Definition

Rectovaginal fistula is an abnormal connection between the rectum and the vagina. Gas or stool may leak from the bowel into the vagina.

Some rectovaginal fistulas close on their own. Most will need a surgery for repair. This condition can be treated. Contact your doctor if you think you may have a fistula.

Healthy Wall Between Vagina and Rectum

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Causes

The most common cause of a rectovaginal fistula is injury during childbirth. Other causes include:

• Crohn’s disease]]>
• Complications following surgery to the perineum (area between vagina and rectum), vagina, rectum, or anus
• Radiation treatment or cancer in the pelvic area
• Perianal infection

Symptoms

If you have any of these, do not assume it is due to a fistula. These symptoms may be caused by other conditions. Talk to your doctor if you have:

• Passing stool or gas via the vagina
• Inability to control bowel movements
• Foul-smelling vaginal discharge
• Recurring vaginal infections
• Pain during sexual intercourse

Diagnosis

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to see a colon and rectal surgeon.

Tests may include the following:

• Anorectal ultrasound—a small wand-like instrument provides a video image of the rectum and anus
• Methylene enema—a tampon is placed in the vagina and methylene blue is placed into the rectum to identify movement of fluid from rectum to vagina
• Contrast studies—barium enema]]> may be used to view a rectovaginal fistula that cannot be seen on physical exam
• Endoscopy—a thin, lighted tube is inserted into the rectum to examine the rectum and the lower colon (to rule out irritable bowel disease)

Treatment

Talk with your doctor about the best plan for you. Treatment options include the following:

Prevention

There are no steps to prevent rectovaginal fistula.