Long-Term Complications Of Rectovestibular Fistula And Rectovaginal Fistulas

Rectovaginal fistula and rectovestibular fistula are two distinct anorectal malformations (ARM) that affect women. Anorectal malformations are structural defects and abnormalities which occur in the lower body near the anus, rectum and reproductive organs. These defects can be congenital or occur in later stages of life due to various reasons.

A rectovaginal fistula is a condition in which a tear occurs between the rectum and the vagina creating a passageway/connection between them. Rectovestibular fistula is similar in terms that the passageway/connection occurs between the rectum and the vaginal vestibule. Rectovaginal fistula quality of life issues are very profound. And they can interfere with the passage of waste material, blood and other body materials, creating extreme discomfort and risks of infections in the long term. Continue reading this blog to understand the rectovaginal & rectovestibular fistula long-term issues, symptoms, treatment and appropriate preventive measures.

A] Risk Factors And Causes Of Rectovaginal Fistulas And Rectovestibular Fistula

Rectovaginal and rectovestibular fistulas can be caused due to various reasons and they are only found in female patients. The exact reason behind congenital rectovaginal & rectovestibular fistulas is still unknown; however, medical experts suggest that it might be caused by certain prescribed drugs, diet or the environment of the mother.

Rectovaginal fistula can be caused in adults due to various reasons such as complications during childbirth, inflammatory bowel disease or complications during pelvis surgery. Cancer and its treatment in the vagina, cervix, rectum, uterus, or anus can also cause small holes in the nearby organs, leading to rectovaginal & rectovestibular fistula.

B] Long-Term Complications of Rectovestibular Fistula And Rectovaginal Fistulas

Congenital rectovestibular fistula and rectovaginal fistulas are not life-threatening diseases; however, they can cause various issues for the child in the long run. If these fistulas are not diagnosed and treated early, they can cause irritation, severely impact the patient’s self-esteem and decrease the quality of life. These rectovestibular fistula concerns will not go away on their own and will stay well into adulthood if not treated in time.

1. Bowel-related complications, such as:

Faecal incontinence: Pediatric patients who are affected by congenital fistula might not be able to hold in their stool. The patient must at least be able to feel proprioception of the urge to evacuate their bowels by 3-4 years of age, if not, they must be medically evaluated. If the patient has proprioception of the bowel but is not able to keep faecal continence, kegel exercises and faradic stimulation are some methods to resolve faecal incontinence in children.
Constipation: Children with ARM might face neuromuscular incoordination due to underdeveloped muscles. Children who find it difficult and painful to pass stools due to neuromuscular incoordination may develop constipation. Parents need to put more effort towards potty training for such patients. Long-term laxatives like lactulose and polyethylene glycol can also help.
Rectal prolapse: Rectal prolapse is a condition where the lower part of the large intestine becomes weak over time due to chronic constipation and hangs out of the anus. It is a long-term effect of fistula which can be noticed in later stages of life. Treating fistulas and cornic constipation early can prevent the risk of rectal prolapse.

2. Urinary complications, including:

Urinary incontinence: Patients who suffer from rectovestibular fistula might find it difficult to control their urinary bladder movement. The involuntary urine leakage in children who are well above the age of being bathroom trained is concerning, and must be examined by a pediatric urologist.
Urinary tract infections: Due to the unnatural passage between the rectum and the vagina and vestibule, faeces can pass through the urinary tract. This can increase the risk of bacterial infections in the urinary tract.

3. Sexual function and fertility issues, such as:

Dyspareunia (painful intercourse): The rectovaginal fistulas do not heal without medical intervention; hence, when the patient grows into adulthood they might experience dyspareunia due to scarred state of the reproductive organ.
Infertility: The scarred and infected state of the reproductive organs can also cause fertility issues. The abnormal structure of the organs can disrupt the sperm’s route, making it harder to conceive. Individuals with fistula must take the doctor’s advice and undergo any necessary treatment before trying to conceive.

4. Psychological and emotional impact on patients due to chronic symptoms

Not treating the rectovaginal or rectovestibular fistula can have many long-term effects on the patient’s daily life which can degrade the patient’s mental and emotional health. The leakage of stool, gas or pus from the vagina and the foul odour that accompanies the vaginal discharge can make the patient self-conscious, affecting self-esteem.

The experience is also extremely discomforting and causes frequent irritation which makes the patient’s negative moods worse. Some patients completely avoid social interaction due to the fear of embarrassment which further impacts psychological well-being.

C] Treatment Options

Surgical interventions: Most people suffering from fistula need to seek medical intervention at the right time for long-term management of rectovestibular fistula. Healthcare providers might use your own tissue or a lab-grown one to fill the gap. Surgery is a really helpful method with a high success rate of treating fistula. It is advisable to visit a paediatric urologist for more information about your condition.

If the fistula is too large, doctors might divert the stool’s path from the large intestine to a surgical opening called a stoma, until the fistula heals. The stool is collected in a bag which needs to be replaced regularly. The stoma is later closed using another surgery.
Non-surgical management: If the fistula is small in size, doctors might recommend you wait for a few months and see if it heals by itself. However, during this period, proper care is crucial. Your doctor might also provide you with antibiotics and inflammation-reducing medicines to heal fistulas caused by Crohn's disease. If this does not help to heal the fistulas, surgery might be your best option.

Rehabilitation And Support For Patients

Patients who have undergone treatment completely heal their fistula and the chances of the fistula reopening are very slim. The patients must follow a multidisciplinary approach to after-surgery care to prevent fistulas from reopening. Here are some strategies and techniques which patients can use to prevent fistulas from opening again after a successful surgery.

Rehabilitation techniques and strategies for managing long-term complications, including:

Conclusion

Congenital rectovaginal or rectovestibular fistulas are known to cause psychological problems as well as affect the physical health of the patient. Recognising and addressing these rectovestibular fistula challenges and concerns early can improve the patient’s quality of life and prevent long-term health risks.

If you notice any symptoms of a fistula, do not waste any time seeking medical attention. Early medical intervention can easily manage and prevent fistula. If you are seeking an experienced medical professional for the diagnosis and treatment of rectovaginal or rectovestibular fistula, contact Dr. Gursev today!

By Dr. Gursev Sandlas