What Is a Rectovaginal Fistula?

Rectal vaginal fistula (RVF) is a congenital or acquired channel between the rectum and the vaginal epithelial surface, which is rare in clinical practice. The main clinical manifestation is vaginal exhaust defecation, and in severe cases, the stool cannot be controlled. It is generally not self-healing, and most patients require surgical intervention. Due to the particularity and complexity of the local anatomy of the lesion, it is difficult to perform the surgery. If it is not handled properly, it will lead to repeated infections and a high recurrence rate, which will often lead to unexplainable pain and decreased quality of life.

Basic Information

English name: rectovaginal fistula
Visiting department: Anorectal
Common locations: Rectum, vagina

Common causes: Perineal laceration, rectal laceration, lateral incision, improper suture during natural delivery, complications after stapler surgery, inflammatory injury, concurrent hemorrhoid surgery, cancerous fistula, etc.
Common symptoms: Vaginal exhaustion and defecation

Causes of rectal vaginal fistula

Natural birth

The occurrence of rectal vaginal fistula is closely related to perineal laceration, rectal laceration, lateral incision, and improper suture during natural delivery. It has been reported that the incidence of rectal vaginal fistula in women with vaginal delivery is 0.1%.

2. Complications after Stapling

In recent years, the high frequency of staplers in rectal surgery has increased the tendency of rectal vaginal fistula caused by surgical injuries.

3. Inflammatory injury

Bacterial inflammation, chemical drugs and radiation-induced enteritis, etc., lead to ischemic necrosis of local tissue to form rectal vaginal fistula.

4. Concurrent surgery

During hemorrhoid surgery or local injection of sclerosing agent, local injury caused by surgery or improper dose of injected drug can cause local necrosis, and then form rectal vaginal fistula.

5. Perianal abscess

A perianal abscess forms a rectal vaginal fistula.

6. Congenital rectal vaginal fistula

Coexisted with anal atresia.

7. Cancerous fistula

Local invasion and metastasis of malignant tumors in the advanced genital and pelvic cavity, and tissue festering caused the formation of rectal vaginal tumor fistula.

8. Patients with diabetes

Diabetic patients are susceptible to infection and complicated with rectal vaginal fistula. If the blood sugar is not well controlled, it will affect the wound and skin healing of the patient and worsen the infection.

9. Other

Rectal Vaginal Fistula Classification

1. According to the size, location and etiology of the fistula, it is divided into simplicity and complexity: those with fistula 2.5cm are complicated, those with fistula <2.5cm are simple.

2. It is divided into 3 types according to the height of the position. The high position means that the vaginal fistula is located at or above the cervical plane; the low position means that the fistula is located at or below the dentate line on the rectal side and the vaginal side is located Labiac lacing or below; labial lacing; median means lying between the two. Recurrent RVF is complex.

3. According to the time when RVF occurs, it is divided into early fistula and late fistula. Early fistula generally refers to those who occur during the perioperative period or within 4 weeks after operation; late fistulas refer to those who occur after 4 weeks after operation.

Clinical manifestations of rectal vaginal fistula

1. If the fistula is small, gas is often discharged from the vagina, and the stool is not discharged from the vagina.

2. If the fistula is large, feces and gas are often excreted through the vagina. As the perineum is stimulated by feces and vaginal secretions for a long time, skin ulcers and eczema may appear on the vulva, perineum and inner thighs.

3. Patients' systemic symptoms are not obvious, and a few patients may have abdominal pain and low fever.

Rectal vaginal fistula

Inspection

Visible lack of rectal vaginal wall, deformity, local redness and swelling in the acute stage, and sometimes secretion overflow.

2. Referral

Digital rectal and vaginal examinations can determine the location of the fistula, and at the same time, check the tissues around the fistula for scars and stenosis.

3. Anoscopy or Vaginoscopy

Can directly observe the fistula site and size.

4.B ultrasound

Transrectal or transvaginal intracavitary ultrasound is suitable for low and mid rectal vaginal fistulas to help understand the situation around the diseased tissue.

5. Magnetic resonance

Mostly used for high rectal vaginal fistula, you can understand the fistula shape, the relationship with the surrounding tissues and organs.

Rectal vaginal fistula diagnosis

The diagnosis of this disease is not difficult, but its position needs to be determined. The position and size of the fistula can be seen from the external vagina with a vaginal speculum. The lower rectal vaginal fistula can sometimes be seen directly from the external opening of the vagina. X-ray inverted film or transfistula intubation can understand the position of the distal end of the rectum and its relationship with the puborectalis.

Rectal Vaginal Fistula Treatment

Drug treatment

Drug treatment is an indispensable process for treating RVF. Regardless of surgical treatment, it is recommended that drug treatment should be performed for 3 to 6 months to control local inflammation. A small number of patients will heal during this period.

(1) For external treatment, use a potassium permanganate solution to sit in a bath or rinse with physiological saline to keep the area clean to prevent repeated infections.

(2) The use of antibiotics through effective anti-infective treatment can control the apparent congestion, edema, or inflammatory lesions of the rectum and perineum. After the inflammation is controlled and the congestion and edema have completely subsided, surgery can be considered. It can also be used for preoperative bowel preparation.

2. Surgical treatment

Most rectal vaginal fistulas require surgical intervention. The choice of surgical method depends on the size, location, etiology of the fistula, and whether it is a recurrent fistula. Proper surgical timing, adequate bowel preparation before surgery, and proper nutritional support after surgery are important to ensure the success of the operation.

Prognosis of rectal vaginal fistula

1. Preoperative preparation and postoperative management are important to improve the cure rate of rectal vaginal fistula. At the same time, pay attention to perineal care, keep local dry and clean, and clear secretions in time.

2. Some patients with rectal vaginal fistula will have recurrent attacks. Local reoperation is difficult, which seriously affects the quality of life of patients. Lifelong colostomy can be used to change the defecation channel.

3. Patients with cancerous fistula need to comprehensively evaluate the survival rate of patients and choose the optimal treatment plan. Those with inflammatory RVF need to find out the cause, actively treat intestinal inflammatory diseases, and control the incentive. Patients with diabetes and other diseases need to actively treat the primary disease at the same time.

Rectal vaginal fistula prevention

1. Timely treatment of perianal abscess and anal fistula, to avoid long-term repeated attacks to form rectal vaginal fistula.

2. Standard surgical procedures and avoiding rectal vaginal trauma as much as possible are important to prevent traumatic RVF.

3. Make a good living habit, regular defecation, take a bath after daily defecation, keep the perineum and anus clean, prevent constipation and diarrhea, avoid the occurrence of intestinal flora imbalance, and have a positive effect on preventing infection.