Rectovaginal Fistula

Rectovaginal fistulas are tunnels or holes between the rectum and vagina and are common. They can occur from delivery or surgical trauma, radiation for cancer, or Crohn’s disease. Bowel contents or air leak through the fistula tract allowing stool or gas or to pass from the rectum into the vagina. These fistulas can have severe physical and social consequences.

Rectovaginal Fistula Causes

The most common cause of a rectovaginal fistula is from an obstretric injury. Other causes include:

• Cancer
• Damage from radiation treatment
• Infection
• Inflammatory bowel disease
• Prior surgery

Rectovaginal Fistula Signs & Symptoms

Some fistulas are so small they are will not have symptoms. But as they get bigger, they have the capacity to allow more air and fluid to pass. Smaller fistulas permit gas to flow through, allowing for uncontrollable flatus. AS they get larger, stool passes through, causing leakage onto pads or underwear. The larger fistulas will permit free passage of stool, which is painful and irritating to vaginal mucosa and can cause frequent urinary tract and vaginal infections.

Rectovaginal Fistula Treatment

If you have a rectovaginal fistula, you will most likely need surgery to repair it. Treatment of the fistula depends on its cause, size, location and effect on surrounding tissue. Local repair through either the rectum or vagina can be performed for small fistulas that are located in the lower rectum. Fistulas with radiation in the area or from chronic inflammation, like Crohn’s disease, may respond to stem cell injection under sedation. Complex fistula or fistulas that have failed primary repair may require a procedure in which healthy tissue is placed between the rectum and vagina.

At our institution, we have had excellent results with ladder of surgical techniques in repairing these complex fistulas.

We recommend a staged surgical approach depending on the fistula. Many patients will respond to conservative therapy or local surgery. Other patients have very thinned out tissue that will need field treatment with healthy, normal mesenchymal stem cells. For severe fistulas or for failed surgery that continues to allow leakage, we recommend a gracilis flap. The procedure involves transferring a long thin muscle called the gracilus muscle in the inner thigh in between the rectum and vagina in order to close the fistula. This technique uses healthy tissue to separate the rectum from the vagina when the tissues are too fragile for repair or have failed prior repairs. Using this muscle does not result in any long term impairment of the leg function.