Colovaginal Fistula

What Is a Colovaginal Fistula?
A colovaginal fistula is an abnormal opening between the colon and the vagina that allows stool or gas to pass through the vaginal canal. While relatively uncommon, this condition can significantly affect quality of life.

Causes
Colovaginal fistulas can develop due to:

• Surgical complications, particularly after a total hysterectomy
• Inflammatory conditions such as diverticulitis or Crohn’s disease
• Infection in the pelvic area
• Cancer or radiation therapy affecting the pelvic organs

Women who have had their uterus removed are at higher risk, as inflammation in the pelvis can create a weak point at the vaginal cuff, leading to fistula formation.

Symptoms
Symptoms of a colovaginal fistula may include:

• Passage of stool, gas, or urine through the vagina
• Foul-smelling vaginal discharge
• Recurrent vaginal or urinary tract infections
• Pain during sexual intercourse
• Abdominal or vaginal pain
• Fever, nausea, or vomiting in severe cases
• Sepsis, which can be life-threatening if untreated

Diagnosis
Diagnosis is based on a combination of patient history and a physical exam. Imaging tests such as CT scans with contrast or endoscopy may be used to identify smaller or less obvious fistulas.

Treatment
Treatment usually involves surgical repair to close the fistula and restore normal function. The surgical approach depends on the size and location of the fistula. If the fistula is caused by diverticular disease, a sigmoid colectomy may be required to remove the diseased portion of the colon and prevent recurrence.