Why is this a serious condition?
Rectovaginal fistula is a pathological connection between the rectum and vagina, through which intestinal contents and gases enter the vagina. In addition to constant inflammation and recurrent infections, the condition is difficult to tolerate psychologically and severely limits social life. The main reasons are perineal trauma during childbirth, especially third- or fourth-degree rupture, complications of operations on the rectum and vagina, Crohn's disease, and radiation therapy of the pelvic organs. The only treatment is surgical: the fistula tract is excised, the intestinal and vaginal defects are sutured separately, and a layer of healthy tissue is formed between them. With high and recurrent fistulas, a temporary colostomy is sometimes required to relieve the plastic area.
Why does the fistula not heal on its own?
Pararectal fistula is a pathological channel between the lumen of the rectum and the skin of the perineum. Most often, it is formed as a result of acute paraproctitis: the abscess has opened, the pus has come out, but the tract lined with epithelium remains.
The walls of the fistula do not grow together, so antibiotics and ointments provide only a temporary lull - the process periodically worsens. The only radical treatment method is surgical.
Classification in relation to the sphincter
- intrasphincteric - inside the internal sphincter, the simplest
- transsphincteric - crosses part of the sphincter fibers
- extrasphincteric - bypasses the sphincter from the outside, the most complex
- incomplete internal - opens only into the intestinal lumen
- epithelial-coccygeal tract - a separate pathology of the sacrococcygeal region
Classic surgery or laser
With classic intervention, the fistula tract is excised with a scalpel along with scar tissue - the method is as radical as possible, but requires caution when the sphincter is involved. Laser destruction works differently: a thin light guide is introduced and processed from the inside, the walls coagulate and collapse. The sphincter muscle is not crossed, so the risk of loss of control is minimal, and healing is faster. The choice of method is determined by the type of fistula, the presence of leaks and previous operations.