Has anyone had personal experience with rectovaginal fistula repair?

Posted by blinken @blinken, Dec 19, 2020

After surgery in August for hemorrhoids and rectal prolapse I was left with fecal incontinence. Soon after going home from the hospital I noticed fecal matter coming also from my vagina. My surgeon said that may have occurred when an attempt was made to remove a fecal impaction that was found during the surgery. He then recommended doing a temporary colostomy. This was intended to allow the rectum and colon to heal for a future repair of the fistula. This was done in September. The morning after the colostomy surgery, my surgeon announced that the 'bridge' ( small plastic piece intended to support the loops of bowel ) was missing. He did not know when or where it had gone. I spent several days in the hospital but eventually went home and had Homecare visits to instruct and help us with the emptying and cleaning of the ostomy appliance. With no support for the bowel loops, my stoma was recessed and has become extremely recessed in the next months. This makes for more difficult care and now the opening that is meant to empty into the pouch, has recessed to the point where it has sunk to to the bottom of the area, barely visible. This may be the reason that i have as much output of stool rectally as into the pouch. After a couple of ER visits, one for ostomy pouch leaking bloody stool, and one for urinary retention, and later, a blood clot, I had lost confidence in my surgeon. My family all was urging me to seek a specialist. I did find a surgeon and now am scheduled for a Rectal Exam under Anesthesia with possible rectal flap procedure or possible SETON placement. He told me that in my situation I have probably less than a 50-50 chance of regaining normal bowel function. He also was less than encouraging about fistula repair outcomes. I am looking at this with more and more trepidation and can't find much online that leads me to believe this will be a positive experience. My primary care physician also made the remark "I hope he told you this is a difficult problem to fix." Do I have a choice? I feel now that everything is broken beyond repair. As of now, I'm spending most of my mornings in the bathroom, first emptying my pouch, sitting on the toilet trying to allow stool to exit my rectum but afraid to strain to help it.....and having the constant feeling of needing to have a bowel movement, As soon as I get cleaned up and stand up from the toilet, I have the urge again to sit back down. My new surgeon suggested tap water enemas for a week to clear out the colon. I did this and the first day I did get results but after that, the water squirted right back out as though it was hitting a wall. Then it seemed as though it might be exiting through the fistula. I stopped the enemas because I was afraid I was going to make the fistula worse. I'm counting the days until my procedure just after the first of the year. I have doubts that I will ever be in a condition which will allow reversal of the colostomy. At this point, I could deal with the ostomy if I did not also have to coax out the stool in my rectum. Has anyone out there had a successful fistula repair?

Interested in more discussions like this? Go to the Ostomy & J-Pouch Support Group.

Profile picture for Colleen Young, Connect Director @colleenyoung

@blinken, you may also wish to inquire about getting an appointment at Mayo Clinic in Rochester MN or Mayo Clinic Health System in La Crosse WI. Here's more information about how to request an appointment as well as links to frequently asked questions and more http://mayocl.in/1mtmR63

Rectovaginal fistula is treated by experts in the department of Obstetrics and Gynecology. See a list of doctors here: https://www.mayoclinic.org/diseases-conditions/rectovaginal-fistula/doctors-departments/ddc-20377114

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@colleenyoung , I’ve seen several gynecologists for my rectal/vaginal fistula. They are unable to help due to the fact my entire rectum was removed during the colectomy with j pouch surgery in 1983. I’m at wits end! Suggestions would be greatly appreciated. I’m in Texas, approx 90 miles East of Dallas.

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I’m not sure I have the same thing as you but perhaps in layman’s terms without knowing the name - I have Jpouch anal stenosis with prolapse of the pouch as well placing it right up to vagunal area and too risky for surgery

My heart goes out to you. I was thinking of revisiting for options the doctor to see if they can help the continual horrible issues within the anal area of when I try to evacuate stool and the irritation of all the food when it passes. Constantly inflamed tissue. Years ago because it was so close to the vaginal area they said it was too risky to
Try and fix. . Reading your post makes me think that neither can really be fixed. I don’t want to risk worse things happening - it actually dumping into vagina , but was hoping they could fix the skin around the anal area at a minimum so it wouldn’t be so sensitive. It doesn’t sound like anything worked for you.
Do you have these issues when trying to evacuate with skin irritation in the annal area. Perhaps you don’t have stenosis but I do think fistulas and fissures are an issue? Years of small pieces of food, getting stuck within the faults of the anus, causing irritation on evacuation. If so, did the surgeries you had help with this at all? I’m sorry I’m not answering your question. I’m just trying to see if we might have the same thing and can relate possible remedies in future.

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