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Gastroenterology  (Expert Forum)
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Rectal Vaginal Fistulas
Answered by
Kevin Pho, MD - Internal Medicine
Kevin, M.D. Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
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MedHelp Member's Question

Rectal Vaginal Fistulas

by MrsPooh1, Dec 13, 2003 12:00AM
51 years of age.  I have survived 30 years of Crohn's - for the most part - active Crohn's. 2 sb resections/1colon resection. Due to a stricture I had a bowel resection last year.  Prior to the surgery I had been passing vaginal gas which indicated something was wrong.  After the surgery as I was preparing to go home a rectal vaginal fistula presented itself.  For the last year I have dealt with the horror of this condition - I found the Atkins diet slowed down the bowel and produced more formed stool, lessening the symptons of the fistula.  I am on Remicade every 8 weeks, 6MPdaily, Cipro daily, lomotil daily, tigan and darvocet as needed. Also vaginal inserts of estrogen in an attempt to build back up vaginal wall - I am post menapausal.  6 weeks ago the fistula reopened fully. I then began to live in a bathroom - 20 formed and/or watery stools a day. 4 weeks later I was admitted to the hospital for uncontrollable cramping pain, frequent bowel activity and weight loss - I was beat. Small bowel follow through revealed nothing.  Colonoscopy revealed fistula area and perhaps a different fistula area higher up in the colon.  I am exasperated with discomfort and living in a bathroom yet doc feel there is nothing significant revealed going on to warrent any form of discomfort.  He has referred me to a local surgeon for workup of this complaint.  I have lost nearly 10 lbs in a couple of weeks recently/I am not one to lose weight.  Have seen specialist in NY last year who says no surgery and no steroid use.  Question: Do active fistulas cause extra bowel activity? Could that be the reason I cannot stay out of the bathroom?  Do active fistulas cause cramping pain?   Doc found no active disease in colonoscopy or sb followthrough.  Sed rate is 20. Other blood work seems to be ok at this time.  Please help me.  I need to know what is causing these new symptons and if they are fistula related.
Doctor's Answer

by Kevin Pho, MD, Dec 15, 2003 12:00AM
Surgeon has kindly addressed your question in his comments below and I agree with his assessment.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Thanks,

Kevin, M.D.

Member Comments (16)

by surgeon, Dec 13, 2003 12:00AM
Not all fistulas cause cramps, but some do: it depends on the reason for the fistula, and the exact anatomy of the area. There is likely inflammation at the point of fistulization, and that could cause small bowel to adhere to the area, and at the point of adherence there could well be a twist or stricture causing partial obstruction, and therefore cramps. It's highly unlikely the fistula will close on its own, no matter what medications are used. As you found, sometimes the amount of drainage can be reduced by dietary means which cause the stool be more solid; but it may not work for various reasons. The bottom line is that it's nearly certain the surgeon will tell you surgery is necessary; the exact nature would depend on anatomy, prior surgery, etc. It's possible that the best option would be colostomy, because with Crohns and prior surgery, it may be judged inappropriate to hook the colon back up to the rectum. This is less than perfect, but at least the output would be controllable into a bag as opposed to constant leakage. On the other hand, if the Crohn's doesn't involve the colon/rectum, and the fistula is from the small bowel, it's probable that hookup with more normal bowel control is possible. Without knowing the details it's not possible to say for sure: but there's reason to believe that surgery could cure the fistula and the cramps.

by MrsPooh1, Dec 13, 2003 12:00AM
Am I the only one who feels discomfort or pain with a rectal vaginal fistula?  After a year I find this mess continues to be a focus of my life.  I am eager to hear from others who have been in situation and have come out well.

by kimbacat, Dec 13, 2003 12:00AM
MrsPooh,



you might want to check out the site: www.ibdsucks.com



in the "CD, UC, IBS and Other Conditions" folder, there is a whole subfolder on fistulas.  there, you can find help, support and current info from a whole bunch of us that have fistulizing CD.  I think the gamut of treatments have been experienced in the group: meds, glue, cetons, fistulotomy/ectomy, flap surgery, resection, etc.



one of the nasty things with CD is that you can do everything absolultely correctly and still have things go horribly wrong.



I hope you can find relief soon.



take care

by surgeon, Dec 13, 2003 12:00AM
please be aware that there's a great deal of difference among fistulae;a rectovaginal fistula is NOT, for example, something to be treated with seton. It's a very different situation from, say, fistula-in-ano, which is the more common -- and more minor -- fistula associated with Crohn's

by yoshi, Dec 14, 2003 12:00AM
why are you taking cipro everyday??

you may want to talk to your doctor -it is a strong antibiotics and if you take it long enough,it will upset your flora and something else too.

by kimbacat, Dec 14, 2003 12:00AM
To: surgeon
you are right, different fistulas require different treatments.  I was just listing the types of treatments those of us with fistulas have undergone.  not all are appropriate for her type of fistula.  a cutting seton definitely would not be used for a rectovaginal fistula, but a draining one is sometimes used.

by kimbacat, Dec 14, 2003 12:00AM
To: surgeon
sorry, don't want to be b*tchy, but there is nothing "minor" about a fistula in a person with