Causes and risk factors
Normally the rectum and vagina is separated by a thin sheath or structure called as rectovaginal septum or rectovaginal fascia. Any abnormal connection between the rectum and vagina can lead to development of symptoms. Injury causing tear of the rectovaginal septum or fascia is one of the major causative factor. This injury more commonly occurs during childbirth. Instrumental delivery, difficult labor or prolonged labor increases the chances of injury. Certain other causes like perianal infection, Inflmmatory bowel diseases, Crohns diseases or radiation treatment for cancerous condition of the rectum contribute to the causation. Rectrovaginal fistula can also occur as a complication of surgeries like vaginal hysterectomy.
Clinical presentation:
The complaints can range from mild to severe one. The women can come up with complain of pain in the vagina and anal region. Foul smelling discharges from the vagina is seen. There occurs passage of gas and feces from the vagina. Burning, itching and pain during intercourse are the other complains with which the patient can come up with. The patient experiences a continuous sense of discomfort. This also hampers the hygiene of the perineum giving way to secondary infections. Rectovaginal fistula can lead to certain complications like urinary and fecal incontinence or abscess formation.
Investigations:
Diagnosis is done on the basis of symptoms narrated by the patient and the physical examination conducted by a gynecologist and surgeon. For visualization of the rectum and colon endoscopy can be done. Barium enema and anorectal and transvaginal ultrasound are also diagnostic tools. Certain other sets of investigations like routine blood test, urine test, blood sugar levels, MRI and CT scan of abdomen can also be done.
Treatment:
The treatment plan consists of administration of medication like antibiotics in cases of infection. Anti inflammatory or pain relieving medications can be given. Surgical intervention consists of repair of rectovaginal fistula.
Other Modes of treatment:
Certain other modes of treatment can also be helpful in coping up the complaints. Taking into consideration the symptoms in holistic way, homoeopathy can offer a good aid for the relief of the symptoms. The Ayurvedic system of medicine uses herbal and certain synthetic derivates. These can also be effective to combat the symptoms. However surgery is mandatory in cases of rectovaginal fistula.
