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Treatments and drugs
By Mayo Clinic staffSymptoms of a rectovaginal fistula can be very distressing, but treatment generally offers good results. Treatment for the fistula depends on its cause, size, location and effect on surrounding tissues.
Medications
Depending on your circumstances, your doctor may recommend medications.
- Antibiotics. If the area around your fistula is infected, you'll be given a course of antibiotics before surgery. Antibiotics may also be recommended for women with Crohn's disease who develop a fistula.
- Infliximab. Another medication that may help heal a fistula in women with Crohn's disease is infliximab (Remicade), which can help reduce inflammation.
Surgery
Sometimes fistulas heal on their own, but most people need surgery to close or repair the abnormal connection. Before an operation can be done, the skin and other tissue around the fistula must be healthy, with no signs of infection or inflammation. Your doctor may advise a waiting period of three to six months before surgery to ensure the surrounding tissue is healthy and see if the fistula closes on its own.
Surgery to close a fistula may be done by a gynecologic or colorectal surgeon. The goal is to remove the fistula tract and close the opening by sewing together healthy tissue. Surgical options include:
- Sewing an anal fistula plug or patch of biologic tissue into the fistula to allow your tissue to grow into the patch and heal the fistula.
- Using a tissue graft taken from a nearby part of your body or folding a flap of healthy tissue over the fistula opening.
- Doing more complicated surgical repair if the anal sphincter muscles also are damaged or if there's scarring or tissue damage from radiation or Crohn's disease.
- Performing a colostomy before repairing a fistula in more complex or recurrent cases to divert stool through an opening in your abdomen instead of through your rectum. This may be needed if you've had tissue damage or scarring from previous surgery or radiation treatment, an ongoing infection or significant fecal contamination, a cancerous tumor, or an abscess. If a colostomy is needed, your surgeon may wait eight to 12 weeks before repairing the fistula. Usually after about three to six months and confirmation that your fistula has healed, the colostomy can be reversed and normal bowel function is restored.
- deBeche-Adams TH, et al. Rectovaginal fistulas. Clinics in Colon and Rectal Surgery. 2010;23:99.
- Champagne BJ, et al. Rectovaginal fistula. The Surgical Clinics of North America. 2010;90:69.
- Tintinalli JE, et al. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th ed. New York, N.Y.: The McGraw-Hill Companies; 2011. http://www.accessmedicine.com/content.aspx?aID=6361536. Accessed Sept. 19, 2012.
- Gregorcyk SG, et al. Rectovaginal fistulas and rectoceles. American Society of Colon and Rectal Surgeons. http://www.fascrs.org/physicians/education/core_subjects/2001/rectovaginal_fistulas_and_rectoceles/. Accessed Sept. 21, 2012.
- Schwartz DA, et al. The role of imaging tests in the evaluation of anal abscesses and fistulas. http://www.uptodate.com/index. Accessed Sept. 21, 2012.
- Fecal incontinence. National Digestive Diseases Information Clearinghouse. http://digestive.niddk.nih.gov/ddiseases/pubs/fecalincontinence/#6. Accessed Sept. 21, 2012.
- Toglia MR. Rectovaginal, anovaginal, and colovesical fistulas. http://www.uptodate.com/index. Accessed Sept. 21, 2012.
- de la Poza G, et al. Genital fistulas in female Crohn's disease patients: Clinical characteristics and response to therapy. Journal of Crohn's and Colitis. 2012;6:276.
- Hoffman BL, et al. Williams Gynecology. 2nd ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com/content.aspx?aID=56720725. Accessed Sept. 19, 2012.
- Brunicardi FC, ed., et al. Schwartz's Principles of Surgery. 9th ed. New York, N.Y.: The McGraw-Hill Companies; 2010. http://www.accessmedicine.com/content.aspx?aID=5014922. Accessed Sept. 21, 2012.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 26, 2012.
- Klingele CJ (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 6, 2012.
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