Rectovaginal Fistula

What Is Rectovaginal Fistula?

A rectovaginal fistula is an abnormal connection (opening) between the rectum and the vagina. This opening allows gas or stool to pass from the rectum into the vagina. Rectovaginal fistulas most commonly occur as a result of childbirth-related trauma, particularly following difficult or prolonged vaginal deliveries.

The tissue between the rectum and vagina is thin and can be injured during labor, especially in cases involving large babies, prolonged pushing, forceps or vacuum-assisted delivery, or severe perineal tearing. When this tissue does not heal properly, a fistula may develop days, weeks, or even months after delivery.

Rectovaginal fistulas are distinct from anal fistulas and require specialized evaluation and treatment.

Causes & Risk Factors

The most common cause of rectovaginal fistula is obstetric injury. Risk factors include:
• Prolonged or obstructed labor
• Operative vaginal delivery (forceps or vacuum)
• Third- or fourth-degree perineal tears during childbirth
• Episiotomy complications
• Poor wound healing after delivery
• Pelvic or colorectal surgery
• Inflammatory bowel disease (including Crohn’s disease)
• Pelvic radiation therapy
• Infection or abscess following childbirth or surgery

Women who have had multiple vaginal deliveries or traumatic births are at increased risk.

Symptoms

Symptoms may appear shortly after childbirth or develop gradually. Common symptoms include:
• Passage of gas through the vagina
• Leakage of stool or mucus from the vagina
• Foul-smelling vaginal discharge
• Recurrent vaginal or urinary tract infections
• Vaginal irritation or burning
• Pain during intercourse
• Emotional distress or embarrassment

Diagnosis

Diagnosis begins with a detailed medical history, including childbirth history, followed by a physical examination. Additional tests may include:
• Pelvic examination to identify the fistula opening
• Dye testing to confirm abnormal communication
• Endoanal or pelvic ultrasound to assess surrounding muscles
• MRI or CT scan to determine fistula size and location
• Colonoscopy or sigmoidoscopy if bowel disease is suspected

This diagnosis is typically found by an OB/GYN and is then referred to us.

Treatment

Most rectovaginal fistulas require surgical repair. Treatment planning takes into account the timing of childbirth, degree of tissue injury, fistula size, and overall pelvic floor health. In some cases, surgery is delayed to allow inflammation from childbirth to resolve and tissues to heal. We work hand in hand with your OB/GYN to decide the best treatment plan for you.

Surgical options may include local repair using healthy surrounding tissue, advancement flap procedures, muscle or tissue grafts, or a temporary colostomy in severe cases.

Rectovaginal fistulas may occur alongside other childbirth-related pelvic floor conditions, such as anal sphincter injury or pelvic organ prolapse. Surgical repair may be coordinated with other specialists to address multiple issues during the same procedure for improved outcomes.

Our surgeons often use minimally invasive and tissue-sparing techniques to optimize healing, reduce pain, and restore normal bowel and vaginal function.

Early diagnosis and treatment following childbirth improve healing, reduce infection risk, and significantly enhance quality of life.