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Healthy Wall Between Vagina and Rectum  
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Definition  

Rectovaginal fistula is an abnormal connection between the rectum and the vagina. Gas or stool may leak from the bowel into the vagina.

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Causes  

A rectovaginal fistula is caused by an injury to this area. It may be caused by physical trauma or a medical condition.

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Risk Factors  

Factors that may increase your risk of rectovaginal fistula include:

  • Crohn’s disease
  • Complications following surgery to the perineum (area between vagina and rectum), vagina, rectum, or anus
  • Injuries during childbirth
  • Radiation treatment or cancer in the pelvic area
  • Perianal infection
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Symptoms  

If you have any of these, do not assume it is due to a fistula. These symptoms may be caused by other conditions. Talk to your doctor if you have:

  • Passing stool or gas via the vagina
  • Inability to control bowel movements
  • Foul-smelling vaginal discharge
  • Recurring vaginal infections
  • Pain during sexual intercourse
  • Persistent pain in the pelvic area
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Diagnosis  

Your doctor will ask about your symptoms and medical history. A physical exam will be done. You may need to see a colon and rectal surgeon.

Tests may include the following:

  • Anorectal ultrasound—a small wand-like instrument provides a video image of the rectum and anus
  • Methylene enema—a tampon is placed in the vagina and methylene blue is placed into the rectum to identify movement of fluid from rectum to vagina
  • Contrast studies— barium enema may be used to view a rectovaginal fistula that cannot be seen on physical exam
  • Endoscopy—a thin, lighted tube is inserted into the rectum to examine the rectum and the lower colon (to rule out irritable bowel disease)
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Treatment  

Talk with your doctor about the best plan for you. Treatment options include the following:

Rectovaginal Fistula Repair Surgery  

Surgery is usually needed. It