This article is for information purposes only; it is not a substitute for an examination and a physician’s assessment.
A rectovaginal fistula is an opening that forms in the wall between the bowel and the vagina; its most typical signs are gas passing from the vagina, foul-smelling discharge and recurring infections. The most common cause is a childbirth injury. For an established fistula, the solution is planned repair surgery — and this is a condition to be treated, not to be ashamed of.
I want to open this article from a slightly different angle. Nearly all of my rectovaginal fistula patients come in for examination months late — not because the symptoms are mild, but because they're hard to talk about. I've listened to patients who couldn't even tell their spouse about passing gas from the vagina, the foul-smelling discharge, or the staining of stool. Let me say this up front: this picture is not your fault — it's a repairable anatomical problem. And yes, it can be treated.
What is a rectovaginal fistula?
The final section of the bowel (the rectum) and the vagina are normally separated by a thin but sturdy wall of tissue. If an opening forms in this wall for any reason, bowel contents begin to pass into the vagina. This passage is called a rectovaginal fistula. Unlike fistulas around the anus, the tunnel opens into the vagina rather than the skin — which is why the symptoms differ too.
Symptoms: let's name them
The classic triad is: gas passing from the vagina (the first sign most patients notice), foul-smelling or stool-tinged vaginal discharge, and the recurring vaginal and urinary tract infections that come with it. Small fistulas may cause only occasional gas leakage; larger ones show clearer stool staining. Pain during intercourse and irritation in the area can also accompany the picture.
Why does it happen?
Childbirth injury is by far the most common cause — especially after difficult, assisted deliveries or those with extensive tearing. Sometimes the fistula becomes apparent right after delivery, sometimes only years later. Pelvic surgeries (uterine or bowel operations) form the second major group. Crohn's disease can erode tissue from within and create a fistula; in younger patients we rule this out first. Tissue that has undergone radiotherapy can develop a fistula even years afterward. Rarely, pelvic abscesses and certain tumors can also be a cause — which is why we never skip the diagnostic stage.
How is it diagnosed?
An examination usually reveals the fistula's opening; for small, hidden fistulas we use MRI or specialized tests. In diagnosis we look for the answer to two questions: exactly where is the passage, and on what underlying condition did it develop? Because the treatment plan for a childbirth-related fistula is not the same as one arising from Crohn's disease.
Treatment: an honest framework
First, you should know this: a rectovaginal fistula is an area that calls less for "laser" treatment and more for planned repair surgery, unlike an anal fistula. Some small, new fistulas may close on their own while under observation; but for an established fistula, the solution is repair with healthy tissue. Where Crohn's disease underlies it, the disease must first be controlled with medication — any repair stitched into inflamed tissue is doomed to recur. Getting the sequence and timing right is half of this surgery — the other half is experience.
Let me also make this clear: the treatment process can sometimes require more than one stage. Knowing this from the start is better than being surprised along the way; at your examination we'll map out a realistic path for you.
Frequently asked questions
Is there a chance it closes on its own?
There is a limited chance in small, new, non-inflamed fistulas; this can be observed under a doctor's follow-up. For fistulas that have persisted for months and pass stool, this chance is practically nonexistent.
Can it appear years after childbirth?
Yes. A wall weakened during delivery can turn into a symptomatic fistula years later — sometimes as tissue thins after menopause. The fact that "my delivery was years ago" does not rule out the diagnosis.
Which department should I go to with this complaint?
A general surgery practice with a proctology focus is the right address; when needed, we work together with gynecology and gastroenterology. What matters is that you don't hesitate to voice the complaint.
Can I return to normal life after treatment?
After a successful repair, most patients return fully to normal bowel and sexual life. Maintaining a soft stool routine during recovery is important for the durability of the result.
If you've recognized these lines in yourself or someone close to you, the first step is an examination — and nothing about that conversation will embarrass you; we discuss these cases every week. Levent: 444 8 623. For fistulas in the anal region, you can also take a look at our general fistula article.
Sources
- American Society of Colon and Rectal Surgeons (ASCRS), fascrs.org
- American College of Obstetricians and Gynecologists (ACOG), acog.org
Content owner: Yasir Gozu, MD
Published: July 10, 2025
Last updated: July 8, 2026
