How can you determine the presence of a vaginal-intestinal fistula? Rectovaginal fistula: symptoms and treatment

In medical practice, a rectovaginal, enterovaginal, or fistula is a lumen formed in the septum between the rectum and the vagina. This phenomenon is very unpleasant and in most cases can only be eliminated surgically. How to recognize pathology in time and avoid possible complications?

General characteristics and types of rectovaginal fistulas

A fistula or fistula is a pathologically formed canal, the walls of which are lined with epithelium. It can form on the gums, between the bronchi and lungs, but most often the disease affects the rectum. Such fistulas are called rectovaginal or enterovaginal.

They are a kind of hole in the septum between the rectum and the size of which can reach from a couple of millimeters to several centimeters. In this case, vaginal discharge can penetrate into the rectum, and gases and feces are released through the vagina. Given that the pressure in the rectum is much higher than in the vagina, it is the contents of the intestines that penetrate the vagina, and not vice versa.

In rare cases, the pathology is congenital; more often it is acquired during life. Depending on the location (location), enterovaginal fistulas are classified into:

Low - located near the very edge of the anus (no further than three centimeters)
Medium - formed at a distance of three to six centimeters from the edge of the anus
High – located far from the edge of the anus and can extend into the uterus

According to the etiology, rectovaginal fistulas can be post-traumatic, postpartum or postoperative. According to the type of secretion released from them, they are divided into: purulent, fecal, mucous or urinary. A fistula defect is formed for various reasons; the developmental features, severity and clinical symptoms depend on them.

Reasons for the development of pathology

Today, there are many known causes and factors that provoke the formation of rectovaginal fistulas. These include:

Difficult and protracted labor with prolonged anhydrous period
Complications after gynecological or urological operations
Birth injuries associated with perineal lacerations and the use of obstetric instruments
Inflammatory and tumor diseases of the genitourinary system or
Damage to the rectovaginal septum or rectal wall during proctological operations
Paraproctitis and Diverticulitis (protrusion of stretched areas of the colon wall)
Inflammatory diseases of the genitourinary system and intestines, Crohn's disease
Damage to the ligamentous-muscular apparatus of the rectum
Opening abscesses in the vagina for infectious diseases such as syphilis, tuberculosis, etc.

And yet, the most common causes of acquired rectovaginal fistula defect are difficult childbirth when the size of the fetus does not correspond to the woman’s birth canal, malpresentation, unprofessional obstetric measures and other injuries during childbirth.

Often the cause of the formation of a rectovaginal fistula is poorly placed sutures after birth ruptures and their subsequent divergence. In such a situation, a second operation is urgently performed, but in ten percent of cases this also leads to complications - inflammation and the formation of non-healing ulcers, which subsequently turn into fistulas.

The congenital form of the disease is very rare, accounting for 0.001% of all known cases, while at the age of forty to sixty years the pathology is observed in one woman out of three hundred. It is quite difficult to navigate these statistics, because not every patient decides to consult a doctor with this delicate problem.

Clinical signs and symptoms

Symptoms of the disease can vary in severity and intensity. In this matter, everything depends on the severity and location of the fistula. The most characteristic symptoms of a rectovaginal fistula are:

Stool discharge and involuntary release of gases from
Purulent vaginal discharge
Spontaneous defecation and fecal incontinence
Pain during sexual intercourse and during periods of exacerbation

Persistent infections and inflammatory diseases of the genital tract (colpitis, candidiasis, etc.) This is due to constant irritation of the mucous membrane of the genital tract with feces and intestinal mucus, as a result of which the natural microflora is disrupted.

All these symptoms cause a woman a lot of problems of a hygienic, psychological and sexual nature. The presence of an unpleasant odor, lack of a full-fledged sex life, the constant need for sanitary pads and the fear that involuntary release of gases will occur at the most inopportune moment lead to the development of numerous complexes. The woman becomes irritable, nervous, and some patients experience apathetic and depressive states.

The situation is aggravated by the fact that many women, out of embarrassment, do not seek professional medical help and try to cope with the disease on their own. As a result, the problem is increasingly gaining momentum: the fistula increases in size and the symptoms intensify.

Due to the lack of sexual intimacy and neuroses, the family breaks up, against the backdrop of a general inflammatory process, health deteriorates and performance decreases, and psychoneurological disorders rapidly develop. To prevent this, you should immediately consult a doctor when the first signs of pathology appear.

Diagnosis and treatment

Modern medicine has developed several methods for diagnosing rectovaginal fistula, including:

A conversation with the patient, during which the specialist determines the medical history (development of the disease). The doctor will ask about the number, nature and severity of childbirth, the presence or absence of operations on the pelvic organs. It is important to talk about existing diseases of the intestines or reproductive system, radiation or chemotherapy (if any).
Next, a clinical examination of the vagina is performed using mirrors and a digital examination, which allows us to determine the presence of scars and structural changes in the mucous membrane at the location of the fistula.
Fistuloscopy is mandatory - a technique in which a dye solution is injected into the vagina. After this, the lumen is examined using special mirrors and a rectoscope. In some cases, the doctor prescribes x-rays, monometry, colonoscopy or other additional tests.
The most successful treatment method today is surgery, during which the inflamed and dead tissue is trimmed and the fistula itself is sutured. The fistula can be closed using various methods:
Using a flap obtained from the base of the small, vaginal or intestinal walls.
Using artificial collagen and other inserts.
Currently, she uses quite a few techniques for surgical removal of rectovaginal fistulas. Each of them is carried out by one of three possible routes of access: rectal, vaginal or perineal.

However, according to statistics, not every operation takes place without subsequent relapses and complications. This fact is explained by the excessive thinness of the septal tissue between the intestine and the vagina, and with fistulas it is also inflamed. Therefore, such an operation should be performed by a highly qualified and experienced surgeon.

The postoperative period is no less important, during which it is recommended to refrain from bowel movements for as long as possible. During recovery, patients must adhere to a special “liquid” diet, and sometimes have to fast for several days. Also at this time you need to protect yourself from colds and infections.

For women who have undergone such an operation, doctors do not recommend giving birth naturally in the future, preferring a cesarean section.

You can try to get rid of a small fistula on your own using traditional medicine recipes:

It is quite simple to prepare an ointment for the treatment of fistulas in the vagina and rectum at home. For this you will need 2 tbsp. Mix a vegetable mixture consisting of oak bark, water pepper grass and flax flowers with four tablespoons of rendered lard and place in the oven for ten hours, on the slowest heat.

Cool the resulting substance, apply it to tampons and insert it into the vagina at night. The course of therapy is three weeks; after a thirty-day break, a second course is possible.

For douching, it is useful to use decoctions of herbs such as calendula, yarrow or sage. These plants have long been known for their anti-inflammatory and antiseptic properties and are widely used to treat fistulas of various locations.

An effective remedy in the fight against fistulas is aloe and mummy juice, mixed in equal proportions with liquid or melted honey. Tampons soaked in this mixture should be inserted into the vagina at night for 15 days, after the same break the course should be repeated.

Before using any folk remedies, you should consult your doctor. Each organism is individual, and its reactions to plant products can be the most unpredictable.

Possible complications and preventive measures

Most complications are observed in the postoperative period. The tissues of the rectal-vaginal septum are very thin, they do not regenerate and grow together well, especially against the background of inflammation. Therefore, the most experienced surgeons who are able to make quick and error-free decisions are allowed to perform such an operation. Sometimes, during the operation it is necessary to resort to elements of plastic surgery.

As practice and statistics show, only about 70% of such surgical interventions are successful and without complications. In other cases, relapses are observed: it opens again, and there is a need for repeated surgery.

In this matter, everything depends on the skill of the surgeon, his chosen technique and proper care in the postoperative period.

It is necessary to exclude the possibility of stool in the first five days after surgery. At this time, the intestines are cleansed through siphon enemas and constant monitoring of the condition of the sutures and postoperative wound is carried out.

Patients adhere to a special diet, consuming only small quantities of kefir, water, broths and rice water, infusions of rose hips and raisins. The regimen and food products are individually selected by the attending physician. It is important that drinks and food are warm; cold or hot drinks and food are contraindicated during this period.

The most common complication after surgery is considered to be incompetence (divergence) of the sutures and insufficiency of the anal sphincter, which leads to involuntary release of gases and incontinence. Therefore, during the recovery period, patients are prescribed special gymnastics to strengthen the ligamentous-muscular apparatus of the rectum.

More often, postoperative relapses and complications are observed in patients whose fistula formation was caused by Crohn's disease or radiation therapy. Sometimes laser therapy helps speed up healing.Dj

While watching the video, you hear about a fistula.

During the recovery period, it is very important to monitor the hygiene of the genitals and anus, adhere to proper nutrition, avoid constipation (regulate daily bowel movements using laxatives and teas) and follow all doctor’s recommendations. This is the only way to get rid of rectal-vaginal fistula forever.

Practical activities:

Rectovaginal fistulas

Rectovaginal fistulas are a relatively rare, but extremely serious disease for patients. Without presenting an immediate threat to life, the main manifestations of these fistulas - involuntary release of gases and feces from the vagina - lead to a sharp change in the usual lifestyle, self-isolation, change of place of work, force patients to give up intimate life, and lead to the breakup of families. Rectovaginal (or rectovaginal fistulas) are the most common type of enterovaginal fistula. In this case, a pathological communication (anastomosis, fistula) occurs between the rectum and vagina.

What are the types of rectovaginal fistulas?

Rectovaginal fistulas are traditionally divided into congenital and acquired. Congenital rectovaginal fistula is a rare disease that is usually combined with other anorectal anomalies (anal atresia, etc.). Typically, anorectal developmental anomalies require correction in childhood, and are the responsibility of pediatric surgeons.

Why do rectovaginal fistulas occur?

In most cases, rectovaginal fistulas are acquired in nature and are divided into traumatic, inflammatory, oncological and radiation.

The most difficult group of patients with rectovaginal fistulas are cancer patients. One of the reasons for the formation of fistulas in such patients is the local spread of the tumor in the pelvis. By growing into adjacent organs, malignant tumors of the bladder, female genital organs, rectum or anal canal can lead to the formation of intestinal fistulas. In the absence of distant metastases, the only chance to save the patient from cancer and fistula may be to perform pelvic exenteration. But more often, a fistula in an oncology patient is not a consequence of progression of the underlying disease, but a complication of antitumor treatment, mainly radiation therapy. Sometimes patients who have been cured of cervical cancer through surgery and radiation therapy “pay” for recovery from the malignant disease by the formation of rectovaginal fistulas. This occurs because radiation therapy damages not only tumor cells, but also normal tissues. The rectum is most sensitive to radiation exposure.

The cause of rectovaginal fistulas of inflammatory origin may be the so-called “anterior” acute purulent paraproctitis, opened in the vagina. Crohn's disease of the large intestine can also lead to the formation of abscesses (pus cavities) in the tissue between the vagina and rectum, and then to the rupture of pus into the vagina and rectum, followed by the formation of a fistula (pathological communication) between them.

There are frequent cases of rectal injury during various gynecological operations. Surgical interventions with an increased risk of rectal injury are operations for rectocele using synthetic prostheses, colpoperineolevatoplasty (plasty of the posterior wall of the vagina and perineum), removal of retrocervical endometrioid infiltrate, removal of the peritoneum of the rectouterine cavity for ovarian cancer, and others.

Often, rectovaginal fistulas are formed as a result of suppuration of the perineal wound after suturing a third-degree perineal rupture during childbirth.

An everyday injury to the rectum is also possible during masturbation with the use of dildos, or when the perineal area falls on sharp objects.

What examination is needed?

Diagnosis of enterovaginal fistulas usually does not present any particular difficulties. Constant uncontrolled release of gases and feces from the vagina are the main symptoms of these fistulas. The patient is examined on a gynecological chair. In this case, you can detect scars in the perineal area, visualize a fistula in the vagina, determine the lack of closure of the anal sphincter, involuntary release of gases and feces. During examination, the integrity of the anal reflex is assessed. To do this, make stroke movements in the area of the anus, labia majora and buttocks, and evaluate the contraction of the external anal sphincter. With a digital examination of the anal canal and rectum, the doctor can determine the level of the fistula on the side of the rectum, assess the condition of the rectal mucosa, the presence of an anal sphincter defect and its tone, and the condition of the pelvic floor muscles. Further, the examination is supplemented with instrumental research methods. Anoscopy allows you to visually assess the condition of the mucous membrane of the anal canal and distal rectum. To exclude concomitant pathology of the large intestine, all patients must undergo colonoscopy or irrigoscopy with double contrast. Transanal ultrasound (US) and magnetic resonance imaging (MRI) allow more accurate visualization of the extent of the anal sphincter defect. It is also sometimes necessary to assess the condition of the closure apparatus (sphincter) of the rectum before surgery. For this purpose, functional methods of instrumental diagnostics are used. Sphincterometry, anal profilometry and electromyography provide the most complete picture of the functional state of the internal and external anal sphincters.

What treatment is possible for rectovaginal fistulas?

Conservative treatment of rectovaginal fistulas is ineffective; the main role is given to surgical treatment. At the first stage of treatment, most patients are given a colostomy, that is, a section of the large intestine located above the fistula area is brought out onto the skin of the anterior abdominal wall. Thanks to this operation, the area of the rectovaginal fistula is “switched off” and isolated from feces. Firstly, it relieves patients from such painful symptoms of the disease as the constant release of gases and feces from the vagina, and an unpleasant odor. Secondly, it helps relieve inflammation in the fistula area. The second stage of surgical treatment is the actual operation to close the intestinal-vaginal fistula. You can refrain from forming a colostomy only for small, low traumatic fistulas. Usually the operation is performed several months after the formation of the fistula. This time is necessary for the inflammation in the fistula area to completely subside and for the formation of favorable conditions for surgery. With post-radiation fistulas, the time before surgery can extend to 6–12 months. Surgery to close a fistula can be performed using an approach through the abdomen, vagina, or rectum. The access option depends on the location and size of the fistula, and the experience of the surgeon. The purpose of the operation is to separate the vagina and rectum and suturing them separately.

If the cause of the formation of a fistula is acute paraproctitis, then only rectal access is used, since it allows not only to separate the rectovaginal fistula, but also to excise the infected crypt at the border of the anal canal and rectum, which caused the formation of the fistula. For other low rectal-vaginal fistulas, the operation of choice is to disconnect the fistula and lower the rectal mucomuscular flap to “cover” the fistula area.

Operations for mid-level fistulas are performed primarily through vaginal access. With large fistulas and post-radiation fistulas, it may be necessary to use various flaps from surrounding tissues for more reliable closure of the fistula.

The greatest difficulties arise when suturing high rectovaginal fistulas. For this purpose, vaginal or abdominal access is used. A few months after the fistula has healed, you can proceed to the third stage of surgical treatment - closing the colostomy and restoring the passage of intestinal contents. In this case, complete medical and social rehabilitation of patients is achieved.

A fistula is a canal formed for any reason that connects organs. Through it, depending on the location of occurrence, pus, mucus, urine, feces and gases can be released.

Causes of formation of genitourinary fistulas

Fistula is a fairly common phenomenon, as there are many reasons that contribute to its formation:

gynecological and surgical operations. During the intervention, the urinary tract is damaged, and urine (urine) begins to be released through the vagina;
improper placement of sutures during interventions on the rectum. The passage of loose stools and gases through the vagina appears already on the third or fourth day;
obstetric injuries, associated with the application of forceps, extraction of the child using a vacuum, prolonged labor and a narrow pelvis. Ruptures of the cervix, vagina and rectum occur. After healing, fistula tracts remain;
criminal abortions, during which unqualified underground “specialists” injure the genitals, urethra and rectum.
ruptures of the vagina or rectum arising after rape, unnatural and rough sex, improper use of intimate “toys”;
diseases of the bladder and rectum, in which pus breaks out through the vagina;
radiation therapy, ending in 5% with the formation of fistula tracts in weakened tissues exposed to irradiation;
improper and prolonged use of synthetic devices used to treat prolapse of the uterus and vagina;
malignant tumors of the genital organs, bladder and rectum. A common cause of fistula tracts is advanced cervical cancer;
genital tuberculosis often accompanied by the occurrence of fistulas, which are difficult to treat.

Signs of genitourinary fistulas

A vesicovaginal fistula forms between the vagina and bladder. A woman complains of urine discharge from the vagina, purulent discharge from the genital tract and tissue inflammation - urinary dermatitis. The hole is discovered when examining the bladder using a device called a cystoscope. Treatment is surgical. The fistula tract is sutured through the vagina.

A urethro-vaginal fistula connects the vagina and urethra. When you urinate, a small amount of urine is released through the vagina. Patients do not go to the doctor, “attributing” the symptoms to age-related or postpartum urinary incontinence. Treatment is vaginal suturing of the fistula opening.

Ureterovaginal fistulas are characterized by constant leakage of urine through the vagina, lower back pain and fever caused by concomitant. Due to impaired urination, swelling occurs. A drain is installed to drain urine. This allows you to save the kidney. An operation is performed to reconnect the bladder and ureter. In 95% of cases, fistulas are eliminated.

Vesicouterine fistula occurs after an unsuccessful cesarean section. A woman experiences pain in the lower abdomen, massive discharge of urine from the vagina, and blood in the urine during menstruation. Due to inflammation of the uterus, the temperature rises. The defect is sutured through the abdominal wall and the uterine sutures are revised.

Signs of rectovaginal fistulas

A woman passes gas and liquid stool through her vagina. This leads to the formation of persistent vaginitis, accompanied by purulent discharge, pain and itching. During a gynecological examination, a hole with a dark border is discovered on the back wall of the vagina - protruding rectal mucosa.

The depth and direction of the fistula tract are measured with a button-shaped probe inserted into the fistula opening. The probe should make contact with the finger inserted into the rectum. Small fistulas are difficult to detect. For this purpose, examination of the vagina (examination of the vagina using a colposcope) and examination of the rectum (rectoscopy) are carried out.

Treatment consists of excision of existing scars and suturing with self-absorbing threads. The mucous membranes of the vagina and rectum are stitched separately. The operation is performed jointly by a gynecologist and a proctologist.

Vaginal fistulas cause physiological and psychological problems in women. Because of the unpleasant smell, she becomes depressed and does not leave the house. The absence of a normal sex life leads to problems in the family and a feeling of inferiority.

Without proper diagnosis and proper treatment, problems arise with the genitals, kidneys and intestines. In severe cases, kidney failure and blood poisoning develop. If you suspect genitourinary or vaginal-rectal fistulas, you should make an appointment with a doctor. Removal of fistula tracts is carried out together with proctologist surgeons.

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Often women face a variety of complications after childbirth. One of them is the formation of a fistula tract, a pathological canal that connects two hollow organs or cavities. The main problem of the disease is that abnormal contents, getting, for example, into the vagina or even the uterus, can cause the development of serious diseases. And this is not to mention the impossibility of sexual intercourse and the psychological discomfort that arises in a young girl.

Why do fistulas form, what are the main symptoms of the disease and methods to combat them?

Read in this article

Causes of fistulas after childbirth

Postpartum fistulas usually connect the vagina (much less often the uterus) with some other structures - the rectum, other parts of the intestines, bladder, etc.

The peculiarities of the anatomy of the pelvic organs are such that all organs here border on each other without additional restrictions or special fatty layers. The rectum is located directly behind the vagina, separated from it only by a thin layer of tissue. And in front lies the bladder. All these organs can be easily palpated through the vagina.

Their development does not always require any serious trauma or, especially, surgical interventions during childbirth. All tissues inside the small pelvis are so close to each other that even with prolonged compression, for example, by the head or other part of the fetus, necrosis subsequently occurs and fistulas are formed.

The main causes of postpartum fistulas are as follows:

Prolonged labor, during which parts of the fetus can press the pelvic organs against the walls of the bones. This is especially dangerous during a long period without water. The fact is that the amniotic sac provides a kind of “cushion” role, preventing excessive exposure. There is a disruption in blood supply and tissue nutrition. If the compression was critical, a fistula subsequently forms in this place.
Large or giant fruit. Moreover, even with careful adherence to all recommendations and manuals, the likelihood of ruptures of the perineum, vagina and other structures is high. And the slightest errors in subsequent sutures or improper care can lead to failure of the ligatures and, as a result, fistula.
3rd and 4th degree ruptures of the perineum, which are accompanied by a violation of the integrity of the rectal mucosa and anal sphincter. If such wounds are not properly sutured, a woman may experience gas and fecal incontinence already on the first day after childbirth.
Primary and secondary weakness of the birth process, as well as rapid labor, increase the risk of developing fistula tracts in the future.
Any obstetric manipulations, such as the application of obstetric forceps, a vacuum extractor, etc. In this case, healthy tissue can accidentally get between the jaws of the instrument and be damaged.

Forms of formation of postpartum fistulas

There are several classifications of postpartum fistulas in women. According to the development mechanism, the following can be distinguished:

independent, which arise during natural childbirth due to ischemia and tissue necrosis;
violent, as a result of poor tissue healing after various surgical interventions (dissection of the perineum, etc.).

According to the organs involved, the following fistulas are distinguished:

Vesicogenital, in which the bladder is connected by pathological fistulas to the uterine appendages, cavity, cervical canal or vagina.
Ureterogenital, in which the ureters (drain urine from the kidneys to the bladder) have fistulous passages with the uterine cavity or vagina. They are rare.
Urethro-vaginal, connects the urethra and vagina. They can form throughout the entire length of the urethra.
Intestinal-genital, in which the rectum, sigmoid, small or large intestine communicates with the vagina and perineum simultaneously or separately.

Depending on the distance at which the entrance/exit hole in the vagina is located, fistulas can be distinguished:

low, if less than 3 cm to the vestibule;
medium, at a distance of 3 - 5 cm;
high when the hole is located close to the cervix, more than 5 cm from the vestibule.

Symptoms of a fistula after the birth of a child

As a rule, it takes several weeks for a full-fledged fistula to form. But already on the second or third day a woman may suspect some kind of violation. The most significant complaint is incontinence of feces and gases. If this is the case, it means that the integrity of the rectal sphincter is compromised and more serious complications are possible.

Sometimes the doctor warns immediately about significant ruptures and injuries. He can also advise how long it will take to see you for a more in-depth examination to rule out complications.

When fistulas form, a woman most often complains about the following:

Discharge of gases from the vagina with a characteristic sound, but sometimes they may not be present. In this case, air can escape not only during stress, but even in a calm state.
The woman will also notice the appearance of atypical leucorrhoea with admixtures of feces. Their number depends on the defect in the wall between the intestines and the vagina.
If a fistula has formed between the urinary system and the reproductive system, then vaginal discharge can be liquid and quite abundant. In this case, a woman may urinate rarely or as usual, it all depends on where the hole is located (in the bladder, in the urethra, etc.) and whether urine will accumulate.
Constant heavy exposure will irritate the skin and mucous membranes of the external genitalia, perineum, thighs, etc. This will ultimately lead to the formation of macerations, possibly causing infection. Taken together, this will bring significant discomfort to the woman.
Permanent atypical flora in the vagina will provoke recurrent cervicitis, and more serious inflammation, including the fallopian tubes and ovaries.
If a fistula connects the genital organs and the urinary system, this can exacerbate infectious processes in the kidneys and other parts of it. Permanent urethritis, etc. occur. The clinical picture is largely determined by the location of the fistula tract.
In addition to everything described, if a woman initially had grade 3-4 perineal injuries, fecal and air incontinence may occur.
As a result of all the above processes, the girl is forced to limit intimate relationships. This can lead to misunderstandings in the family and even a breakdown in relationships.

As a result, most women have psychological trauma to varying degrees of severity; they often require the help of specialists in this field.

Watch the video about vaginal-rectal fistula:

Diagnosis of obstetric fistulas

Diagnostic measures largely depend on in which organs the fistula tracts open. The most commonly used are the following:

General gynecological examination, during which you can see the opening of the fistula on the vaginal wall. The presence of atypical flora will also be detected in a smear or during a thorough examination. During the examination, a bimanual rectovaginal examination may be performed. This way you can identify defects in the wall between the rectum and vagina.
Various methods are also used to study the intestines. These are sigmoidoscopy (examination of the rectum and sigmoid colon), colonoscopy (examination of the entire large intestine), irrigoscopy (use of barium suspension to contrast the intestine under the influence of X-ray radiation in the future).
Fistulography is often used. In this case, a contrast agent is injected into the suspected pathological canal, which makes it possible to determine all its possible courses for the subsequent most radical treatment.
Sometimes ultrasound examination of the abdominal and pelvic organs helps to identify fistula tracts and the organs involved in their formation.
Hysteroscopy is used if there is a suspicion of communication with the uterine cavity.
Cystoscopy (examination of the bladder), chromocystoscopy (additional use of contrast) and some other methods are used if the organs of the urinary system are involved.

Treatment of fistula after childbirth

The choice of treatment method largely depends on the size and structure of the fistula, how long the woman has had it, how it was formed and some other factors.

Regarding most obstetric similar moves, they have a more or less favorable prognosis for treatment. It's all about the mechanism of their formation. In 95% of cases, such fistulas have an entrance and exit opening at approximately the same level; leaks and multiple passages rarely form. This is their main difference from those that are formed according to the “fall on a stake” type, where multiple tissue defects are formed in the vertical plane.

It is possible to cure urogenital and enterogenital fistulas using a conservative method in rare cases, in approximately 3 - 5%. Surgery is considered a radical method.

The approach in each case is individual; several options and types can be used simultaneously. Access can be through the perineum, vagina, and less commonly, the rectum and bladder. Also, sometimes it is necessary to perform abdominal operations.

One-step interventions

They can only be used if there is no inflammation in the area of the fistula, which can be very difficult to achieve. In this case, the pathological canal is excised; if necessary, plastic surgery of the vagina, rectal wall, levatoroplasty (correction of the muscles that lift and close the anus) and some other manipulations are performed.

Intervention in several stages

They include the following:

creation of a colostomy;
conservative therapy to reduce the severity of inflammation;
surgery to remove the fistula tract;
colostomy removal.

On average, such treatment takes at least 3 - 6 months, most of the time the woman is forced to be on sick leave.

Colostomy is the artificial removal of the intestine in a specific area (most often the large intestine). As a result, the evacuation of all contents occurs into a reservoir specially fixed on the anterior abdominal wall. Feces do not reach the rectum and sigmoid colon. In this way, you can relieve all inflammatory processes in this area and prepare the area for surgical correction.

As soon as conditions allow, the fistula tract is excised and all necessary elements are repaired. Another month or more is allotted for healing. After this, the colostomy is reduced - the outlet on the anterior abdominal wall is removed and the normal passage of intestinal contents is restored.

Complications that mom may face

If a woman does not treat fistulas in a timely manner, they can contribute to the development of many diseases, not only gynecological, but also urological and proctological. Most often you encounter the following consequences:

infertility;
chronic inflammatory processes in the vagina, cervical canal, uterine cavity, etc.;
problems with pregnancy (threats, undeveloped pregnancies, premature birth, etc.), this is facilitated by constant infection of the genital area;
recurrent inflammatory processes of the urinary tract;
disruption of digestion and normal evacuation of food masses (constipation, etc.);
violation or complete impossibility of intimate relationships;
mental trauma, social phobia, etc.

Prevention of fistulas after childbirth

Fistulas bring a lot of inconvenience to a woman’s life, reduce the quality of her intimate relationships, and lead to poor health. Pathological passages are prone to relapses, especially if the treatment is irrationally selected or the causes that caused their appearance are not eliminated. Preventive measures to prevent their occurrence include the following:

A woman should prepare psychologically for pregnancy. This way she will be able to adequately respond to all comments during the birth process and thereby reduce the risk of injury.
You should follow all doctors’ recommendations for the care and treatment of perineal wounds, regulate stool and try to avoid constipation after epistomy, etc.
It is important to choose the right method of delivery. Sometimes a gentle caesarean section can save you from many problems in the future.

Postpartum fistulas are a serious pathology, untimely treatment of which can cause significant damage to a woman’s health. Proper psychological preparation for pregnancy and the birth of a baby, competent provision of all necessary obstetric care will help to avoid such complications.