Rectovaginal Fistula: Diagnosis and Management

What is a Rectovaginal Fistula

A rectovaginal fistula is an irregular link in between the lower part of your large intestine– your rectum– and also your vagina. Digestive tract components can leak via the fistula, enabling gas or stool come out through your vagina. The problem may create psychological distress and also physical pain, which can influence self-confidence and affection.

Cause of Rectovaginal Fistula

• Injury during childbirth
• Obstructed labour
• Rectal or Anal canal cancer
• Ovarian or Uterine Cancer
• Cervix cancer
• Crohn’s disease or various other inflammatory bowel condition
• Radiation therapy or cancer in the pelvic location
• Complication arising with surgical treatment in the pelvic location
• Faecal Impaction
• Vaginal Injuries
• Perineal injuries

Clinical Presentation of a Rectovaginal Fistula

• Passage of gas, stool or pus from your vaginal canal
• Smelly vaginal discharge
• Recurrent vaginal or urinary tract infections
• Irritability or pain in the vulva, vagina and also the location between your vaginal canal and also anus (perineum).
• Pain during intercourse.
• Anal Incontinence
• Perianal Abscess
• Pelvic Abscess

Diagnosis of Rectovaginal Fistula

Physical examination

Your physician will certainly execute a physical examination to attempt to locate the rectovaginal fistula as well as look for a any tumour mass, infection or abscess. It includes checking your vaginal canal, rectum as well as the location in between them (perineum) with a gloved hand. Unless the fistula is really low in the vaginal area as well as easily visible, your medical professional might make use of a speculum to see inside your vagina. A tool similar to a speculum, called a proctoscope, may be inserted into your rectum and also anus to check. A biopsy might be taken at the same time.

Investigations for location Rectovaginal Fistula

One might not locate a fistula through the physical exam. Other tests might be required to find and also assess a rectovaginal fistula. These examinations can additionally help your clinical team in preparing for surgical treatment.

Contrast tests for Rectovaginal fistula

• A vaginogram or a barium enema can aid determine a fistula situated in the upper potion of rectum. These examinations make use of a dye material to show the vagina or the bowel on an X-ray image.
• Blue dye examination. This test includes placing a tampon right into your vagina, after that infusing blue color dye into your rectum. Blue staining on the tampon shows a fistula.
• CT Scan. A CT scan of your abdomen and pelvis gives a lot more information than does a conventional X-ray. The CT check can help situate a fistula as well as establish its reason.
• Magnetic vibration imaging (MRI). This examination can show the place of a fistula, whether other pelvic body organs are included or whether you have a lump.
• Anorectal manometry. This examination measures the level of sensitivity and also feature of your anus and can give information about the rectal sphincter as well as your capacity to control stool passage. This examination does not locate fistulas, yet may help in planning the fistula repair service.
• Anorectal ultrasound. This procedure uses sound waves to produce a video clip image of your anus as well as rectum. Your physician inserts a slim, wand-like instrument into your rectum and rectum. This examination can examine the structure of your anal sphincter and may reveal childbirth-related injury.
• Other examinations. If your physician believes you have inflammatory digestive tract illness, he or she may get a colonoscopy to see your colon. During the treatment, your medical professional can take small examples of tissue (biopsy) for laboratory evaluation, which can aid validate Crohn’s illness.

Treatment of Rectovaginal Fistula

Treatment for the fistula depends upon its reason, dimension, area and also effect on bordering tissues. Surgery is the mainline of treatment. Surgery has to be planned meticulously. Antibiotics or chemotherapy may have to be given before definitive surgery is planned. There are high chances of failure of repair of rectovaginal fistula in the presence of infection or residual cancer.

Surgical procedures for Rectovaginal Fistula

Prior to a procedure can be done, the skin and also various other cells around the fistula have to be healthy and balanced, without infection or swelling. Your doctor might recommend waiting 3 to six months prior to having surgical treatment to ensure the surrounding cells is healthy and also see if the fistula closes on its own.

Surgery to shut a fistula is usually done by a colorectal surgeon as well as a gynaecologist. The objective is to remove the fistula tract and close the opening by stitching healthy and balanced layers of tissues. Surgical options consist of:

Diversion stoma or colostomy: Carrying out a colostomy before repairing a fistula to divert stools via an opening in your abdominal area rather than with your rectum. This is temporary in nature but may be required for up to 6 months or more.

The type of surgery is dependent on the cause of the fistula. It may involve utilizing a tissue graft taken from a neighbouring part of your body or folding a flap of healthy and balanced tissue over the fistula opening, repairing the anal sphincter muscles if they’ve been harmed by the fistula and removal of the cancer.

Outcome after surgery for Rectovaginal Fistula

The outcome will depend on many factors. It is a complex surgery and may be done in stages. The repair is not done in the presence of infection or cancer. At time radiotherapy has damaged the surrounding tissues so much that there are high chances of the surgery to fail. Thus lot of discussion and counselling of the surgery are required with the patient and family. Good outcomes are expected in cases of trauma, childbirth related injuries and non-malignant conditions. Success rates can vary between 50 to 80 percent in the best of situations. Surgery should be done by a team of experienced colorectal and gynaecologists.