Experiencing fecal leakage from the vagina can be a distressing symptom. It represents a recognized medical condition that occurs when an abnormal connection forms between the rectum and the vagina. This situation requires prompt medical attention to identify the underlying cause and pursue appropriate intervention.
Understanding Pelvic Anatomy
The female pelvic region houses several organs in close proximity, including the rectum and the vagina. The rectum, the final section of the large intestine, holds stool and gas before elimination. Adjacent to the rectum, the vagina is a muscular canal extending from the uterus to the outside of the body. These distinct structures are typically separated by a thin tissue wall. Any damage or compromise to this wall can create an unnatural passageway between the rectum and the vagina, allowing bowel contents to divert from their normal path and leak.
Causes of Fecal Leakage from the Vagina
Fecal leakage from the vagina is primarily caused by a rectovaginal fistula, an abnormal opening connecting the rectum and vagina. This connection often results from tissue damage.
Childbirth Complications
The most frequent cause is complications from childbirth. Injuries during vaginal delivery, such as severe perineal tears extending into the bowel, or episiotomies that do not heal correctly, can directly create this abnormal passageway.
Surgical Procedures
Surgical procedures in the pelvic area can also lead to rectovaginal fistulas. Operations like hysterectomies, rectal surgeries, or repairs for pelvic organ prolapse might inadvertently injure tissues, or poor healing post-surgery could result in a fistula.
Inflammatory Bowel Disease
Inflammatory bowel diseases, particularly Crohn’s disease, are another significant cause. The chronic inflammation and tissue damage associated with Crohn’s can penetrate the bowel wall, forming ulcers and abscesses that may eventually tunnel into the vagina.
Other Causes
Radiation therapy directed at the pelvic region, often used for treating cancers like cervical or colorectal cancer, can also cause rectovaginal fistulas. Radiation can lead to long-term tissue inflammation and poor healing, sometimes resulting in a fistula months or even years after treatment. Less commonly, infections around the anus or vagina, or certain types of cancer affecting the rectum, vagina, or cervix, can erode the tissue and create a fistula.
Identifying the Symptoms
Recognizing rectovaginal fistula symptoms is important for timely medical evaluation. The most common symptom is the passage of gas, stool, or foul-smelling discharge from the vagina. The nature and quantity of leakage can vary, ranging from small amounts of gas or mucus to more significant passage of liquid or solid stool, depending on the fistula’s size and location.
Individuals may also experience recurrent vaginal or urinary tract infections, as fecal matter in the vagina can disrupt the natural bacterial balance. Irritation, discomfort, or pain in the perineal area (the skin between the vagina and anus) is also common due to constant exposure to fecal material. Pain during sexual intercourse, known as dyspareunia, can occur due to the presence of the fistula or associated inflammation. These symptoms indicate a need for professional medical consultation.
Diagnosis and Treatment Approaches
Diagnosing a rectovaginal fistula begins with a medical history and physical examination. A healthcare provider will inquire about symptoms and conduct a pelvic and rectal exam, using a speculum and gloved hand. A thin probe may identify the fistula tract, or if not apparent, additional diagnostic tests confirm its presence, size, location, and underlying cause.
Imaging and Endoscopy
Imaging tests provide detailed views of pelvic structures. These may include:
A CT scan of the abdomen and pelvis, which helps locate the fistula.
An MRI, providing detailed soft tissue images of the fistula’s location and organ involvement.
A fistulogram, which involves injecting dye into the fistula and taking X-rays to outline the tract.
Endoscopic procedures, such as a colonoscopy or sigmoidoscopy, allowing direct visual examination of the rectum and colon.
Treatment for a rectovaginal fistula often requires surgical intervention to close the abnormal connection. Before surgery, managing any infection or inflammation with antibiotics improves repair chances. Surgical options vary by fistula size, location, and cause, involving removal of the tract, tissue repair, or using a graft or flap; damaged anal sphincter muscles may also be repaired.
In complex cases, especially those with extensive tissue damage from radiation or inflammatory bowel disease, a temporary colostomy might be necessary. This diverts stool away from the rectum and fistula, allowing healing before definitive repair. While surgical repair is frequently needed, small fistulas, especially from obstetric trauma, may sometimes heal without surgery with watchful waiting and supportive care. Consulting a healthcare professional is important for an accurate diagnosis and personalized treatment plan.