Depending on the fistula`s size and location, you may have minor symptoms or significant problems with continence and hygiene. Signs and symptoms of a rectovaginal fistula may include:
- Passage of gas, stool or pus from your vagina.
- Foul-smelling vaginal discharge.
- Recurrent vaginal or urinary tract infections.
- Irritation or pain in the vulva, vagina and the area between your vagina and anus (perineum).
- Pain during sexual intercourse.
A fistula may be the first warning of a more serious problem, such as an infected, pus-filled area (abscess) or cancer.
A rectovaginal fistula may form as a result of:
Injuries during childbirth. Delivery-related injuries are the most common cause of rectovaginal fistulas. This includes tears in the perineum that extend to the bowel, or an infection of an episiotomy — a surgical incision to enlarge the perineum during vaginal delivery. These may happen following a long, difficult, or obstructed labor. These types of fistulas 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 an inflammatory bowel disease in which the digestive tract lining is inflamed. Most women with Crohn`s disease never develop a rectovaginal fistula, but having Crohn`s disease does increase your risk of the condition.
Cancer or radiation treatment in your pelvic area. A cancerous tumor in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula. Radiation therapy for cancers in these areas can also put you at risk. A fistula caused by radiation usually forms within six months to two years after treatment.
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. The fistula may develop as a result of an injury during surgery or a leak or infection that develops afterward.
Other causes. Rarely, a rectovaginal fistula may be caused by infections in your anus or rectum; infections of small, bulging pouches in your digestive tract (diverticulitis); long-term inflammation of your colon and rectum (ulcerative colitis); dry, hard stool that gets stuck in the rectum (fecal impaction); or vaginal injury unrelated to childbirth.
