Rectovaginal Fistula: Causes, Symptoms, and Treatment Options

Vaginal-rectal swab

I underwent a vaginal-rectal fistula repair after giving birth to a son on March 20.
The delivery involved a midline episiotomy, and the wound healing has not been satisfactory.
I would like to present the following observations and questions for your assessment:
1.
I was hospitalized for three days after delivery.
On the first day, there was no record of bowel movements due to an enema administered on the day of delivery.
However, I had normal bowel movements for the next three days, and the stools were well-formed.
2.
On the second day postpartum, I noticed that when passing gas, I suspected that gas was escaping from the vagina.
Due to the pain and discomfort from the episiotomy, I thought it might be an illusion and did not pay much attention to it.
3.
On the second day after discharge, I passed soft stools and felt that feces were coming out of the vagina.
I used a mirror to check and indeed found some feces at the vaginal opening.
As I continued to have bowel movements while observing with the mirror, I was shocked to see feces coming from both the anus and the vagina.
I immediately contacted the hospital and rushed to the outpatient clinic for a re-suturing of the episiotomy wound.
4.
After the re-suturing of the episiotomy, on the morning of the first day, I carefully monitored my bowel gas passage and was relieved to find gas coming from the anus.
Since I had taken the stool softener prescribed by the doctor the previous day, the stools were loose.
However, by the evening, during another bowel movement, I again experienced feces coming from the vagina.
Upon examination at the hospital, the doctor indicated that the inflammatory response of the wound tissue led to poor healing, and there is now a fistula formed between the rectum and vagina.
The doctor suggested two options for improvement: (a) to place a colostomy and, once the surrounding tissue stabilizes, perform a repair, and after the repair site heals, remove the colostomy; (b) to wait for the inflammatory response to subside and then proceed with the repair, which would take two to three months.
My concerns are: the first option requires three surgeries to complete, and I am worried about my physical strength being inadequate due to postpartum weakness; the second option would require enduring two to three months of vaginal discharge, which brings various inconveniences to my daily life.
I am also deeply concerned about the risk of bacteria in the feces ascending and causing infections in the uterus or related organs.
Thank you for taking the time to read my letter.
I look forward to your professional assessment and recommendations.
Thank you very much!

Anny, 30~39 year old female. Ask Date: 2005/05/12

Dr. Wei Fumao reply Obstetrics and Gynecology

I am more inclined to accept the treatment approach of placing the drain for two to three months, as the diameter of the fistula may decrease or it may heal, allowing for further management.
Additionally, Escherichia coli is unlikely to cause an ascending pelvic infection.

Reply Date: 2005/05/12

More Info

Understanding rectovaginal fistulas is crucial for anyone experiencing symptoms or complications following childbirth, particularly after procedures like episiotomy. A rectovaginal fistula is an abnormal connection between the rectum and the vagina, which can lead to significant discomfort and complications, including the passage of gas or fecal matter through the vagina, as you have described.

Causes
The most common cause of rectovaginal fistulas is trauma during childbirth, especially in cases where an episiotomy is performed or if there is significant tearing of the perineum. Other potential causes can include inflammatory bowel disease, radiation therapy, or surgical complications. In your case, the fistula likely developed due to the healing process following your episiotomy, compounded by inflammation and possibly infection.

Symptoms
Symptoms of a rectovaginal fistula can vary but typically include:
- Passage of gas or fecal matter from the vagina
- Recurrent vaginal infections
- Discomfort or pain in the vaginal area
- Unpleasant odor
- Difficulty with bowel movements
In your situation, the sensation of gas escaping from the vagina and the presence of fecal matter are classic indicators of a rectovaginal fistula. The fact that you experienced these symptoms shortly after childbirth and following surgical intervention suggests that the fistula may have formed due to complications during the healing process.

Diagnosis
Diagnosis is usually made through a physical examination, and sometimes imaging studies or endoscopy may be required to assess the extent of the fistula and any associated complications. It’s essential to consult with a healthcare provider who specializes in pelvic floor disorders or colorectal surgery for a thorough evaluation.

Treatment Options
Treatment for rectovaginal fistulas typically involves surgical intervention. The two options your physician has suggested are:
1. Temporary Colostomy: This involves creating an artificial opening in the abdominal wall to divert stool away from the rectum and vagina. This allows the surrounding tissue to heal without the stress of bowel movements passing through the fistula. After a period of healing, the fistula can then be surgically repaired.

2. Direct Repair: If the inflammation has subsided, the fistula can be repaired directly. This option may require a waiting period of several weeks to months to ensure that the tissue is healthy enough to support healing.

Concerns and Considerations
Your concerns about undergoing multiple surgeries and the potential for infection are valid. It’s understandable to feel apprehensive about the implications of having a colostomy and the impact on your daily life, especially in the postpartum period. However, it’s important to note that while the thought of a colostomy may seem daunting, it is often a necessary step to ensure proper healing and to prevent further complications.

Regarding your worry about bacteria from fecal matter potentially leading to infections of the uterus or other pelvic organs, it is a legitimate concern. However, the risk of such infections is generally low, especially if you are vigilant about hygiene and follow your healthcare provider's recommendations.

Conclusion
In summary, rectovaginal fistulas can be a distressing complication following childbirth, but with appropriate medical intervention, they can be effectively managed. It’s crucial to maintain open communication with your healthcare provider, express your concerns, and work together to determine the best course of action for your situation. Remember, prioritizing your health and recovery is essential, and addressing these issues promptly can lead to better outcomes in the long run.

Similar Q&A

Understanding Rectovaginal Fistula: Treatment Options and Care Tips

Could you please provide information regarding the treatment methods for rectovaginal fistula, the duration of medical care, and any precautions that should be taken? Thank you!

Dr. Zhang Zhenxiang reply Surgery
Rectovaginal fistula is a complex condition with diverse causes, sizes, and locations, as well as various treatment options ranging from conservative natural healing to aggressive surgical interventions involving resection of the vagina or rectum. It is difficult to summarize in ...

Understanding Rectovaginal Fistulas: Symptoms, Treatment, and Risks

Hello Doctor: Several years ago, I experienced vaginal flatulence, which surprised me. After researching, I found that it might be a rectovaginal fistula. If that is the case, is treatment necessary? If left untreated, could there be any long-term consequences?

Dr. Qiu Shoutiao reply Surgery
Typically, a rectovaginal fistula causes feces to pass through the vagina. If there is only vaginal flatulence without feces exiting the vagina, it cannot be confirmed whether a rectovaginal fistula is present, and further examination is required for diagnosis. Common diagnostic ...

Solutions for Managing Rectovaginal Fistula After Childbirth

Hello Dr. Jian, I would like to ask what methods are available to address the issues caused by a fourth-degree tear during childbirth that has resulted in a fistula. Additionally, could you please provide information on outpatient clinics in Taichung? Thank you.

Dr. Jian Hongmou reply Obstetrics and Gynecology
Fistula repair is a simple minor surgery that can be performed at our affiliated Taichung Hospital's Colorectal Surgery Department.

Understanding Anal Fistulas: Symptoms, Treatment, and Recovery

Hello, I discovered frequent discharge on my underwear around October last year. The discharge was greenish-yellow and odorless. There was no pain or unusual symptoms during bowel movements. I delayed seeking treatment until February of this year when I visited Chi Mei Medical Ce...

Dr. Xu Kaixi reply Surgery
Dear Dr. Hsu Kai-Hsi of the Department of Surgery at Tainan Hospital, Ministry of Health and Welfare: We kindly request that you come to the outpatient clinic for an examination to clarify and address the issues you have described. Wishing you good health and safety from the Dep...