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Recto Vaginal Fistula, How long does it take to heal?
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An_197500 posted:
I had my second child Dec 1, 2010 and still healing from my fourth degree tear. I have been diagnosed with a recto vaginal fistula. I'm not passing stools from my vagina, only air, but it seems like it is not getting any better. My OB will be referring me to a GI specialist in June if it has not healed on its own. Just wondering if any of you out there have dealt with this and how long it took it to heal?
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Jane Harrison Hohner, RN, RNP responded:
Dear Anon: I am grieved to hear about your forth degree tear. That adds so much more difficulty to caring for a new infant--and care taking another child. I could not find any published data on length of healing. There are many variables which impact healing.

However, after several searches at the National Library of Medicine site, this study from the Cleveland Clinic did discuss incidence and long term outcomes for an obstetric caused R-V fistula (emphasis mine):

Dis Colon Rectum. 2010 Sep;53(9):1240-7.
Are there predictors of outcome following rectovaginal fistula repair?
Pinto RA, Peterson TV, Shawki S, Davila GW, Wexner SD.

Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida 33331, USA.

BACKGROUND:

Rectovaginal fistula is a distressing condition for patients and for physicians who are continuously challenged in providing durable treatment options. The aim of this study is to assess the results of rectovaginal fistula repair and identify predictive factors for poor outcome.
METHODS:

Retrospective analysis of patients who underwent rectovaginal fistula repair from 1988 to 2008 was performed. chi tests and logistical regression analysis were used to study treatment outcomes according to the following fistula characteristics: etiology, size, location, and number of prior attempts at fistula repair. In addition, patient factors such as age, body mass index, smoking history, comorbid condition of diabetes, use of steroid and immunosuppressive medications, number of prior vaginal deliveries, and presence of a diverting stoma were analyzed.
RESULTS:

A total of 184 procedures were performed in 125 patients. Inflammatory bowel disease was the most common indication for surgery (45.6%), followed by obstetric injury (24%) and surgical trauma (16%). The mean duration of fistula presence was 31.2 months. The procedures performed included endorectal advancement flap (35.3%), gracilis muscle interposition (13.6%), seton placement (13.6%), and transperineal (8.7%) and transvaginal repair (8.1%). The overall success rate per procedure was 60%, with no difference in recurrence rates based on the type of repair. Patients with Crohn's disease had more recurrent fistulas (44.2% success per procedure; P < .01), although 78% eventually healed after an average of 1.8 procedures. Patients with obstetric injuries had an 89% success rate after an average of 1.3 procedures per patient, which is similar to the success rate for traumatic fistulas. Pouch vaginal fistulas had a 91% success rate after an average of 1.6 procedures per patient. The overall success rate per patient was 88% after multiple procedures with a mean follow-up of 16.3 months. Age, body mass index, diabetes, use of steroids and immunosuppressive agents, size and location of the fistula, number of vaginal deliveries, time interval between a recurrent episode and subsequent repair, and the presence of fecal diversion did not affect outcomes. The presence of Crohn's disease and a smoking history are strongly associated with rectovaginal fistula recurrence (P = .02). ....

Anon, some of the newer repair techniques for RV fistula include placement of mesh, and a fibrin "glue". We hope that, if a repair is needed, it has a perfect outcome.

In Support,
Jane
 
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cstaroba responded:
Hi,
I had a baby in March - 4th degree tears and i also have a recto vaginal fistula. I am not passing stool either, only air (as far as I can tell), however, I am very tender to the touch down there.

I've seen two doctors, the 1st one was a dr. my OB referred me to, he told me it would take about 6 weeks to heal. He also said it just depends on the person. Some women can go back to work after 2 - 3 weeks.

I was reading a lot about the recto vaginal fistula and I saw I should be seeing a Colorectal surgeon. I've gone to see him and am cancelling my surgery with the other dr. I should be getting surgery sometime in August.

Do you have surgery scheduled or have you had it yet?

Courtney
 
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cstaroba responded:
So Sorry Anon,
I just re-read your question. I don't think many recto vaginal fistulas heal on their own. I think most require surgery, if they are bad enough to need surgery.

One of the Dr.'s I talked to said it would take about 6 weeks to heal AFTER surgery. Just wanted to comment again after my last post.

If your still checking this feed, please reply if you'd like, I'd like to hear about your experience and if you've had surgery or are getting surgery etc. I am going through the same thing.
 
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hope0527 replied to cstaroba's response:
Hi,
Sorry I didn't respond sooner but I didn't get an email notification on this till today. I never went to see my GI specialist. Hoping time will let it heal on it's own. My gyno did say that the tissue has healed nicely and surgery could be an option now. It's been 9 months since I gave birth so I'm not real sure if it's going to heal now or not. Don't know if you have Facebook or not but I have found a great group called
Living with Obstetric Fistula.
It's a support group. The girls there are very nice and have been through a lot more than I have. They give great advice and can tell you all about their surgeries. Some have had multiple surgeries.

 
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Jane Harrison Hohner, RN, RNP replied to hope0527's response:
Dear hope & cstaroba: Thank you both SO much for taking the time to write, and to suggest a support group referral. Many times a woman with a recto-vaginal fistula may feel isolated as it is not an easy topic to bring up. As you can note from the citation located above, the average number of surgeries for a successful repair was 1.3. This means that 1 out of 3 women had more than one surgery.

Given the magic of the internet, the information you both shared is likely to pop up on a Google search that some other woman is making. Your input is invaluable!

In Appreciation,
Jane
 
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Remz27 replied to hope0527's response:
Hi I am new on here I read the discussion, and I tried to go onto the Facebook group Living with obstetric fistula but I could not find it

Is there any other forum for fourth degree tears or fistula? I cant seem to find any? I guess we are a very small percentage?

Remz
 
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someonewhocares3 replied to Remz27's response:
Sorry you women are dealing with this problem! Found the group here - http://community.babycenter.com/post/a27101955/living_with_obstetric_fistula . It contains a link to Facebook.

Sending healing thoughts...
 
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Remz27 replied to someonewhocares3's response:
thanks sooo much I joined the group on fb and its amaaaazing!! so thank you soooo much for putting the link up.

Remz
 
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AidensMama1 responded:
http://www.facebook.com/#!/groups/109334165772642/ A great support group. We know what you are going through.-Tara
 
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Dustbuster replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

I've been up all night crying,(now 3:42AM CO time) due to researching & educating myself via internet on this subject; I'm a later in life mom of 53yrs. Have two grown kids, also currently to my beautiful 13yr. old. I reached full menopause various hotflashes..no hysterectomy 1 &1/2yrs. ago. Last summer, I also dealt with and healed from frozen arm; I also ended up in ER, because baby finger was severly excruciating me(verculititus?) I also have RA, and husbands a continuing colon cancer survivor/ patient. Recently this past month, I've really noticed passing gas through this other area, now with hints of fecal streaking? I'm scared to death and have every reason in the world to fret and cry...right? Thank you for your kindness.
 
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Dustbuster replied to AidensMama1's response:
Hi,
I'm new here and to this topic and issue; scared to death..need to find out and the facts first; probably shouldn't be this way, until i know for sure i guess; guess because my husband is a surviving colon cancer survivor, i known in advance to some of this i suppose, and certainly know what he went through, as to why i guess I'm so scared and up crying all night. Thanks for any helps.
 
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WorriedNow replied to Dustbuster's response:
Dear Dustbuster,

I am also up tonight researching and your story really connected with me. I am also 53...well, now I am 54 since it was my birthday yesterday...and I had scheduled my annual GYNO appointment. I mentioned to her this strange passing of gas through the vaginal canal, thinking it must be some menopausal weirdness (I had had air from that area in my younger more "active" years after intercourse, so I did not think it would be any big deal), but when I explained that there was an odor involved and was happening more often, she told me that "it was not normal" and mentioned RVF. I am doing some low tech test right now that she suggested....taking charcoal tablets and wearing a tampon to see if there is any leakage into the vagina. I am also reading everything I can get my hands on and am in a total panic. I also am a "late in life" mom to a 13 year old! Since I have read that this condition is most often a result of a vaginal birth, I am doubting whether this could show up 13 years (well....maybe 10 years....since I think I first noticed this about 3 years ago very occassionally) AFTER giving birth. They used forceps and I think I had an episiotomy...but all healed normally, as far as I know. SO, of course now I am thinking that a fistula must be cancer related, since I have no other condition associated with it. I am wondering (hoping) if I had a small weakening from childbirth all these years and the changes of menopause caused it to weaken further? I know that it will still be cause for concern if surgery is the only answer, BUT at this point I would be so relieved to find out that is all it is...

Sorry for all the rest you are dealing with. I cannot imagine how tough that must be. Today, I have a new view of the (minor) worries that have been on my mind....ten extra pounds...hot flashes....a teenageer....etc. Thank you for reading this and any encouragement you can provide.
 
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Jane Harrison Hohner, RN, RNP replied to WorriedNow's response:
Dear WorriedNow & Dustbuster: Thank you so much for writing about the issue of recto-vaginal fistula in "mature" women. In your case WorriedNow, there is a POSSIBILITY that a very small fistula may be more symptomatic now. The most important thing in diagnosing a RV fistula is thinking about it as a potential diagnosis. If a fistula is far back in the vaginal canal it may be less apparent. After actual menopause, when lower levels of estrogen cause thinning of vaginal tissues, this can impact healing time in the vagina.

A very recent citation in the National Library of Medicine site details a newer treatment for very small RV fistulas:

Int J Surg Case Rep. 2012;3(7):327-9. doi: 10.1016/j.ijscr.2012.03.029. Epub 2012 Apr 5.
Case report: Treatment of rectovaginal fistula with Bioglue(?).
Garcia S, Dissanaike S.
Source

Department of Surgery, Texas Tech Health Science Center, Lubbock, TX 79340, United States.
Abstract
INTRODUCTION:

Rectovaginal fistulas have a multitude of causes and it is well known that obstetric and gynecological problems form a large part of these causes such as our case.
PRESENTATION OF CASE:

We present a 45-year-old female that presented with complaints of stool per vagina and was found to have a rectal vaginal fistula near the vaginal cuff from her previous uncomplicated vaginal hysterectomy. The patient was originally scheduled for a complex open abdominal surgery based on examination but underwent a sigmoidoscopy with vaginal examination and identified a small opening with minimal inflammation. The patient was treated with Bioglue(?) and had complete resolution of the fistula at follow-up.
DISCUSSION:

There are numerous cases presented in the literature on the use of bioglue for anal fistulas and rectovaginal fistulas with multiple cases of success. However, in looking at the literature failure appears to be due to ongoing inflammation from the previous disease process.
CONCLUSION:

Although the use of Bioglue(?) may not be suitable for all patients with rectovaginal fistulas, it offers yet another treatment modality for select patients.

As always, your own GYN's can give you the most "for sure" answers. I hope that, if a fistula is present, it is a very small type.

Yours,
Jane
 
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WorriedNow replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane,

Thank you for your response. Since I have not passed ANY stool, just gas...and the Gyn Nurse Practioner could not see any opening upon exam (using her purple glove and looking along the vaginal canal), I am hoping that it is SMALL. Also, the charcoal/tampon test resulted in what looked like a small spot of light brown on the very LOW end (by the string) of the tampon. I have not had any vaginal infections or pain....until I tried to use a tampon for this test....and it seemed to adhere to the walls from being so DRY in there! When I pulled it out, it caused some irritation...and very light red staining on the tampon. I have had "0" bleeding since stopping periods about 2 years ago..not a single "spotting" incident up to now. The Nurse-Practioner also screened me for blood in stool...and it was negative. My GYNO is referring me to a doctor in his practice who he says handles "less common cases", but it is freaking me out because this doctor is a GYNO-ONCOLOGIST. They assured me that they are not suspecting cancer....but being a "part-time hypochrondriac" (I only focus upon worries about disease when something like this happens), I am now in the internet researching for anything that might reassure myself that there is another reason beside cancer for this situation. I am truly in a PANIC....and can think of nothing else. What I am trying to find out is whether a gyno or recto cancer could cause THIS with no other bleeding or such? AND ...whether this would have been going on for three years without other bothersome symptoms? If you can comment on any of that, I would be SO appreciative. I have my appointment in a week....but I wish I could convince myself not to immediately go to the worst possible explanation.

Thank you.


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