A rectovaginal fistula is a medical condition where there is a fistula

Fistula

In medicine, a fistula is an abnormal connection or passageway between two epithelium-lined organs or vessels that normally do not connect. It is generally a disease condition, but a fistula may be surgically created for therapeutic reasons.-Locations:Fistulas can develop in various parts of the...

 or abnormal connection between the rectum

Rectum

The rectum is the final straight portion of the large intestine in some mammals, and the gut in others, terminating in the anus. The human rectum is about 12 cm long...

 and the vagina

Vagina

The vagina is a fibromuscular tubular tract leading from the uterus to the exterior of the body in female placental mammals and marsupials, or to the cloaca in female birds, monotremes, and some reptiles. Female insects and other invertebrates also have a vagina, which is the terminal part of the...

.

Rectovaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence

Flatulence

Flatulence is the expulsion through the rectum of a mixture of gases that are byproducts of the digestion process of mammals and other animals. The medical term for the mixture of gases is flatus, informally known as a fart, or simply gas...

 and feces

Feces

Feces, faeces, or fæces is a waste product from an animal's digestive tract expelled through the anus or cloaca during defecation.-Etymology:...

 to escape through the vagina, leading to fecal incontinence

Fecal incontinence

Fecal incontinence is the loss of regular control of the bowels. Involuntary excretion and leaking are common occurrences for those affected. Subjects relating to defecation are often socially unacceptable, thus those affected may be beset by feelings of shame and humiliation...

. There is an association with recurrent urinary and vaginal infections. This type of fistula can cause pediatricians to misdiagnose imperforate anus

Imperforate anus

An imperforate anus or anal atresia is a birth defect in which the rectum is malformed. Its cause is unknown.-Features:There are several forms of imperforate anus:* A low lesion, in which the colon remains close to the skin...

.

Causes

Rectovaginal fistulae are often the result of trauma during childbirth (in which case it is known as obstetric fistula

Obstetric fistula

Obstetric fistula is a severe medical condition in which a fistula develops between either the rectum and vagina or between the bladder and vagina after severe or failed childbirth, when adequate medical care is not available.-Symptoms and signs:The resulting disorders typically include...

) in situations where there is inadequate health care, such as in some developing countries. Rates in Eritrea

Eritrea

Eritrea , officially the State of Eritrea, is a country in the Horn of Africa. Eritrea derives it's name from the Greek word Erethria, meaning 'red land'. The capital is Asmara. It is bordered by Sudan in the west, Ethiopia in the south, and Djibouti in the southeast...

 are estimated as high as 350 per 100,000 vaginal births. Fistulas can also develop in women and children who are raped; women with rectovaginal fistulae are often stigmatized in third world countries, and become outcasts. It is also associated with female genital mutilation.

Rectovaginal fistulae can also be a symptom of various diseases, including infection by Lymphogranuloma venereum

Lymphogranuloma venereum

Lymphogranuloma venereum is a sexually transmitted disease caused by the invasive serovars L1, L2, L2a or L3 of Chlamydia trachomatis....

, or the unintended result of surgery, such as episiotomy

Episiotomy

An episiotomy , also known as perineotomy, is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labor. The incision, which can be midline or at an angle from the posterior end of the vulva, is performed under local anaesthetic , and is sutured...

 or sexual reassignment surgery. They may present as a complication of vaginal surgery, including vaginal hysterectomy. They are a recognized presentation of rectal carcinoma

Carcinoma

Carcinoma is the medical term for the most common type of cancer occurring in humans. Put simply, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that generally arises from cells originating in the endodermal or ectodermal germ layer during...

 or rarely diverticular disease of the bowel or Crohn's disease. They are seen rarely after radiotherapy treatment for cervical cancer

Cervical cancer

Cervical cancer is malignant neoplasm of the cervix uteri or cervical area. One of the most common symptoms is abnormal vaginal bleeding, but in some cases there may be no obvious symptoms until the cancer is in its advanced stages...

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External links

• Clinical and functional results after tailored surgery for rectovaginal fistula Original article: Pelviperineology Vol.26 N.2 June 2007
• One By One - a nonprofit organization working to eliminate obstetric fistula.