Rectovaginal Fistula Repair
Fistulas are defined based on location. Once the location is known, a decision can be made of how it can be repaired.
Fistulas of the vagina are abnormal connections between the vagina and another organ:
- Rectum (recto).
- Ileal pouch (pouch).
- Colon (colo).
- Small bowel (entero).
- Anal canal (ano).
Causes of fistulas include:
- Injury during childbirth.
- Inflammatory bowel disease.
- Prior colorectal surgery.
Based on location, the repair may be done through the abdomen, vagina, or rectum. In a rectal 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. With a complex fistula, an ostomy may be created to divert the stool away from the repair. This will aid healing. We will explain to you the details of your repair.
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 in the anal canal.
- Nerve tests check how the nerve is working with the anal muscles.
- Barium enema can be useful in finding the fistula.
- Flexible sigmoidoscopy and anoscopy help to find and assess the site of the fistula.
Risks of Surgery
- Bleeding (rare).
- Failure of the repair and breakdown of the sutures and nearby tissue.
Follow these steps to empty stool from your bowel to prepare for surgery. “Clear” means no solids, particles or sediment; it does not mean no color.
2 days before surgery, eat breakfast then drink only clear liquids.
• Clear Jell-O® homemade from box only
• Clear broth or bouillon
• Juice with no pulp (apple, grape, no orange)
• Crystal Light®
• Coffee or tea, no creamer – sugar is OK
• Gatorade® or other clear sports drinks
• No alcohol or dairy products
• Gatorade® G3 Recover Series -protein drink
Try to drink at least one bottle of Gatorade G3 Recover® each day for 2 days before surgery. Mix GoLYTELY® with warm drinking water to top of line on bottle and shake. It will be clear. Store this in the refrigerator. Use within 48 hours. It is okay to add Crystal Light® powder mix to each glass.
1 day before surgery, drink only clear liquids all day.
• 9am (or earlier): Take 4 bisacodyl tablets with water. Do not chew or crush.
Do not take within 1 hour of taking an antacid or other morning medicine. It is
okay to do this step earlier in the day.
• As soon as you have a bowel movement, start to drink the GoLYTELY®. Drink
1 -8oz glass every 10 minutes until half the bottle is gone– or your
stools are clear. If you see sandy particles in the toilet water, drink one cup
of GoLYTELY® at a time until all solid matter is gone and it looks clear. Do not
sip slowly. It works better if you drink quickly.
• 1 hour after you finish the GoLYTELY®: Take the 1st dose of antibiotics
• 3-4 hours later: Take the 2nd dose of antibiotics
• 10 pm: Take the last dose of antibiotics
Continue to drink clear liquids until bedtime. Shower before going to bed.
Morning of surgery (at least 1 hour before leaving home): Give yourself a Fleets® phosphate enema. Shower again.
You may feel cramps in your lower abdomen while drinking the GoLYTELY®. If you have steady stomach pain, are light-headed or dizzy, don’t have any bowel movements at all or can’t drink the GoLYTELY®, call the clinic at
(608) 890-5000. This is a 24 hour number.
Toll free: 1-855-342-9900
After hours, weekends and holidays ask for the doctor on call for Dr. _____________________.
Tell them your problem.
Do not take your scheduled medicines for 1 hour before or after drinking the GoLYTELY® they will not be absorbed.
Expect to have bloody drainage from the vagina. This is normal. Wear a pad to manage and check the output. Foul smelling drainage or soaking a pad with blood is not normal. If have a temporary ostomy to help you heal, we will teach how to take care of it.
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, including second hand smoke.
- It is okay to shower.
- Take your temperature at the same time each day until your follow-up visit.
- Nothing more strenuous than walking until okayed by your doctor. Walk each day.
- Sex may be resumed when okayed by your doctor.
- Do not lift more that 10 pounds. We will discuss the details with you
- Do not drive while taking narcotic pain pills.
You will be on a full liquid diet the first few days. Then, plan to eat a low fiber diet for 2 weeks. To avoid constipation you may take a stool softener. Expect to have loose stools while on the low fiber diet.
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
- Any other symptoms that concern you
Digestive Health Center: (608) 890-5000.
After hours, weekends or holidays ask for the doctor on call or ask for Dr. Harms, Heise, Kennedy, or Foley. Leave your name and phone number with area code. We will call you back.
Toll Free: (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: 06/26/2013
Copyright © 06/26/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7122
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