Simon Radley is a co-author on a recently published book chapter on the management of recto-vaginal fistula in the textbook of Gynecologic and Obstetric Surgery (Challenges and Management Options).

Recto-vaginal fistula is not a common condition and occurs when a hole is formed between the rectum (lowest part of the large bowel) and the vagina. As a result of this, wind, liquid and sometimes even solid stools can leak into the vagina. This obviously can become very distressing for those affected.
The chapter addresses the common causes of such fistulae obstetric (childbirth) injuries, abscesses around the anus and vagina and Crohn’s disease. Complications from surgery to the anus rectum and vagina can rarely result in a fistula as can certain cancers affecting those areas.

It is important to have an experienced, multidisciplinary team to identify and manage these problems. The chapter explores common ways of repairing recto-vaginal fistula. Repair may be either through the vagina or anus where the fistula is close to the entrance of the vagina or alternatively sometimes an operation through the abdomen may be required where the upper part of the vagina is affected. These fistulae can be difficult to treat and the success usually depends upon the cause of the fistula and in some cases repair may not be possible.