Rectovaginal Fistula – Symptoms and Causes
Overview
A rectovaginal fistula is an abnormal opening that forms between the rectum and vagina. This unwanted connection allows intestinal contents to pass into the vagina. Women with this condition may experience stool or gas leaking from the vaginal area.
Several factors can cause rectovaginal fistulas:
- Childbirth injuries – tears during delivery.
- Inflammatory bowel conditions – particularly Crohn’s disease.
- Cancer treatments – radiation to the pelvic region.
- Surgical complications – following procedures in the pelvic area.
- Diverticulitis complications – from infected pouches in the digestive tract.
The physical symptoms can lead to significant emotional distress. Many women feel embarrassed, uncomfortable, and may struggle with self-confidence and intimate relationships.
While some small fistulas might heal without intervention, most cases require surgical repair.
Signs and Symptoms
The main symptom of a rectovaginal fistula is the passing of gas or stool through the vagina. This happens because of an abnormal connection between the rectum and vagina.
Your symptoms might be mild or severe depending on the size and location of the fistula. Some people have only slight discomfort, while others struggle with significant leakage and hygiene issues.
When You Should Contact a Healthcare Provider
If you notice any unusual passage of gas or stool from your vagina, contact your doctor right away. Don’t delay seeking medical help even if symptoms seem minor, as early treatment can prevent complications and improve outcomes.
Causes
Rectovaginal fistulas can develop from several different sources. Understanding these causes helps patients and healthcare providers address the condition properly.
Birth-related injuries are the most common cause. During childbirth, tears can occur in the perineum (the area between the vagina and anus) that extend to the bowel.
These tears may damage the anal sphincter, the muscle rings that help control bowel movements. Infections following delivery can also lead to fistula formation.
Inflammatory bowel conditions represent the second most frequent cause, particularly Crohn’s disease and ulcerative colitis. These conditions create inflammation in the digestive tract lining.
While most people with Crohn’s disease never develop a rectovaginal fistula, the disease does increase the risk.
Cancer and radiation treatment in the pelvic area can also cause these fistulas. Tumors in the rectum, cervix, vagina, uterus, or anal canal may create abnormal connections.
Radiation therapy for these cancers can lead to fistula formation, typically within two years after treatment.
Surgical complications are less common causes. Operations involving the vagina, perineum, rectum, or anus occasionally result in fistula development. This may happen due to direct injury during the procedure or from infections that develop afterward.
Surgery to remove an infected Bartholin’s gland (located near the vaginal opening) carries this risk.
Diverticulitis complications can create fistulas when infected pouches in the digestive tract cause the rectum or large intestine to adhere to the vaginal wall.
Skin infections around the anus or vagina rarely lead to rectovaginal fistulas, but remain possible causes.
Healthcare providers evaluate a patient’s medical history carefully to determine the underlying cause, which helps guide the most effective treatment approach.
Risk Factors
There are no clear risk factors for rectovaginal fistulas. Medical experts have not identified specific conditions or behaviors that consistently lead to the development of this condition.
Complications
Rectovaginal fistulas can lead to several challenging problems:
- Fecal leakage (inability to control bowel movements).
- Hygiene difficulties in the genital and anal areas.
- Frequent infections in the vagina or urinary system.
- Skin inflammation around the vagina, perineum, or anus.
- Return of the fistula after treatment.
- Psychological impact on self-image and sexual relationships.
People with Crohn’s disease face higher risks when fistulas develop. They may experience poor healing outcomes or develop additional fistulas later. These complications can significantly affect quality of life and require ongoing medical attention.
Prevention
A rectovaginal fistula cannot be prevented through specific measures. This condition usually develops as a complication from other medical issues or procedures rather than occurring on its own.
