Know All About Rectovaginal Fistula Treatment in Bangalore

Overview

A fistula refers to an abnormal connection between any two body parts, which includes organs, blood vessels, or other structures. When it comes to a rectovaginal fistula, this abnormal connection occurs between the rectum and the vagina. This connection leads to the leakage of bowel contents, allowing gas/stool to pass through the vagina. Read on to understand more.

What is meant by a Rectovaginal Fistula (RVF)?

A rectovaginal fistula is an abnormal connection between the rectum and vagina, which can result from a number of conditions, including surgery and childbirth. This connection allows the contents of the rectum, such as stool, gas, or mucus, to pass into the vagina, where they should not be present. It leads to emotional distress and physical discomfort, thereby impacting one’s self-esteem as well as intimacy. Rectovaginal fistulas can significantly impact a person's quality of life and may require surgical intervention to repair the abnormal connection and restore normal bodily functions.

What Causes a Rectovaginal Fistula?

The most common causes are:

Childbirth: In complicated cases, it may result in a tear in the perineum (sensitive patch of skin between your genitals), leading to the formation of a rectovaginal fistula.

Inflammatory bowel disease (IBD): IBD can be of two types - Crohn’s disease or ulcerative colitis, both of which cause inflammation in the digestive tract. This can lead to the development of an RVF.

Cancer or radiation in the pelvis: Radiation therapy to treat cancer in the vagina, cervix, uterus, anus, or rectum can increase the risk of RVF.  

Surgery: An injury or an infection from surgery in these parts can also lead to the formation of such an abnormal opening.

Other possible causes include sexual assault, infection due to HIV, anal/rectum infection, infected pouches in the intestine, or stool stuck in the rectum.

What are the Symptoms of a Rectovaginal Fistula?

Symptoms of a rectovaginal fistula include the following:

• Passing gas or stool from the vagina
• Trouble controlling bowel movements
• Repeated vaginal infections
• Discharge with a foul odor from the vagina
• Pain in the anal or rectal area, especially during bowel movements
• In severe cases, chronic diarrhea and malabsorption of nutrients can lead to dehydration and malnutrition 

It's important to note that the severity and combination of symptoms can vary from person to person. Some individuals may have mild symptoms, while others may experience significant discomfort and disruption of daily life.

How is a Rectovaginal Fistula Diagnosed?

Tests that might be required for rectovaginal fistula diagnosis are:

Physical examination: First, the doctor asks you about your symptoms and physically examines the area either with a speculum or a proctoscope, devices used to see the areas clearly (the vagina, rectum, and the surrounding region).

Digital rectal examination: It involves the doctor inserting a gloved finger into the rectum to assess any abnormalities. This is also a manual exam that helps in the identification of any abnormal connection between the rectum and the vagina.

Colonoscopy or sigmoidoscopy: A colonoscopy helps the surgeon examine the inside of the rectum and all of the large intestine. Flexible sigmoidoscopy is to view the rectum and the colon (the lower part of the large intestine).

Blood tests: Tests like CBC (complete blood count) and inflammatory markers (like C-reactive protein) may be done to find any signs of inflammation or infection associated with rectovaginal fistula. 

Anorectal or transvaginal ultrasound: A wand-like instrument is inserted into the anus and rectum, or vagina, and an image is created from the inside of the pelvis.

Methylene enema: A tampon is inserted into the vagina and a blue dye is injected into the rectum. If it, the tampon, turns blue post 15-20 minutes, you have a fistula. 

Barium enema: A contrast dye is used for the doctor to see the fistula on an X-ray. 

CT scan: A detailed picture of the inside of your pelvis is created using powerful X-rays.

MRI: MRI scans can provide clear images of the pelvic area and help locate the fistula.

Once the diagnosis of an RVF is confirmed, your healthcare provider will discuss treatment options based on the size, location, and underlying cause of the fistula.

What are the Treatment Options for a Rectovaginal Fistula?

The treatment for a rectovaginal fistula typically involves a surgical repair to close the opening between the vagina and the rectum. The treatment method chosen will depend upon the size, location, and underlying cause of the fistula, as well as the patient's overall health. The main treatment options for RVF include the following.

Conservative Methods

• Your doctor may suggest a wait-and-watch approach to see if the fistula closes by itself.
• Manage any underlying conditions such as Crohn's disease that may be contributing to the condition.
• Dietary modifications and medications such as antibiotics to control any infection.

Surgical Management

• Transvaginal Repair: The fistula is accessed through the vagina, and the surgeon closes it using sutures or other closure methods. This approach is suitable for smaller RVFs located near the vaginal opening.
• Transanal Repair: The surgeon accesses the fistula through the anus and rectum, closing it from the inside. This approach is suitable for RVFs located closer to the rectum.
• Abdominal Repair: Complex or high-up RVFs may require an abdominal approach, where the surgeon accesses the fistula through an abdominal incision and repairs it from there. This approach may be necessary for large or deep-seated RVFs.

Other Methods

• Colostomy or Ileostomy: In cases where the fistula is not accessible due to an infection or inflammation, a temporary pathway is created in order to divert stool. This allows the area to heal.
• Biologic Therapies: If the fistula is a result of conditions such as an inflammatory bowel disease (IBD), that develop due to a weakened immune system, biologic therapies may be used to control inflammation and promote healing. 

The choice of treatment is determined by the healthcare provider after a thorough evaluation of the RVF and consideration of the patient's overall health and specific circumstances. 

How to Prevent Rectovaginal Fistulas?

Here’s how you can prevent rectovaginal fistulas:

• Seek proper obstetric care during childbirth to avoid complications.
• Address prolonged labor promptly and consider a C-section if needed.
• Maintain regular bowel habits to prevent constipation and straining.
• Practice good perineal hygiene to avoid infections.
• Take precautions against sexually transmitted infections.
• Avoid pelvic trauma and follow safety guidelines.
• Manage underlying medical conditions like Crohn's disease or ulcerative colitis.
• Do pelvic floor exercises to strengthen pelvic muscles.
• Eat a balanced diet with fiber to prevent constipation.
• Address gynecological issues promptly.
• Attend regular checkups to monitor and manage potential risk factors.

Consult with a healthcare provider if you suspect an RVF or are at risk due to specific medical conditions. Early diagnosis and treatment are crucial.

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