Recto-vaginal fistulas

Billy · Site Admin Joined: 23 Jul 2005 Posts: 306

This thread is an extension of the Rectal Vaginal Fistula thread. Please continue posting within this thread.

shellsue42 · Newbie Joined: 31 Mar 2007 Posts: 37

Rooney...that sounds like my story to a tee...the whole my dr. should have done a c-section...but didn't...and now have suffered 8 surgeries and am still not back to normal.

Currently, I have a perianal fistula, which is just an extra tract from my rectum (above the sphincter) to my perineum. I have left it alone for 4 months, hoping that it was just closing up on it's own since after my failed plug repair, the pain went away for a while.

Now it's been getting really sore, and for the first time in a while, I actually reached down there and felt to see if there were any absesses, and I felt something really weird. When I look now, I can see something protruding from the fistula hole, just a little, but something nonetheless!! It hurts really bad to the touch...and I feel like my whole perineum is collapsing...kinda like when my sphincter was disconnected...

My fear right now is that I think I might be having an anal prolapse through my fistula tract. Is that even possible??

I take antidiahrea every day b/c I was on constipating pain killers for so long that I get diahrea pretty instantly if i don't take them every day...so for a while I was getting really constipated and pushing pretty hard.

Anyway...I feel for everyone here who has to deal with this crap...and Rooney, I wish I had talked to you a few years ago, b/c I looked into suing, and no-one wanted to take my case b/c it was not open and shut and it's hard to prove fault...

am64 · Newbie Joined: 10 Sep 2007 Posts: 1

I just found this site -- THANK YOU to all of you who have posted! Like many of you, I have also felt alone and self-conscious in this.

Can any of you recommend websites that explain the various repair options? What are the plug and button approaches that some of you have mentioned?

I have been living with an RVF for nearly 16 years, following 4th degree tearing while delivering a 9lb 4oz baby (1991). I checked into getting it repaired by a colorectal surgeon about 3 months after the birth (spring 1992) , but when I asked about the safety of the postsurgical constipating drugs, he said, "We'll have to see if we can find some drugs that won't affect your baby." For a nursing mother, that "if" was a huge turn-off. Then I found out that a resident would be doing the surgery and decided not to go through with it.

In 1992, my second (smaller!) baby was also born vaginally. My plan was to let the site re-tear and then re-do the repair, which my doctor thought could succeed because of the increased blood supply to the region during pregnancy. It didn't. The fistula reformed, larger than before. Being very careful about cleanliness has helped me avoid yeast infections and UTIs (only two in 16 years).

Three years ago, I looked into repair again. This time the repair would include a diverting colostomy, an OBGYN and a general surgeon. I found a very positive site about living with -ostomy, but was completely turned off by the idea of living with it myself, even temporarily, as well as having a second surgery only 6-8 weeks later to reverse the colostomy. Too much surgery for me, plus a scar as a permanent reminder.

I've looked online for repair methods, trying to educate myself before checking into repair again. So far, no luck finding options. I'm hoping some of you can point me in the direction of information.

Thank you!

shellsue42 · Newbie Joined: 31 Mar 2007 Posts: 37

You could ask your colorectal surgeon about these other options (BTW - I would ONLY allow a colorectal surgeon do any procedure. You were smart to not have it done with an intern!):

Mucosal Advancement Flap

Surgisis Plug, I think they have a new one with a button on the end to hold it in place. They usually put a few stitches.

Perianal reconstruct, with or without the sphincter overlap repair.

Do you know if your connection goes through your musle? And how is your control?

If your muscle is ok, I would leave it alone, and just try to get the hole fixed, etiher with the plug (which has a very low success rate, I've had 2 fail), or you can ask about the mucosal advancement flap. I had mine done from the rectal side, they cut a flap and pull it down over the hole...it's delicate...but could work.

The colostomy is probably just to keep the area clean and to keep you from having to strain during any repair recovery you decide to have done. It's an interesting option that I was never offered, and never really thought about, but probably wouldn't have opted for either. I have had all of the above procedures done, and now have to decide what to do next because I have a new fistula which developed after my sphincter repair.

I had some ano-rectal testing done this morning and am waiting on results to find out how my muscles and nerves responded to the "probing." The ultrasound was very interesting to see. I have a perinanal fistula that goes right through my sphincter muscle, so I only have a few options...do nothing and suffer as it is, try plug after plug to see if they eventually work, of have a full reconstruction done AGAIN of my perineum/sphincter.

This by far was the WORST surgery I've ever had to deal with, very painful, very hard recovery, and the dr can't guarantee that the problem won't come back...or that I won't lose control again...so I don't know what to do about it...

jaidynsmom · Newbie Joined: 19 Sep 2007 Posts: 1

I would like to know if anyone has gotten an RVF that was not due to the vaginal delivery of a child?

I was diagnosed w/a perirectal abscess in June '06 and I was told that a RVF was possible after my surgery to remove the abscess. And as it usually is for me, if there can be a problem, there will be. As I was being admitted to the hospital for the abscess surgery, the abscess ruptured in my vagina. I was told by my surgeon that this would heal by itself as would the two other holes that he cut to drain the abscess. Well needless to say a fistula has now developed. I am having gas and stool pass through my vagina.

With all of the posts, I am beginning to think that my chances for 100% repair are pretty slim.

Any suggestions on which would be the best possible repair?

Guest · Guest

Thank you, Shellsue. I appreciate having some options to read up on before meeting with another doctor.

How were the results of your testing? Was there any information that points to a repair method with a high chance of succeeding for you??

A doctor a few years back told me that I was lucky to have as much rectal control as I do (almost as good as before childbirth) after two spincter tears. She did tell me, though, that I have a thin perineal body, which could eventually lead to bladder prolapse.

It's said that childbearing changes a woman's body forever, but no one ever mentioned any of this!

Guest · Guest

I had a hysterectomy that resulted in a RVF. My doctor accidentally cut into my rectum. The hysterectomy started out be vaginal, but she decided to complete it abdominally. I noticed the RVF 4 days after the hysterectomy. I went to a colorectal surgeon, who performed a repair of the RVF and also performed an ileostomy to allow for healing of the repair. I have about a month to go before tests are done to determine if the repair has healed. If it has, I will have another surgery to do the ileostomy repair. It has been a rough road, both physically and emotionally. I would not wish this on anyone.

shellsue42 · Newbie Joined: 31 Mar 2007 Posts: 37

My test results came back and it looks like I have good sphincter resting tone, which is what someone else mentioned...being surprised about how much control they had after these surgeries...what I don't have is much of a squeeze strength...so if I can't hold something in, I can't hold it in, and I don't think this will ever get better without a surgery. The ultrasound showed that both my inner and outer sphincter muscle rings are defective, meaning they are not attached fully and are not working to capacity. This really surprised me since that is what I had fixed (sphincter overlap) and suffered through for 8 months...

After talking to the dr and discussing our options, I have decided to leave things alone for now and deal with the situation as it is. I really don't want to put myself through another reconstruction only to be back to where I am now, or worse since she would be going through my muscle for the 4th time, and I already don't have much to work with. The dr. didn't sound too confident in anything she wanted to do, and I figure if the surgery didn't hold the first time, why bother again a second time right?

am64 Did you meet with your dr. about other options? What did you come up with??

Jaidynsmom - that sucks that your absess turned into RVF! I'm so sorry you have to go through this. There are always chances that the less invasive surgeries will work, so before having a full reconstruct done, you may want to opt for the surgisis plug first. That is pretty uninvasive, an outpatient surgery with a semi-delicate recovery.

If that doesn't work, there are other options that I mentioned in my previous post. I'm not sure where to even tell you where to begin, but it doesn't sound like the RVF is through your sphincter muscle, which may be a plus, but if it is, it may be a bit more complicated to repair.

Guest · Guest

Has anyone had problems with fistulas or episiotomies re-opening years later? After having my first child and being torn six ways to Monday, I had three more C-sections to avoid going through that again. Now, almost 18 years after my only vaginal delivery, I'm noticing blood again (and have for a month or so now) in a straight line along the perineum. It's definitely not menstrual, so I'm a little worried that something may have opened up again.

shellsue42 · Newbie Joined: 31 Mar 2007 Posts: 37

Unfortunately, I haven't experienced that b/c I've yet to be back to normal...but, maybe someone else?

I would think it might be possible if when you were repaired years ago, there was still a small pocket, and just developed another...

Recto-vaginal fistulas

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