A rectovaginal fistula is a medical condition where there is a fistula or abnormal connection between the rectum and the vagina. Passage of gas, stool or pus from the vagina. Foul-smelling vaginal discharge. Recurrent vaginal or urinary tract infections. Irritation or pain in the vulva, vagina and the area between the vagina and anus (perineum) Pain during sexual intercourse.
After diagnosing rectovaginal fistula, it is best to wait for around 3 months to allow the inflammation to subside. For low fistulae, a vaginal approach is best, while an abdominal repair would be necessary for a high fistula at the posterior fornix. A circular incision is made around the fistula and vagina is separated from the underlying rectum with a sharp circumferential dissection. The entire fistulous tract, along with a small rim of rectal mucosa is incised. The rectal wall is then closed extramucosally.
The majority of rectovaginal fistulas, 88%, are caused by obstetric trauma (postpartum rectovaginal fistula). The total number of cases corresponds to 0.1% of all vaginal births. Rectovaginal fistula occurs in 0.2–2.1% of patients with chronic inflammatory bowel disease (particularly Crohn's disease), and following low anterior rectal resection, the frequency is as high as 10%. In recent years, rectovaginal fistula has been an increasingly common complication following hemorrhoid or pelvic floor surgery, particularly in cases where staplers or foreign materials were used. No statistics are available since the results have primarily been published in the form of case studies.