Treatment

Symptoms of a rectovaginal fistula can be distressing, but treatment is often effective. Treatment for the fistula depends on its cause, size, location and effect on surrounding tissues.

Medications

Your doctor may recommend a medication to help treat the fistula or prepare you for surgery:

• Antibiotics. If the area around your fistula is infected, you may be given a course of antibiotics before surgery. Antibiotics may also be recommended for women with Crohn's disease who develop a fistula.
• Infliximab. Infliximab (Remicade) can help reduce inflammation and heal fistulas in women with Crohn's disease.

Surgery

Most people need surgery to close or repair a rectovaginal fistula.

Before an operation can be done, the skin and other tissue around the fistula must be healthy, without infection or inflammation. Your doctor may recommend waiting three to six months before having surgery to ensure the surrounding tissue is healthy and see if the fistula closes on its own.

Surgery to close a fistula may be done by a gynecologic surgeon, a colorectal surgeon or both working as a team. The goal is to remove the fistula tract and close the opening by sewing together healthy tissue. Surgical options include:

• Sewing an anal fistula plug or patch of biologic tissue into the fistula to allow your tissue to grow into the patch and heal the fistula.
• Using a tissue graft taken from a nearby part of your body or folding a flap of healthy tissue over the fistula opening.
• Repairing the anal sphincter muscles if they've been damaged by the fistula or by scarring or tissue damage from radiation or Crohn's disease.
• Performing a colostomy before repairing a fistula in complex or recurrent cases to divert stool through an opening in your abdomen instead of through your rectum. Most of the time, this surgery isn't needed. But you may need this if you've had tissue damage or scarring from previous surgery or radiation treatment, an ongoing infection or significant fecal contamination, a cancerous tumor, or an abscess. If a colostomy is needed, your surgeon may wait eight to 12 weeks before repairing the fistula. Usually after about three to six months and confirmation that your fistula has healed, the colostomy can be reversed and normal bowel function restored.