Definition: Abnormal communication between the rectum and vagina with involuntary escape of flatus and/or feces into the vagina is called rectovaginal fistula (RVF).
CAUSES OF RECTOVAGINAL FISTULA
Acquired: - Obstetrical
- Incomplete healing or unrepaired recent CPT is the commonest cause of RVF.
- Obstructed labor—The rectum is protected by peritoneum of pouch of Douglas in its upper-third, by the perineal body in the lower-third and by the curved sacrum in the middle-third. However, if the sacrum is flat, during obstructed labor the compression effect produces pressure necrosis infection sloughing fistula. Instrumental injury inflicted during destructive operation.
- Following incomplete healing of repair of old CPT (commonest).
- Trauma inflicted inadvertently and remains unrecognized in operations like—perineorrhaphy, repair of enterocele, vaginal tubectomy, posterior colpotomy to drain the pelvic abscess, reconstruction of vagina, etc.
- Fall on a sharp pointed object.
- Malignancy of the vagina (common), cervix or bowel.
- Lymphogranuloma venereum or tuberculosis of the vagina.
- Diverticulitis of the sigmoid colon abscess bursts into the vagina.
- Inflammatory bowel disease: Crohn’s disease involving the anal canal or lower rectum.
Congenital: The anal canal may open into the vestibule or in the vagina.
DIAGNOSIS OF RECTOVAGINAL FISTULA
- Involuntary escape of flatus and/or feces into the Vagina. If the fistula is small, there is incontinence of flatus and loose stool only but not of hard stool.
- Rectovaginal examination reveals the site and size of the fistula.
- Confirmation may be done by a probe passing through the vagina into the rectum. If necessary, methylene blue dye is introduced into the rectum which is seen escaping out through the fistula into the vagina. Examination under anesthesia may be conducted to facilitate clinical diagnosis.
INVESTIGATIONS OF RECTOVAGINAL FISTULA
- Barium enema.
- Barium meal and follow through may be needed to confirm the site of intestinal fistula.
Sigmoidoscopy and proctoscopy are helpful for the diagnosis of inflammatory bowel disease or for taking biopsy of fistula edge.
HOMOEOPATHIC MANAGEMENT OF RECTOVAGINAL FISTULA
The medicines that can be thought of used after the total case history of the patient is done and considering the totality of symptoms are: -
- Silicea terra
- Hepar sulph
- Myristica sebifera
- Acid nitric
- Apis Mel
- Calcarea Flour
- Collinsonia etc