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Rectovaginal Fistula

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A rectovaginal fistula is an abnormal connection between your rectum and your vagina allowing stool to leak from your bowel into your vagina.


The symptoms of a rectovaginal fistula often cause emotional distress as well as physical discomfort. Depending on the size and location of the fistula, you may have very minor symptoms or significant problems with continence and hygiene. Signs and symptoms of a rectovaginal fistula may include:

  • Passage of gas, stool or pus from your vagina
  • A foul-smelling vaginal discharge
  • Recurrent vaginal or urinary tract infections
  • Irritation or pain in the vulva, vagina and the area between your vagina and anus
  • Pain during sexual activity

Causes and Risk Factors

Rectovaginal fistulas are relatively rare in Western culture.  It may be the first indication of a more serious problem such as an area of infection or cancer. It's important that your doctor identify the cause of the fistula and determine whether and when it should be repaired.

A rectovaginal fistula may form as a result of:

  • Injuries in childbirth
  • Crohn's disease
  • Surgery involving your vagina, perineum, rectum or anus
  • Cancer or radiation treatment in your pelvic area
  • Infections in your anus or rectum
  • Diverticulitis
  • Vaginal trauma.

Diagnostic Tests

Your symptoms are the most clear signs of a vaginal fistula. Your doctor will want to talk about your symptoms, as well as any surgery, trauma, or disease that could have caused a fistula.

In addition to a physical exam, your doctor may perform the following tests:

  • Using dye in the vagina, bladder or rectum to find all signs of leakage
  • Urinalysis to check for infection
  • Blood test to check for signs of infection in your body
  • Computerized tomography (CT) scan to help locate a fistula and determine its cause.
  • Magnetic resonance imaging (MRI) to show the location of a fistula as well as involvement of pelvic organs or the presence of a tumor.
  • Anorectal ultrasound to evaluate the structure of your anal sphincter and may show defects caused by obstetric injury.

Treatment and Procedures

Treatment for a rectovaginal fistula depends on its cause, size, location and effect on surrounding tissues. It's important to have a rectovaginal fistula evaluated. Some rectovaginal fistulas may close on their own, but most need to be repaired surgically. Before surgery, your doctor will see whether the tissue is healthy or needs to heal first.

  • You may need medicine or wound care to heal the tissue before surgery.
  • If you have inflammatory bowel disease, your doctor will not do surgery during a symptom flare.
  • If you have a large rectovaginal fistula, your doctor may first place a colostomy to keep the fistula clear for the surgery. After the fistula repair heals, the colostomy is taken out.

Your health is our greatest concern. Please contact the Center for Colon & Rectal Surgery at 407.303.2615for a private consultation today.