an ultrasound, CT scan, or an MRI may be ordered.

HOW IS RECTOVAGINAL FISTULA TREATED?

Surgery is necessary to correct a rectovaginal fistula. If the area around the fistula is infected, a patient may be given a course of antibiotics before surgery.

The type of operation performed depends on the size and location of the fistula.

Possible options for surgery include:

  • Simple fistulotomy (opening up of the fistula tract)
  • Advancement flap (creation of a flap of muscle and lining of the rectum) to cover the fistula.
  • Combination of fistulotomy with an anal sphincter repair, referred to as sphincteroplasty

It is common for an injury to the anal sphincters to occur at the time of the obstetrical trauma. In very complicated fistulas, your surgeon may recommend a diverting colostomy prior to embarking on a challenging repair. Your surgeon should discuss whether this is a likely option.

WHAT ARE THE COMPLICATIONS OF RECTOVAGINAL FISTULA?

Complications of rectovaginal fistula may include:

  • Vaginal infections
  • Urinary tract infections
  • Pain and irritation
  • Emotional distress

WHO IS AT RISK FOR RECTOVAGINAL FISTULA?

Those who are most at risk of developing rectovaginal fistula are:

  • Women who have given birth
  • Women who have had radiation treatments or cancer in the pelvic area
  • Women who have had pelvic surgery
  • Also at higher risk are women who suffer from Crohn's or inflammatory bowel disease.

NEXT STEPS

  • Stay aware. Rectovaginal fistula can affect women of different ages. Stay aware of the symptoms of this condition and seek medical intervention immediately if you begin experiencing them.  
  • Be proactive. If left untreated, rectovaginal fistula can lead to more serious complications. To request an evaluation at Loma Linda University Health for rectovaginal fistula symptoms, contact your provider or schedule the appointment through MyChart.