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Causes
By Mayo Clinic staffA rectovaginal fistula may form as a result of:
- Injuries in childbirth. Obstetric injuries are the most common cause of rectovaginal fistulas. Such injuries include tears in the perineum that extend to the bowel or an infection or tear of an episiotomy — a surgical incision to enlarge the perineum during vaginal delivery. These may happen following a long, difficult labor. Fistulas arising from childbirth may also involve injury to your anal sphincter, the rings of muscle at the end of the rectum that help you hold in stool.
- Crohn's disease. The second most common cause of rectovaginal fistulas, Crohn's disease is a type of inflammatory bowel disease in which the lining of your digestive tract becomes inflamed. Most women with Crohn's disease never develop a rectovaginal fistula, but having Crohn's disease does increase your risk of the condition.
- Surgery involving your vagina, perineum, rectum or anus. Prior surgery in your lower pelvic region, such as removal of your uterus (hysterectomy), in rare cases can lead to development of a fistula.
- Cancer or radiation treatment in your pelvic area. A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can lead to development of a rectovaginal fistula. Radiation therapy for cancers in these areas can also put you at risk of developing a fistula. A fistula caused by radiation usually forms within two years following the treatment. Before the fistula forms, you may experience pain in your anus or rectum, bloody diarrhea, or bright red blood in your stool. If you spot these warning signs, your doctor will first rule out a return of cancer as the cause.
- Other causes. Less commonly, a rectovaginal fistula may be caused by infections in your anus or rectum; infections of small, bulging pouches in your digestive tract (diverticulitis); or vaginal trauma.
References
- Lentz GM. Anatomic defects of the abdominal wall and pelvic floor: Abdominal and inguinal hernias, cystocele, urethrocele, enterocele, rectocele, uterine and vaginal prolapse, and rectal incontinence: Diagnosis and management. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/196058617-5/0/1524/134.html?tocnode=53759433&fromURL=134.html. Accessed April 19, 2010.
- Champagne BJ, et al. Rectovaginal fistula. The Surgical Clinics of North America. 2010;90:69.
- Burke C. Rectovaginal fistulas. Clinical Journal of Oncology Nursing. 2005;9:295.
- Welton ML, et al. Anorectum. In: Doherty GM. Current Diagnosis & Treatment: Surgery. 13th ed. New York, N.Y.: McGraw-Hill Medical; 2010. http://www.accessmedicine.com/content.aspx?aID=5310106. Accessed April 20, 2010.
- Crohn's disease. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/crohns/. Accessed April 20, 2010.
- Fecal incontinence. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/. Accessed April 20, 2010.
- Toglia MR. Rectovaginal, anovaginal, and colovesical fistulas. http://www.uptodate.com/home/index.html. Accessed April 19, 2010.
- Andreani SM, et al. Rectovaginal fistula in Crohn's disease. Diseases of the Colon and Rectum. 2007;50:2215.
- Novi JM, et al. Rectovaginal fistula. Journal of Pelvic Medicine & Surgery. 2005;11:283.
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