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Recto-Vaginal Fistula - Does it *have* to be treated/fixed?

The reason I ask if it *has* to be be fixed/treated is that although I have one, other than passing gas through the vagina, I have no other symptoms or problems with it.

I have never ever had stool come through it ... only gas. And since I had a bowel re-section (last summer), I have had a LOT of loose/watery bm's. And never ever has any liquid come out of it. But it does seem like gas comes out of it more often now than it used to. Like if I feel gas coming on, it will "seep" from that hole, and then if I place some pressure, it will come out of the rectum as it should instead of from the vagina. Also, in three years, it has never become infected.

Years ago (probably 5-6 years ago) I had a very painful abscess in the vagina ... this was before I was dx'd with Crohn's. I went to a doctor to look at it and literally sitting in his waiting room it burst, and I had a huge rush of liquid-ish pink/creamy stuff come out (like pus with a bit of blood in it). After it burst, the pain immediately ceased, and I felt fine. The doctor was seeing me for another reason (I had just become pregnant, and it was my first pre-natal appt) so he didn't actually look at it. He assumed it was a bartholin's gland cyst and he just told me to do sitz baths and come back if it got infected again. I went through my whole pregnancy just fine and it didn't happen again. After my delivery though, I didn't "heal" properly. The first time DH and I tried to be intimate, it was horribly painful and I bled a ton of fresh blood. Upon closer inspection, I had some fleshy "tissue" down at the base of my vagina that was just sort of hanging there. Went back to the OB, and he took one look and thought for sure it was some kind of cancerous growth. He took a biopsy (benign) and scheduled surgery on it. He ended up slicing open the entire length of my vaginal wall to cut out this "growth" and re-stitching it. Didn't say anything about noticing a fistula (but at this time, I was still undiagnosed, and I had no symptoms of a fistula other than that first infection).

Over the next couple of years, I had two more infections similar to the first, and once I went to my doc to check it out and he saw nothing. Another time, same thing. He said my vagina looked completely normal. But then within a day or two (both times) the "cyst" ruptured on its own, and a bunch of pus-like stuff came out. I think the last time this happened was about 3 years ago. But then my Crohn's hit full-force, and I was s-i-c-k for about a year, going from obstructions with puking, to 15 bm's in one day ... lots of cramping and bowel spasms, just awful. And I think that's when I started to notice that I was passing wind through my vagina. It had never happened before that. And now in the last three years, while I feel like maybe the wind-through-the-vagina is more frequent, I have never had another infection/abscess, and I've never had any liquid come through it. Just prior to my re-section, I mentioned this to my surgeon, who took some kind of scope and examined my vaginal and rectal area and saw nothing. He discussed setting up an MRI to have a look, but I never heard from them again so I assume he forgot to arrange it (he was a student) and I was more concerned about my surgery than that issue.

So my question is this ... do I need to pursue this? Does it sound like a fistula? Maybe I'm wrong? I've never been formally diagnosed with it, but I am assuming that's what I've had. Back when I was seeing my OB/GYN, we thought it was one thing, when in fact it was likely due to the Crohn's. When I had the "growth" after I had my baby, I thought maybe it was excess skin or something either from the delivery, or from the abscess (it was HUGE and swollen practically inside out -- I'd say that at least 1/4 cup of pus and fluid came out of it) -- so I thought that maybe it had torn open when I had the baby, and left a big chunk of flesh dangling there from where it had opened.

I did have two other fistulas that were taken out when I had the re-section (up in the small bowel), but this one seems to be very low in the recto-vag area, so it was not noticed in my surgery.

What do you think?

thanks for your time,
Angie
 
Hi Angie,
I also have one of these that arrived when I had my first child in 2003. I told the gyno about the wind and was assured that all was well, sometimes birth "changes things" It was not properly identified until I had a EUA in 2011 for a perianal fistula. The surgeon did put a seton in but he only left it in for a couple months. It didn't seem to make any difference and because my disease is so active there he will not even discuss possible surgical fixes as he says they are risky at thus point.

Do you need to investigate it? In my experience it did not matter - however I never had an abscess there. If nothing else it might do you some good just to know what is going on there. Frankly, my experience has been that a EUA is alot more accurate then an MRI. I had an MRI and it only detected the perianal one. Good luck whatever you decide.
 
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