Fistulas: Causes, Symptoms, and When to Seek Help - Obstetrics and Gynecology

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Fistulas are abnormal connections between two body parts, often occurring between organs or vessels. They can arise from various causes, including surgical complications, inflammatory diseases, infections, or trauma. In your case, the history of multiple surgeries, particularly cesarean sections and myomectomy, raises the possibility of a surgical fistula, particularly a rectovaginal fistula, which can occur when there is an abnormal connection between the rectum and the vagina.


Causes of Fistulas
1. Surgical Complications: As you mentioned, you have undergone several surgeries. Surgical procedures can sometimes lead to the formation of scar tissue, which may disrupt normal anatomical structures and create a fistula.


2. Inflammatory Diseases: Conditions like Crohn's disease can lead to fistula formation due to chronic inflammation of the intestines.

3. Infections: Infections can also lead to the development of fistulas, particularly if there is an abscess that drains into another organ.

4. Trauma: Any significant injury to the pelvic area can result in fistula formation.


Symptoms of Fistulas
Symptoms can vary depending on the type and location of the fistula. Common symptoms include:
- Unusual Discharge: You mentioned experiencing gas passing through the vagina, which is a classic symptom of a rectovaginal fistula. This occurs when gas from the intestines escapes through the abnormal connection into the vaginal canal.


- Incontinence: Some patients may experience fecal incontinence or difficulty controlling bowel movements.

- Recurrent Infections: Fistulas can lead to recurrent urinary tract infections or vaginal infections.

- Pain or Discomfort: Depending on the location, there may be associated pain or discomfort.


When to Seek Help
Given your symptoms, it is crucial to seek medical attention. While some fistulas may not cause significant issues, others can lead to complications such as infections or worsening of symptoms. Here are some reasons to see a doctor:
- Persistent Symptoms: If the symptoms persist or worsen, it is essential to consult a healthcare provider.

- Signs of Infection: If you experience fever, increased pain, or unusual discharge, these could be signs of an infection that requires immediate attention.

- Impact on Quality of Life: If the symptoms interfere with your daily activities or quality of life, it is advisable to seek help.


Which Specialist to See
For your situation, you should consider consulting a gynecologist or a colorectal surgeon. A gynecologist can evaluate the possibility of a rectovaginal fistula and assess any gynecological issues. A colorectal surgeon specializes in conditions affecting the colon, rectum, and anus and can provide a comprehensive evaluation and treatment options.


Conclusion
In summary, your symptoms suggest the possibility of a fistula, likely related to your surgical history. It is essential to seek medical evaluation to determine the exact cause and appropriate treatment. Early intervention can prevent complications and improve your quality of life. Please do not hesitate to reach out to a healthcare provider for a thorough assessment and management plan.