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Treatments and drugs
By Mayo Clinic staffTreatment for a rectovaginal fistula depends on its cause, size, location and effect on surrounding tissues. 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 up to three months before surgery to ensure the surrounding tissue is healthy and see if the fistula closes on its own.
Medications
If the area around your fistula is infected, you'll take a course of antibiotics before surgery. Antibiotics may also be recommended for women with Crohn's disease who develop a fistula. Another medication that may help heal a fistula in women with Crohn's disease is infliximab (Remicade). This drug blocks the action of an immune system protein called tumor necrosis factor-alpha (TNF-alpha), which causes inflammation. Side effects may include chest pain, chills, fever, flushing, hives, itching and troubled breathing.
Surgery
An operation to close a fistula may be done by a gynecologist or a colorectal surgeon. The goal is to remove the fistula tract and close the opening by sewing together healthy tissue around it. The repair may require using a tissue graft taken from an adjacent part of the body, or folding a flap of healthy tissue over the fistula opening. More complicated operations may be needed if the anal sphincter muscles are also damaged or if there's scarring or tissue damage from radiation or Crohn's disease.
To clean out your bowel before the operation, you may take laxatives or follow a liquid diet for several days. This may be followed by an enema shortly before surgery. You'll also be given an antibiotic medication before surgery.
In some cases, the surgeon may do a colostomy before repairing a fistula. A colostomy is an operation that diverts 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.
After an operation to close a fistula, you'll be on a liquid diet for about three days, followed by a low-fiber diet for several weeks. A low-fiber diet reduces the frequency and volume of stools. Your care team may recommend that you take sitz baths two to three times a day and dry off with a blow dryer to keep the area clean and dry.
Some doctors suggest that a woman who's had surgery to repair a fistula consider having a Caesarean delivery for the next pregnancy.
