mayof these be done muscles to help and assess can assessthese muscles. for weakness. This may Endoanal involve anal manometry, which assesses the tone and contractility

ultrasound may also be used to look for disruption of the Rectovaginal muscles or whether the fistula tract involves these muscles. A Guide for Women It can also be used to further evaluate location of the recto- vaginal fistula. Further imaging studies like a CT scan or 1. colonoscopy may be utilized to rule out fistula tracts involv- 2. ingcer. colon or small bowel. Other medical conditions should What is a rectovaginal fistula? be ruled out including inflammatory bowel disease and can- 3. What are the treatment options? What causes a rectovaginal fistula? 4. How is a rectovaginal fistula assessed? What are the treatment options? Not all need surgical intervention. Often rectovagi- nal fistulas associated with inflammatory bowel disease What is a rectovaginal fistula? close on their own with medical management. If diagnosed right after traumatic event, direct closure may be consid- to resolve. A rectovaginal fistula is an abnormal communication or ered. Though most often rectovaginal fistula repairs are tract between the and . Some woman may delayed to allow inflammatory tissue around fistula tract be asymptomatic but most complain of an uncontrollable either a transvaginal or transanal repair. This depends on passage of gas and/or stool through the vagina. This may The surgical approach to rectovaginal fistulas may involve bethe associated incontinence with of rectalgas and bleeding, stool that foul-smelling leads women discharge to seek from vagina, or recurrent vaginal infections. It is usually the tissuesurgeons to heal training following and extent the repair of fistula. and then If theclose fistula the co is tween vagina and rectum. large a surgeon may consider a diverting colostomy to allow therapy and may not know an abnormal tract is present be- - What causes a rectovaginal fistula? lostomy once the fistula is healed. No matter the approach the fistula tract should be excised to allow normal tissue with a good blood supply to be brought together. Often The(e.g. majorityforceps and of rectovaginalvacuum deliveries) fistulas as are well caused as 3rd by and child 4th- times the tissue near the fistula tract has poor blood supply birthdegree injury. tears Traumaincrease related risk of to development operative vaginal of rectovaginal deliveries and may need a graft to help promote healing near fistula tract. Grafts or flaps can include a woman’s own fat tissue or muscle that is placed over the repaired fistula tract. Other fistulas.el disease. Rectovaginal There are rare fistulas cases can of congenital also develop rectovaginal following biologic grafts taken from animal tissue or human cadavers radiation to the or in women with inflammatory bow- can also be used. The repair may also involve reconstruc- tion of the internal and external anal sphincter muscles. fistulas usually associated with . Congenital anorectal anomalies The success rate following rectovaginal fistula repair is Risk factors for development of rectovaginal fistula include: high ranging from 90-95%. Though patients with recurrent • fistulas or history of radiation may have a poorer prognosis. • Obstetric trauma FollowingAvoiding constipation rectovaginal and fistula diarrhea surgery is important women should as this watch can Violent trauma • Gynecologic or colorectal surgery theircause bowel disruption habits to with the therepair goal and of daily increase soft, formedrisk of woundstools. infection. • Perianal infections • Inflammatory bowel disease Radiation to pelvis • • How is a rectovaginal fistula assessed? • Malignancy

An initial discussion with your doctor who reviews your healthwomen history complain and of recent passage surgeries of gas or can stool help through him/her the sus va- pectgina. a possible genitourinary fistula tract. Though most -

Initially, a pelvic exam should be done to assess the perine- um (area of skin between vagina and anus), as well as the anus and rectum. A rectal exam may help isolate the fistula tract and applying pressure during the exam may express stool into vagina to see the tract. A thin probe may also be used to identify the fistula tract. Rectovaginal fistulas often may involve disruption to the in- ternal and external anal sphincter muscles. Further testing The information contained in this brochure is intended to be used for educational purposes only. It is not intended to be used for the diagnosis or treatment of any specific medical condition, which should only be done by a qualified physician or other health care professional. IUGA Office | [email protected] | www.iuga.org Reviewed December 2015©2011