We were alerted to a post circulating in various Facebook mummy groups recently about how a Singapore mum’s alleged defect in post-delivery stitching left her passing gas and fecal matter through her vagina, leaving her with a rectovaginal fistula (we’ll tell you more about this condition later).
The incident reportedly took place a month or so ago, and a friend of this mummy brought attention to what happened via a Facebook post. The incident was also reported in The Independent recently.
theAsianparent reached out to both the mummy’s friend and the hospital in question to confirm the story and find out more details but we have not heard back from them.
The original Facebook post and The Independent article have been taken down. But, if you want to read in detail about what happened, you may read the Hardware zone forum thread for details.
We are unsure if this incident is real since the Facebook post has been deleted, but we did decide to find out more about rectovaginal fistula, what causes it and what treatments are available.
Rectovaginal Fistula: What do you know about this condition?
Image source: iStock
A rectovaginal fistula (RVF) is an abnormal connection between the lower portion of your large intestine — your rectum — and your vagina, like a tunnel between two underground stations. In this case, the tunnel runs between the anus (or rectum) and the vagina.
This tunnel allows the content of the bowel such as wind, mucus, bacteria or even stool to pass from the rectum into the vagina. Bowel contents can leak through the fistula, allowing gas or stool to pass through your vagina.
Symptoms of rectovaginal fistula
The commonest symptom of RVF is to experience the passage of wind out through the vagina. Women with RVF may also experience frequent gynaecological or urinary infections and may even pass mucus or stool through the vagina.
Causes of RVF
Image source: iStock
- Injury during childbirth: Delivery-related injuries are the most common cause of rectovaginal fistulas.
The most common cause is an
injury to the tissue between the rectum and the vagina during childbirth. This is called an obstetric injury and occurs in a very small proportion of women who undergo a severe tear during vaginal delivery.
- Crohn’s disease or other inflammatory bowel disease: Most women with Crohn’s disease never develop a rectovaginal fistula, but having Crohn’s disease does increase your risk of the condition.
- Radiation treatment or cancer in the pelvic area: A cancerous tumour in your rectum, cervix, vagina, uterus or anal canal can result in a rectovaginal fistula.
Radiation therapy for cancers in these areas can also put you at risk.
- Complication following surgery in the pelvic area (vagina, perineum, rectum or anus): Prior surgery in your lower pelvic region, such as removal of your uterus (hysterectomy), in rare cases can lead to development of a fistula.
The fistula may develop as a result of an injury during surgery or a leak or infection that develops later on.
Confirming RVF
Image source: iStock
Your doctor will ask you about your symptoms and examine the rectum and/or the vagina with a short telescope to try and visualise and assess the fistula. If a fistula is suspected, tests such as an ultrasound may be used.
Ultrasound is used to assess the anal sphincter muscle as well as to look for the fistula itself. Occasionally a contrast study (where x-ray dye is placed in the rectum and x-rays taken to see if it leaks into the vagina) is necessary.
Treatment options for rectovaginal fistula
- A fistula caused by Crohn’s disease may be treated with Crohn’s medications in the first instance to try and encourage it to heal.
- When a fistula occurs straight after child birth, the first thing to do is wait. Many of these fistulas will simply heal up on their own without the need to resort to surgery.
- If the fistula persists, surgery may be necessary. Unfortunately, surgery for RVF is not always successful and many women face repeated operations before successful closure of the fistula is achieved.
The majority of women with a rectovaginal fistula do get healed by surgery, even if more than one attempt is necessary. There are several different types of surgery performed, some through the abdomen and others by operating in the perineum (between the anus and vagina). Your surgeon will decide what’s best for you.
- Some women are never ‘cured’ of their fistula. This means that it never fully closes. However, surgery often shrinks the fistula to such a small size that further surgery is declined because an acceptable situation has been reached.
Sometimes a surgical thread called a seton is placed through the fistula to help control drainage and again, symptoms are controlled such that no further surgery is required.
(Source: Mayoclinic, St Mark’s Hospital)