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Has anyone had personal experience with rectovaginal fistula repair?
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?
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Hi Teresa, I'm sorry to say that I am still awaiting treatment for the fistula. The search for the fistula was conducted under anesthesia with blue dye introduced into my rectum and a white sponge into my vagina. There was no discoloration on the sponge so the surgeon was unable to locate the fistula with this method. There was stool in my rectum, however, so that may have obscured the opening. He did make two tiny incisions into the rectal stricture caused by the rectal prolapse surgery in August of last year, to allow stool to pass more easily. It is still pretty tight so have been instructed by him to do tap water enemas 3 times a day in order to loosen the stool. Most times I believe the water squirts out via the fistula and I'm unable to keep the water in. I have increased my fiber by using chewable fiber supplements, eating a prune before bedtime, having Activa Yogurt, old fashioned oatmeal and raisin bran (yes, all three each breakfast) trying to drink 6-8 10 oz. glasses of water daily and eating more bean based dishes and using veggie burger in casseroles and tacos or sloppy joes. Snacks are usually grapes and nuts or apples, etc. I have gained considerable weight with all these carbs and am frustrated with the enemas. You might remember that I also have a "temporary" colostomy that I'm hoping can be reversed but only if we find that I can pass stool totally on my own and be able to control it. Before the surgery in August for the prolapse my stools were not formed so the fact that now I have firm stools confounds me. As to the colostomy, the stool coming into the bag varies, usually it's a mashed potato consistency but sometimes like clay. The surgeon who I transferred my care to and who specializes in colon procedures is unsure how to proceed since the fistula was not found. The next thing he suggests is to do a manometry of the the rectum to see if I can push out an inflated balloon and also if I can keep it from being ejected in order to determine if I can have normal control of my bowel movements. At first, a few weeks after I had the colostomy surgery, when I started having stool that bypassed the colostomy, the stool was soft and easily passed. I don't think the scar tissue had yet formed the stricture. This doctor is not sure how best to proceed with me and we talked about second opinion. He said he would be happy to write a referral somewhere but I don't need one for my insurance and have made an appointment with a Colo-rectal surgeon at UW Madison. I would be willing to travel and transfer my care to him even though it is difficult for us at our age to drive in city traffic. My husband has macular degeneration which makes driving on unfamiliar freeways difficult. The appointment is at the end of March so hopefully we won't have winter weather to deal worry about. Thanks for listening...
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2 ReactionsI will, thanks again.
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1 ReactionYou are right, @blinken. The more informed a patient is, the better they can advocate for themselves. Wishing you all the best!
Will you post after your procedure and let me know how you are doing?
Thank you. I have read a few things but the more I can learn, the better equipped I will be to deal with things afterward.
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2 Reactions@blinken Here is a Connect discussion about fistulas. https://connect.mayoclinic.org/discussion/anal-fistula-procedures/
Also, here is a Mayo Clinic video that gives information about the SETON procedure.
https://connect.mayoclinic.org/page/gastroenterology-and-gi-surgery/newsfeed-post/the-role-of-setons/
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1 ReactionI'm scheduled for January 6 for Exam under Anesthesia with possible rectal flap or possible SETON placement.
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1 ReactionHello @blinken,
I'm glad to hear that you have a procedure scheduled with a specialist in colon/rectal issues. I hope that helps. When will this procedure be done?
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1 ReactionThank you for your suggestions, Colleen. I desperately wish we were closer to a Mayo facility. At our age and condition, a trip to either LaCrosse or Rochester is beyond our capability. I will have to continue my search with a closer destination. Milwaukee area would be difficult for us but we could do it. Green Bay would be easier for us, Appleton, Neenah, Oshkosh, Fond du Lac all familiar and doable for us. I will continue my search. I see the recommendations for Urogynecologists and will seek out someone closer to us. As it is, I currently have a procedure scheduled for a surgeon with specialization in colon/rectal issues.
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3 Reactions@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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3 ReactionsHello Teresa, thank you for addressing my post. We are a couple of hours from Madison's UW hospital but I would consider seeing someone there even though winter travel may cause some problems. I think, being in our late 70's, travel to Marshfield would be extremely difficult, unfortunately. But if someone could direct me to a particular clinic/specialist at UW Hospital-Madison, I would definitely seek an appointment there. I just have no idea how to go about finding the right place there for me to go. Thanks again for your consideration.
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