Article Sections

Introduction

A rectovaginal fistula (RVF) is an aberrant connection between the rectum and the vagina, allowing fecal matter to pass into the vagina.

Pathophysiology

An RVF ( Figure 1) develops within the rectovaginal septum, creating a pathologic connection between the rectum and the vagina that results in the direct passage of fecal matter into the vagina.  RVFs are classified relative to the anal dentate line:

  • Low (anovaginal):  fistulas that occur below the dentate line and are more likely to be associated with occult anal sphincter injuries
  • High (rectovaginal):  fistulas that occur cephalad to the dentate line

Fistulization occurs with prolonged pressure, inflammation, infection, direct (surgical) injury, or malignancies.  Therefore, the most common risk factors include:

  • Obstetric injury:  prolonged and obstructed labor leading to ischemic necrosis of the rectovaginal septum, third- and fourth-degree perineal lacerations (ie, obstetric anal sphincter injuries [OASIS] increase the risk for low RVFs), forceps-assisted vaginal deliveries, and episiotomies

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Figures

Figure 1
Figure 1

Tables

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