Rectovaginal Fistulas: Symptoms, Treatment, and Risks

Rectovaginal fistula

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?

Xiao Min, 20~29 year old female. Ask Date: 2002/06/14

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 methods include injecting methylene blue dye into the rectum via the anus; if a rectovaginal fistula exists, the blue dye will enter the vagina and stain the gauze previously placed inside.

Treatment may involve attempting total parenteral nutrition and fasting.
Fasting eliminates feces, preventing them from traversing the rectovaginal fistula, allowing the fistula to close naturally with granulation tissue.
This method has a very low success rate; typically, surgery is performed to create a temporary colostomy, diverting feces away from the rectovaginal fistula, while also allowing the fistula to close naturally with granulation tissue.
Later, another surgery can be performed to close the colostomy.

Reply Date: 2002/06/14

More Info

Rectovaginal fistulas are abnormal connections between the rectum and the vagina, which can lead to a variety of symptoms and complications. Understanding the symptoms, treatment options, and potential risks associated with this condition is crucial for effective management.

Symptoms of Rectovaginal Fistulas
The primary symptom of a rectovaginal fistula is the passage of gas or fecal matter from the rectum into the vagina, which can be quite distressing and socially embarrassing. Other symptoms may include:
- Foul-smelling vaginal discharge: This can occur due to the presence of fecal matter.

- Recurrent vaginal infections: The abnormal connection can lead to increased risk of infections.

- Pain or discomfort: Patients may experience pain during intercourse or while sitting.

- Urinary symptoms: In some cases, there may be associated urinary issues, although this is less common.

Treatment Options
The treatment for a rectovaginal fistula typically involves surgical intervention, especially if the fistula is causing significant symptoms or complications. The surgical options may include:
1. Fistula Repair: This is the most common treatment, where the surgeon will excise the fistula and close the defect. This can often be done through a vaginal or abdominal approach, depending on the fistula's location and complexity.

2. Seton Placement: In some cases, a seton (a type of drain) may be placed to help manage the fistula and allow for healing before definitive repair.

3. Colostomy: In severe cases, especially if there is significant tissue damage or if the fistula is not amenable to direct repair, a temporary colostomy may be performed to divert stool away from the area while allowing the fistula to heal.

4. Biologic or Synthetic Fistula Plug: In certain cases, a plug made from biological or synthetic materials may be used to close the fistula.

Risks of Not Treating Rectovaginal Fistulas
If left untreated, rectovaginal fistulas can lead to several complications, including:
- Chronic Infections: The presence of fecal matter in the vagina can lead to recurrent infections, which may require antibiotics and further medical intervention.

- Skin Irritation: Continuous exposure to fecal matter can cause skin irritation and breakdown in the vaginal area.

- Psychosocial Impact: The embarrassment and discomfort associated with the symptoms can lead to significant psychological distress, affecting quality of life and interpersonal relationships.

- Nutritional Issues: In some cases, if the fistula is associated with other gastrointestinal issues, it may lead to nutritional deficiencies.

Conclusion
If you suspect that you have a rectovaginal fistula, it is important to seek medical evaluation. A healthcare provider can perform a thorough examination, often including imaging studies, to confirm the diagnosis and assess the extent of the fistula. Early intervention can help prevent complications and improve your quality of life. While surgery is often the definitive treatment, conservative management may be appropriate in certain cases, depending on the severity of symptoms and the patient's overall health.
In summary, rectovaginal fistulas are a condition that warrants attention, and treatment options are available to help manage symptoms and prevent complications. Do not hesitate to consult a specialist, such as a colorectal surgeon or a gynecologist, for a comprehensive evaluation and personalized treatment plan.

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