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A rectovaginal fistula occurs when there’s an opening between the rectum and the vagina. This opening allows gas and stool to pass through the vagina.

Rectovaginal fistulae can cause both physical and emotional discomfort. Some rectovaginal fistulae can close on their own, but typically, they will require surgery. The expert colorectal surgeons at WakeMed can help women treat this condition and improve their quality of life.

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What Are the Symptoms and Risk Factors of Rectovaginal Fistula?

Rectovaginal fistulae are commonly caused by childbirth injuries, generally after having had a long or problematic delivery. Other causes include Crohn’s disease, ulcerative colitis and surgery or radiation treatment in the pelvic area.

Symptoms of a rectovaginal fistula can include:

  • Passage of gas or stool from the vagina
  • Strong-smelling vaginal discharge
  • Pain or irritation in the vaginal area
  • Pain during sexual intercourse
  • Frequent urinary tract infections or vaginal infections

How Is Rectovaginal Fistula Diagnosed?

To diagnose a rectovaginal fistula, the doctor will first perform a physical examination, and look at the vagina, rectum, and surrounding area. The doctor may need to use a speculum or proctoscope to look inside the vagina or rectum.

If the doctor suspects a fistula, he or she may order additional tests, including:

  • Barium enema, in which the doctor inserts barium liquid into the patient’s rectum, and then takes a detailed look using an X-ray camera
  • Imaging scans, including either computed tomography (CT) or magnetic resonance imaging (MRI) scans
  • Endoanal ultrasound, which uses sound waves to produce pictures of the pelvic area
  • Methylene enema, or blue dye test, which involves placing a tampon into the vagina, and injecting blue dye into the rectum. Seeing the tampon turn blue would indicate a fistula.

How Is Rectovaginal Fistula Treated?

Treatment for a rectovaginal fistula typically involves surgically closing the opening.

After the patients receives anesthesia, the surgeon will make an incision in either the abdomen, vagina, or perineum. They’ll then use a piece of tissue to separate the rectum from the vagina after the fistula has been closed. If the anal sphincter muscles have been damaged, the surgeon will repair these as well. Occasionally, a colostomy will also need to be performed, in which an opening called a stoma is created in the abdomen so that body waste can be collected in a disposal bag.

Surgery cannot be performed if the patient has an infection or inflammation, so patients may require medication to treat any underlying issue before they’re ready for surgery.

Learn more about what to expect from colorectal surgery.