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.

Anybody know of a specialist in surgery for rectovaginal fistula repair in or around Nebraska? I first had 2 different ultra sounds, I had to go back for the second one because they weren't sure about the results. They talked amongst themselves and one said "Do you know how rare this is?" Then they set up an MRI with and without contrast dye on Sept. 27th where they found 2 fistulas. I don't think rectovaginal fistulas are rare-maybe one is a colovesical fistula but what do I know? But I won't even BEGIN to know until mid December when I will have my first consult with a general colon and rectal surgeon that works in 2 hospitals in my town. And he probably will be able to repair the 2 fistulas just fine. The problem is he seems to be too busy. No telling what could happen between then and now. I'm on my 3rd round of antibiotics for UTI already...Anyone know of anyone?

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Hello,
I have been here many times re my CKD3 kidney disease. This question is for a good friend of mine who has many physical conditions but this one is not one of them. About a year ago my friend had an extreme pain starting from her vagina and all the way up to her mouth making her want to vomit. Since this first one she just had fistula surgery which was quite serious. The other day the same pain started (she was in a store at the time) and this one was more painful and she actually had to vomit in the store. She has told doctors about this but they don't seem to take it seriously. Has anyone had this happen to them and did they get a diagnosis for this?? Thanks in advance. Nancy

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That is the issue. After about 10-14 days with the catheter in and after the surgery, the hole opens up again. I woke up with a big wet spot and some blood on the 14 day with the catheter in. My surgery at UTSW suggest going with a female urologist at UTSW that can do the surgery robotically. I am also going to speak with my urogynocologist when she receives the reports from UTSW. Dr. Lemack and Dr. Hassell seemed to have done the same procedures with no success. One use 3 layers and Dr. Hassell only used 1. They both checked the bladder after the surgery while I was under and said it was not leaking. Seems like Urologists should do better since its just closing up a hole.

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Profile picture for cnh @cnh

I too have a vaginal fistula and after 3 surgeries which all have failed, I do not know where to go. The head of Urology at UTSW suggest I see one of his colleagues who can do the surgery robotically. I believe that the procedure is not the problem. The problem is the materials used to try and close up the fistula. Im 72 and my whole life is turned upside down. Both doctors that performed the surgery do not know what went wrong and would do nothing different. So where do I go from here?

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Welcome, @cnh. It sounds like having a consult with the surgeon might be a good next step.

I’m hoping that @trishanna may have some thoughts for you as well. Trishanna, how are you doing?

CNH, have you and your doctors talked about alternatives that could be used to close up the fistula and if that indeed is the issue?

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Profile picture for trishanna @trishanna

My lovely fistula (hole in my vagina) is getting worse. I, too, recommend Mayo and requested a second opinion, and was refused. I am with you in spirit and shall follow even though I can't help. One cannot imagine oily diarrhea gushing out of one's vagina. Worse experience of my life and I am 82. Lack of knowledge out here in monstrous! Recommend a colorectal surgeon.

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I too have a vaginal fistula and after 3 surgeries which all have failed, I do not know where to go. The head of Urology at UTSW suggest I see one of his colleagues who can do the surgery robotically. I believe that the procedure is not the problem. The problem is the materials used to try and close up the fistula. Im 72 and my whole life is turned upside down. Both doctors that performed the surgery do not know what went wrong and would do nothing different. So where do I go from here?

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My lovely fistula (hole in my vagina) is getting worse. I, too, recommend Mayo and requested a second opinion, and was refused. I am with you in spirit and shall follow even though I can't help. One cannot imagine oily diarrhea gushing out of one's vagina. Worse experience of my life and I am 82. Lack of knowledge out here in monstrous! Recommend a colorectal surgeon.

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@mahoney @blinken. Thanks for your response. I'm so upset that I failed to post correct name.

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Profile picture for kenc @kenc

Hope it all works out for you.

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Than you very much. I appreciate that 🙂

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Profile picture for mahoney @mahoney

I had surgery to repair a rectalvaginal fistula. I never knew I had a problem until diarrhea started spewing out of my vagina. The cause was diverticulitis that had blown a hole in my colon; however, I didn’t know until after a very long surgery. They removed 1/3 of my colon which resulted in colostomy. I went septic the next day, my heart had to be restarted and was in ICU a week. Unbeknownst to me at the time, the surgeons also severed my left utter. After I healed, all I wanted was a reversal. Instead of a reversal, 3 months later I was diagnosed with breast cancer and had a bilateral mastectomy followed by chemo.

I went to Mayo in Jacksonville and my left kidney was full of waste. Due to my utter being severed, it couldn’t drain to my bladder. They ordered a CT scan and my left kidney was so full, not contrast could go in. So I’ve got a pouch in the front and great doctors drilled a hole in my back to my left kidney and I have a bag in the back to drain the urine from my kidney.

So here’s where I am. In 2 1/2 weeks I have a team of excellent surgeons at Mayo who are going to fix my huge hernia that encompasses my entire abdominal wall, hopefully successfully reconnect my colon and remove my left kidney as I went into renal failure due to the utter being severed. I can not wait to be free from pouches and tubes.

Oh and by the way, the fistula repair was a success. He did it robotically.

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Hope it all works out for you.

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Profile picture for blinken @blinken

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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I need results like from your diet, but suspect huge diary! Ha!

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