Rectovaginal Fistula
Introduction
What Is a Rectovaginal Fistula?
A rectovaginal fistula is an abnormal connection between the rectum or lower bowel and the vagina. Because of this opening, gas or stool can pass through the vagina instead of leaving only through the anus. Cleveland Clinic describes it as a tunnel-like opening that develops between these two organs. A rectovaginal fistula (RVF) is an abnormal connection (hole) between your vagina and rectum. It causes poop and gas to leak out of your vagina. Several situations can lead to RVFs, but childbirth injuries are the most common cause. Surgery can often treat RVFs.
The condition can be physically uncomfortable and emotionally distressing, but it is treatable. Prompt medical evaluation is important because the best treatment depends on the fistula’s location, size, cause, and effect on surrounding tissues.
Common Symptoms of Rectovaginal Fistula
The most recognizable symptom is passing gas or stool from the vagina. Some people notice only occasional gas, while others experience persistent leakage, moisture, odor, irritation, or difficulty keeping the area clean. Symptoms may vary depending on how large the fistula is and where it is located.
Some patients also experience pelvic or vaginal discomfort, recurring infections, inflammation, or pain during sexual activity. The symptoms can affect self-esteem, relationships, work, and daily routines. Mayo Clinic notes that gas and stool leakage may cause both emotional distress and physical discomfort. The condition may cause gas and stool to leak out of the vagina. This may lead to emotional distress and physical discomfort for you, which may impact your self-esteem and intimacy.
Contact a healthcare professional if you notice bowel gas or stool coming through the vagina, especially after childbirth, pelvic surgery, radiation, or a diagnosis of inflammatory bowel disease.
What Causes a Rectovaginal Fistula?
Childbirth injury is one of the most common causes. Severe tearing, prolonged labor, assisted delivery, or tissue damage can create an opening between the rectum and vagina. A fistula may appear soon after delivery or develop later as damaged tissue heals poorly.
Other possible causes include Crohn’s disease and other inflammatory bowel diseases, pelvic radiation, pelvic cancers, complications after gynecologic or colorectal surgery, and diverticulitis. A rectovaginal fistula may result from: Injury during childbirth; Crohn’s disease or other inflammatory bowel disease; Radiation treatment or cancer in the pelvic area; Complication after surgery in the pelvic area; Complication from diverticulitis, an infection of small, bulging pouches in the digestive tract.
Infections, abscesses, and poor blood supply can also interfere with healing. Identifying the underlying cause is essential because active inflammation or infection may need treatment before repair is attempted.
How Doctors Diagnose Rectovaginal Fistulas
Diagnosis usually begins with a detailed medical history and pelvic examination. Your clinician may ask when leakage began, whether it followed childbirth or surgery, and whether you have bowel disease, pain, fever, or weight changes. During the exam, the vagina, rectum, anus, and perineum may be inspected to locate the opening and check for infection, an abscess, a tumor, or damaged tissue.
A speculum or proctoscope may help the provider see areas that are difficult to examine. Mayo Clinic explains that a biopsy may be performed when cancer is a concern. Your health care provider does a physical exam to try to locate the rectovaginal fistula and check for a possible tumor, infection or abscess. In the rare case that your health care provider thinks the fistula may be due to cancer, the provider may take a small sample of tissue during the exam for testing.
Imaging and Additional Tests
Some fistulas are easy to see during an examination. Others are hidden, narrow, or connected to additional pelvic disease. In those cases, imaging can clarify the fistula’s path and help surgeons plan treatment.
- CT scan: May show the fistula’s location and help identify its cause.
- MRI: Provides detailed images of soft tissue and may show whether other pelvic organs are involved.
- Colonoscopy: May be recommended when inflammatory bowel disease or another condition affecting the colon is suspected.
Mayo Clinic lists CT, MRI, and other tests among the tools used when a fistula is not found during a physical examination.
Rectovaginal Fistula Treatment Options
Treatment is individualized. A small fistula caused by a temporary problem may sometimes close without surgery, but many rectovaginal fistulas require a repair procedure. Mayo Clinic states that some may close on their own, while most need surgery. Some rectovaginal fistulas may close on their own, but most need surgery to fix them.
Before repair, doctors may treat infection, drain an abscess, control Crohn’s disease, improve nutrition, or allow inflamed tissues to heal. Conservative care may include hygiene support, skin protection, stool-management strategies, and treatment of diarrhea or constipation. These measures can reduce symptoms but do not necessarily close the abnormal connection.
Surgical Repair and Recovery
Surgery may be performed through the vagina, rectum, perineum, abdomen, or a combination of approaches. The surgeon may remove unhealthy tissue and close the opening with healthy, well-supplied tissue. The recommended technique depends on fistula location, previous repairs, scarring, bowel disease, and the condition of the anal sphincter.
Complex or recurrent fistulas may require staged treatment. In selected cases, a temporary diverting ostomy may protect the repair while tissues heal. Recovery can involve dietary adjustments, careful wound care, restricted activity, and follow-up examinations. Healing is not guaranteed after one procedure, so continued communication with a colorectal surgeon and gynecologic specialist may be important.
When to Seek Medical Care
Make an appointment promptly if you notice stool, mucus, or gas passing through the vagina. Do not dismiss these symptoms as normal after childbirth or pelvic surgery. Early assessment can identify infection, inflammation, or an underlying condition that may affect healing.
Seek urgent care for fever, worsening pelvic pain, heavy bleeding, vomiting, severe swelling, or signs of a serious infection. Be prepared to describe your symptoms honestly; rectovaginal fistulas are medical problems, not personal failures, and clinicians are trained to evaluate them respectfully.
Living With a Rectovaginal Fistula
While waiting for treatment, gentle cleansing and thorough drying may help protect irritated skin. Ask your clinician before using creams, antibiotics, antidiarrheal medicines, or special diets. A healthcare professional can recommend safe products and strategies based on your symptoms and medical history.
Emotional support also matters. Leakage and odor can lead to embarrassment, isolation, anxiety, or concerns about intimacy. Counseling, a trusted support person, or a patient community may make treatment easier to manage. Share changes in symptoms with your care team rather than trying to cope alone.
Key Takeaway: Rectovaginal Fistulas Are Treatable
A rectovaginal fistula is an abnormal connection that can allow gas or stool to pass through the vagina. Childbirth injury, inflammatory bowel disease, surgery, radiation, cancer, and diverticulitis are recognized causes. Diagnosis may involve an examination, CT, MRI, colonoscopy, or biopsy, depending on the situation.
Because treatment varies, seek evaluation from a qualified healthcare professional—often a colorectal surgeon, gynecologist, or both. The right plan can address the underlying cause, protect your health, and work toward closing the fistula. This article is for education and does not replace personalized medical advice.
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