Fistulas are abnormal connections between two structures. A rectovaginal fistula is a connection between the rectum and the vagina. It has multiple causes but may be associated with inflammatory bowel disease, diverticulitis (especially after a hysterectomy), a history of previous radiation to the pelvis and prior intestinal surgery or cancer. A rectovaginal fistula presents with stool draining from the vagina. The connection may be high in the vagina (typically seen following hysterectomy) or low down near the anus. Your doctor will need to determine the location with a series of tests in the office and by ordering radiologic examinations. The location and underlying cause must be determined since they affect the type of treatment used.
The treatment for rectovaginal fistulas is individualized based on the location and underlying cause. In general, low rectal fistulas can be treated by a surgery through the anus. This may involve raising a flap of normal tissue to cover the fistula opening. Higher fistulas usually must be addressed by surgery through the abdomen. A fistula that is resistant to surgical treatment may require a colostomy to divert feces to a bag on the skin and allow the area to heal.
While rectovaginal fistulas are a frustrating occurrence, they do not represent a life-threatening emergency in most cases and your doctor will want to gain as much information as possible about them before offering specific treatment. They often can be difficult to cure and patience is required during the evaluation and treatment process.