What Are the Treatments for Rectovaginal Fistula?
A rectovaginal fistula occurs when the rectum and vagina form an abnormal connection. This can cause a woman to pass gas or stool through the vaginal opening. The most common causes are injuries resulting from childbirth, surgical complications, cancer or inflammatory bowel diseases. It can be an embarrassing topic to discuss with a doctor, but it must be examined. The fistula sometimes closes on its own, but in most cases, treatment is needed.
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General Treatment Information
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A doctor will take into account the cause of the fistula, its size, location and impact on nearby tissues when determining treatment. In order to perform an operation, the area around the fistula must be free of infection and inflammation. A woman may need to wait at up to three months for the procedure to ensure the tissue is healthy and to see if it will close on its own.
Medications
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If surrounding tissue has an infection, pre-surgery antibiotics will be required. This is especially common if the patient has an inflammatory bowel disease like Crohn's disease, which frequently causes inflammation. She might also receive Remicade, which blocks the action of immune system proteins that cause inflammation. Possible side effects are chest pain, fever, flushing, hives, itching and difficulty breathing.
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Colostomy
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Before surgery, the doctor might do a colostomy. This operation will cause stool to move out of the abdomen rather than the rectum. This procedure is common if past surgeries or radiation treatments have caused scarring or tissue damage, of the patient has an ongoing infection, extensive fecal contamination, cancerous tumor or an abscess. The surgery to repair her rectovaginal fistula usually follows eight to 12 weeks after the colostomy.
Surgery
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The surgical procedure is done by either a gynecologist or colorectal surgeon. It involves getting rid of the fistula tract and sewing together the surrounding healthy tissue to close the opening. A tissue graft from a nearby part of the body may be needed.
Before the operation, the bowel needs to be cleaned out. Laxatives or following a liquid diet for several days before the surgery may be necessary. Right before the surgery, the patient will also get an enema.
Post-Surgery
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After the operation, the intestines need to rest, so the patient will be on a liquid diet for three days. Afterwards, she will stick to a low-fiber diet for several weeks to cut down on the frequency and bulk of her stool. Her doctor might also suggest a sitz bath two to three times a day.
Women who have had fistulas might want to consider a Caesarean section for future childbirths.
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