Rectovaginal Fistula Repair in Northern New Jersey
A rectovaginal fistula is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina. Bowel contents can leak through the fistula, allowing gas or stool to pass through your vagina.
How a Rectovaginal Fistula Forms
- Injuries during childbirth. Delivery-related injuries are the most common cause of rectovaginal fistulas. This includes tears in the perineum that extend to the bowel, or an infection of an episiotomy — a surgical incision to enlarge the perineum during vaginal delivery. These may happen following a long, difficult, or obstructed labor. These types of fistulas may also involve injury to your anal sphincter, the rings of muscle at the end of the rectum that help you hold in stool.
- Crohn’s disease. The second most common cause of rectovaginal fistulas, Crohn’s disease is an inflammatory bowel disease in which the digestive tract lining is inflamed. Most women with Crohn’s disease never develop a rectovaginal fistula, but having Crohn’s disease does increase your risk of the condition.
- Cancer or radiation treatment in your pelvic area. A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. Radiation therapy for cancers in these areas can also put you at risk. A fistula caused by radiation usually forms within six months to two years after treatment.
- Surgery involving your vagina, perineum, rectum or anus. Prior surgery in your lower pelvic region, such as removal of your uterus (hysterectomy), in rare cases can lead to development of a fistula. The fistula may develop as a result of an injury during surgery or a leak or infection that develops afterward.
- Other causes. Rarely, a rectovaginal fistula may be caused by infections in your anus or rectum; infections of small, bulging pouches in your digestive tract (diverticulitis); long-term inflammation of your colon and rectum (ulcerative colitis); dry, hard stool that gets stuck in the rectum (fecal impaction); or vaginal injury unrelated to childbirth.
Symptoms of a Rectovaginal Fistula
Depending on the fistula’s size and location, you may have minor symptoms or significant problems with continence and hygiene. Signs and symptoms of a rectovaginal fistula may include:
- Foul-smelling vaginal discharge
- Irritation or pain in the vulva, vagina and the area between your vagina and anus (perineum)
- Passage of gas, stool or pus from your vagina
- Recurrent vaginal or urinary tract infections
- Pain during sexual intercourse
Treatment for Rectovaginal Fistulas in New Jersey
Most people will require surgery to repair or close a rectovaginal fistula, and such surgeries are only performed by urogynecology surgery specialists such as Dr. Ghomi
Before an operation can be done, the skin and other tissue around the fistula must be healthy, without infection or inflammation. Your doctor may recommend waiting three to six months before having surgery to ensure the surrounding tissue is healthy and see if the fistula closes on its own.
Surgery to close a fistula may be done by a gynecologic surgeon, a colorectal surgeon or both working as a team. The goal is to remove the fistula tract and close the opening by sewing together healthy tissue. Surgical options include:
- Sewing an anal fistula plug or patch of biologic tissue into the fistula to allow your tissue to grow into the patch and heal the fistula.
- Using a tissue graft taken from a nearby part of your body or folding a flap of healthy tissue over the fistula opening.
- Repairing the anal sphincter muscles if they’ve been damaged by the fistula or by scarring or tissue damage from radiation or Crohn’s disease.
- Performing a colostomy before repairing a fistula in complex or recurrent cases to divert stool through an opening in your abdomen instead of through your rectum. Most of the time, this surgery isn’t needed. But you may need this if you’ve had tissue damage or scarring from previous surgery or radiation treatment, an ongoing infection or significant fecal contamination, a cancerous tumor, or an abscess. If a colostomy is needed, your surgeon may wait eight to 12 weeks before repairing the fistula. Usually after about three to six months and confirmation that your fistula has healed, the colostomy can be reversed and normal bowel function restored.