Rectovaginal Fistula

What is Rectovaginal Fistula?

A Rectovaginal Fistula (RVF) is an abnormality in the tissues that connect the intestines, rectum and vagina. As a result, fecal material and gas leak from the vaginal opening. It can result in infection, pain and odors. It can also greatly impact intimacy and cause emotional problems.

Possible causes are inflammatory bowel diseases including Crohn’s, childbirth complications, cancer of the pelvic region, radiation therapy and surgical damage. A rectovaginal fistula can heal without treatment, but it usually requires surgery.

What are the Symptoms of Rectovaginal Fistula?

They symptoms depend on the severity of the fistula and the location. Symptoms may include:

  • Vaginal excretion of feces, pus and gas
  • Malodorous vaginal discharge
  • Chronic urinary tract and vaginal infections
  • Discomfort and pain in and around the vaginal area
  • Painful intercourse

Rectovaginal Fistula Causes

The most common cause of a rectovaginal fistula is injury during intensive or obstructed labor of up to several days. This includes injury to the perineum (the area between the anus and vulva) or the anal sphincter (a ring of muscle that helps control bowel movements). An episiotomy (an incision to enlarge the perineum for easier labor) may develop into a fistula. Rectovaginal fistulas caused by childbirth are more likely in developing countries, but are decreasing due to improved maternal healthcare.

Medical treatment can inadvertently lead to the formation of fistulas, such as surgery involving the vagina, perineum, rectum or anus. Rarely, a hysterectomy can later create a fistula. Radiation treatment can cause ulcers which form into fistulas in six months to two years. Certain cancerous tumors themselves may cause tearing in the pelvic area.

Another common cause of rectovaginal fistulas include inflammation and infections of the anus, rectum, or digestive tract. Women with Crohn’s disease or other inflammatory bowel diseases (IBDs) may develop fistulas. Fistulas can form due to fecal impaction, or stool drying and becoming stuck in the rectum. Traumatic injuries to the vagina unrelated to childbirth can also cause rectovaginal fistulas.

How is Rectovaginal Fistula Treated?

The treatment of a vaginal fistula depends on the underlying cause, the location and the size of the opening. A physical exam, imaging, contrast tests and dye tests may be used to diagnosis the condition.

Treatment may include:

  • Keeping the vaginal area clean and dry
  • Irritant avoidance (e.g. tampons, scented products)
  • Wet wipe use instead of dry tissue paper
  • Cream or unscented non-medicated powder to ease and prevent irritation
  • Incontinence pads can be used to prevent garment soiling
  • Wearing comfortable loose-fitting bottoms to promote airflow and prevent irritation
  • Antibiotics to treat pre-surgical infection or for those with Crohn’s disease
  • Anti-inflammatory medication to promote healing without surgical repair
  • Biological tissue patching
  • Tissue graft patching
  • Anal sphincter repair
  • Surgical repair
  • Colostomy for stool diversion before surgery and after repair while healing

Rectovaginal Fistula Prevention

Most initiatives dedicated to the prevention of rectovaginal fistulas encourage education and better maternal healthcare.

In developing countries, contraceptives and other birth control methods are provided to prevent childbirth injuries or provide time for existing injuries to heal. A woman delaying pregnancy until reaching a certain age can reduce the risk of childbirth complications.

A partograph, or partogram, is a tool endorsed by the World Health Organization that is used to measure vital statistics during labor. Correct usage of the partograph is meant to reduce obstructed labor and related injuries by providing guided early warnings.

Women in obstructed labor can avoid fistulas by undergoing a cesarean section.

Last Reviewed:
October 09, 2016
Last Updated:
December 06, 2017