Rectovaginal Fistula – Diagnosis and Treatment

Diagnosis

Clinical Evaluation and Examination

Doctors begin by asking about symptoms, such as unusual discharge, pain, or incontinence.

They carefully examine the vagina, rectum, and the perineum for any openings, inflammation, or signs of infection. A gloved hand may gently feel for abnormal connections and tenderness.

If a fistula is not easily seen, doctors use tools like a speculum to open the vaginal walls for better viewing.

Occasionally, they place a proctoscope or similar instrument into the anus or rectum to look for a possible tract.

If there are concerns about cancer, they may take a small biopsy sample and send it to the laboratory for review under a microscope.

Procedures and Imaging Used to Confirm Fistula

When the physical exam does not clearly show a rectovaginal fistula, doctors may order special tests to confirm diagnosis and understand the problem’s extent.

Imaging Techniques

Test	What It Shows	Why It’s Used
CT Scan	Detailed images of abdomen and pelvis	Finds fistula location and cause
MRI (Magnetic Resonance Imaging)	Images of soft tissues in the pelvic region	Reveals involvement of organs, tumors
Anorectal Ultrasound	Looks at tissues near the anal area	Good for small or hidden fistulas

Contrast and Dye Studies

• Vaginogram: Doctors place contrast in the vagina, then take X-rays to trace the path of any abnormal opening.
• Barium Enema: They introduce barium into the rectum to outline abnormal tracts on X-ray.
• Blue Dye Test: They apply dye in the rectum or vagina to reveal hidden fistulas if the dye leaks into another area.

Other Procedures

• Colonoscopy or Sigmoidoscopy: Endoscopic tools examine the lining of the colon and rectum. Doctors can collect biopsies to check for Crohn’s disease or ulcerative colitis as potential underlying causes.
• Exam under Anesthesia: In difficult cases, doctors perform an examination while the patient is asleep to get a more detailed look, especially if prior trauma, surgery, or radiation has caused scar tissue or hidden passages.

Healthcare providers use these methods to confirm a rectovaginal fistula, look for possible complications like abscess or infection, and prepare for treatments or surgery.

Treatment

Medicine-Based Options

Doctors often use medicine to manage related problems or to help the body get ready for surgery.

• Antibiotics: Doctors prescribe antibiotics if there is any infection near the fistula. This helps reduce germs and lowers the risk of more problems. They also use antibiotics if someone has Crohn’s disease and develops a fistula.
• Anti-Inflammatory Drugs: These medications can reduce swelling and support the healing of fistulas, especially if Crohn’s disease is the root cause.
• Other Supportive Medications: Sometimes, doctors use medicine to help with symptoms such as pain, or to control bowel movements and reduce pressure on the area.

Doctors may wait several months to see if medicines alone can close a small fistula before moving on to surgery. In many cases, medication helps manage infections and inflammation, making later surgery safer and more likely to work.

Surgical Ways to Fix a Fistula

Surgeons usually need to perform surgery to fully close or fix most rectovaginal fistulas, especially when medicine alone does not help.

They choose from several types of operations based on fistula size, location, and cause. The main goal is to remove the unhealthy tunnel and bring together healthy tissue for repair.

Popular Surgical Techniques:

Surgery Type	Purpose	Notes
Fistula removal and repair	Close the abnormal tunnel and heal tissue	Often first choice
Tissue/muscle flap techniques	Use new tissue to strengthen and seal the repair	For stubborn cases
Anal sphincter repair	Fix muscles for better bowel control	With incontinence
Colostomy	Divert stool to let the area rest and heal	Usually reversible

• Removing the Fistula Canal: The surgeon removes the fistula tunnel and repairs both the vaginal and rectal walls with stitches to ensure a strong closure.
• Using Tissue Flaps or Grafts: Sometimes, the surgeon moves a piece of nearby healthy tissue to cover and support the repair area. This could involve an endorectal advancement flap or a muscle flap from the rectum or vagina.
• Repairing Sphincter Muscles: If fecal incontinence is present, surgeons may fix damaged anal sphincter muscles to help regain control over bowel movements.
• Temporary Colostomy: In complex cases or if the tissues are weak from scarring, past surgery, or radiation treatment, the surgeon may perform a colostomy. This surgical step diverts stool through an opening in the belly, giving the damaged area time to heal. Most colostomies for this problem are temporary and can be reversed later.

Key Steps Before Surgery:

• The tissue around the fistula must show no severe infection or swelling.
• Sometimes, the surgeon puts a seton (a special string) in the fistula first to keep the area drained and free from infection before the main surgery.

Benefits and Considerations:

• Surgery can address lasting symptoms such as stool or gas passing into the vagina.
• Not every patient will need all types of surgeries—treatment is tailored by the health team.
• Recovery can take a few weeks, and follow-up visits are needed to check for proper healing.

Everyday Care and At-Home Tips

Good hygiene is important for those healing from a rectovaginal fistula. Keeping the area clean can lower the risk of new infections and help make daily life more comfortable.

Below are some suggestions to support healing:

• Gently cleanse after bathroom use. Rinse or shower the outer genital area using only warm water whenever there is stool or discharge. Avoid harsh scrubbing.
• Skip irritants. Mild, unscented soap may be used occasionally if needed, but strong soaps, perfumes, and scented personal products should be avoided. Items like scented pads, tampons, and vaginal sprays can make irritation or infection more likely.
• Allow to dry completely. Let the skin air-dry or pat dry softly with a fresh cloth after washing. Airflow can help reduce skin breakdown.
• Choose gentle wiping options. Avoid rubbing with dry toilet paper. Use alcohol-free, unscented wet wipes or cotton balls moistened with plain water for cleaning.
• Wear breathable fabrics. Loose cotton underwear and clothing allow air to reach the skin, reducing irritation. Change any wet or soiled clothes quickly. For extra protection, choose products such as absorbent pads or adult briefs with materials that keep moisture away from the body.

Nutrition and Hydration Table:

Tip	Benefit
Eat foods rich in fiber.	Helps prevent straining.
Drink plenty of water.	Lowers chance of constipation.
Avoid foods that trigger diarrhea.	Reduces irritation.

Following these steps can make symptoms easier to manage and help support the skin’s healing process. Always follow guidance from a healthcare provider for the best care.

Getting Ready for Your Visit

Steps to Prepare Before Your Medical Appointment

Being organized before seeing a healthcare professional can help make the most out of the visit. Patients should consider the following steps to prepare:

• Check for Pre-Visit Guidelines: Call the clinic to see if there are any instructions to follow before the appointment, especially if certain tests will be performed.

• List Symptoms: Write down all symptoms, even those that might not seem connected to the main problem. Including small or occasional issues can help the doctor get a complete picture.

• Bring Medical History and Medication Details: Make a note of current health conditions, all previous surgeries, and relevant medical history. Prepare a list of all current medications, including prescription drugs, over-the-counter medicines, herbal products, and supplements, along with exact doses.

• Prepare Questions for the Provider: Patients should write down any questions to ask during the visit. Having these on paper helps make sure everything important is covered.
  Some good questions might include:
  • What could be causing these symptoms?
  • Are more tests needed? How do I get ready for them?
  • What treatments are available and which are recommended?
  • Are there other treatment options?
  • Will surgery be needed?

• Take Notes During the Visit:Patients should bring a notepad or phone to jot down instructions or answers from the provider. This can help remember details discussed during the appointment.

Tip: Bringing a friend or family member can be helpful for support and to help remember instructions.

Questions Your Health Care Provider Might Ask

During the appointment, the health care professional will likely want detailed information. Being ready to provide clear and honest answers can help with diagnosis and planning.

Questions may include:

Topic	Possible Questions
Symptoms	When did these symptoms start?
	Do the symptoms come and go, or are they always there?
	How severe are the symptoms?
Factors	What makes symptoms better or worse?
Bowel Movements	Is there any trouble with normal bowel movements, leakage, or constipation?
Medical and Personal History	Any history of vaginal delivery, pelvic surgery, or pelvic radiation?
	Any other ongoing health problems, such as Crohn’s disease?

Patients should answer each question as accurately as possible.