Rectovaginal Fistula Repair
Fistulas of the vagina are abnormal connections between the vagina and another organ such as
- Rectum (recto).
- Ileal pouch (pouch).
- Colon (colo).
- Small bowel (entero).
- Anal canal (ano).
There are many causes of fistulas including
- Injury during childbirth.
- Inflammatory bowel disease.
- Prior colorectal surgery.
Recto-or ano-vaginal fistulas are sorted based on where they are located. Once this is known, it can be decided if and how it can be repaired. The repair may be through the abdomen, vagina, or rectum. Through an anorectal approach, rectal tissue and /or muscle are moved to cover the rectal opening. If there is an anal-muscle defect, this may also be repaired. When a fistula is more complex, an ostomy may be created to divert the stool away from the repair. This will aid healing.
When the anal muscles are involved, tests may be done to assess the sphincter and nerves of the canal. These tests can help your doctor evaluate the problem.
- Ultrasound, thru the anal canal, allows your doctor to see the anal muscles and look for injury or defect.
- Anal manometry measures resting and squeeze pressures throughout the length of anal canal.
- Nerve testing checks how the nerve is working with the anal muscles.
- Barium enema can be useful in finding the fistula.
- Flexible sigmoidoscopy or anoscopy-may be used to find and look at the site of the fistula.
Risks of Surgery
- Bleeding (rare).
- Failure of the repair and breakdown of the sutures and nearby tissue.
Getting Ready for Surgery
Two days before surgery, you will start a full bowel prep to clean out your bowel. We will discuss the details with you. If you smoke, it is important that you quit. Smoking delays wound healing. We can help you quit.
Expect to have drainage which will include some bleeding especially from the vagina. This is normal. Wear a pad to help manage and check the output. Foul smelling drainage or soaking a pad with blood is not normal.
It is normal to have pain or pressure in the area of repair. You will have narcotic pain pills to take for pain.
- Avoid all tobacco. This includes second hand smoke.
- It is okay to shower.
- Take your temperature at the same time each day until your follow-up visit.
- Nothing strenuous until okayed by your doctor. Walking is fine. It is an important part of your recovery.
- No intercourse until it is okayed by your doctor.
- You may have a lifting limit. We will discuss the details with you.
- For safety reasons, no driving while you are on narcotic pain pills.
You will be on a full liquid diet the first few days. You will move to a low fiber diet for a few weeks. It is important to avoid constipation. You may need to take a stool softener. Until you are eating more fiber, expect to have loose stools.
You may have a temporary ostomy to divert the stool away from the healing area. If you do, we will teach you what you need to know.
When to Call the Doctor
- Excess swelling
- Excess bleeding
- Foul smelling drainage
- Pain not controlled with pain pills
- Problems with bowel movements
- Problems passing urine
- Temperature greater than 100.4°F by mouth for two readings taken 4 hours apart
Digestive Health Center: (608) 890-5000.
After hours, weekends or holidays this number will be answered by the paging operator. Ask for the doctor on call or ask for Dr. Harms, Heise, Kennedy, or Foley. Leave your name and phone number with area code. The doctor will call you back.
If you live out of the area, call (855) 342-9900.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 04/24/2013
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