Rectovaginal Fistula Management in Low-Resource Settings

Abstract

Rectovaginal fistula (RVF) is an abnormal connection between the rectum and vagina that affects women globally. In low- and middle-income countries (LMIC), RVF is most commonly due to obstetric complications such as prolonged labor or perineal tears, female genital mutilation and trauma such as sexual violence or iatrogenic surgical injuries. Women affected by this condition suffer from debilitating physical symptoms, social isolation, economic disempowerment, psychological trauma, low self-esteem, and loss of role fulfillment. Lack of accessible, high-quality, and effective healthcare is a major barrier to timely and safe obstetric care and to care for subsequent complications such as RVF. Additionally, social, cultural, financial, and systemic barriers put women at risk of acquiring fistula and contribute to delays in seeking and receiving care. Literature evaluating RVF repair in those able to access care offers limited information about management and outcomes. It is difficult to ascertain which surgical techniques are used. To reduce the burden of this often-preventable disease, appropriate investment in healthcare infrastructure to strengthen maternal care in LMICs is paramount. Furthermore, more standardized reporting of severity and treatment approach along with outcome data are critical to improving the quality of care for patients impacted by RVF.

Keywords: maternal care; obstetric complications; rectovaginal fistula.

Fig. 1

( A ) Small rectovaginal fistula secondary to obstetric injury with intact perineum and anal sphincters. Printed with permission from Dr. Ann Lowry. ( B ) Large, complex fistula with anterior sphincter disruption and loss of perineal tissue secondary to obstetric injury. The white arrow depicts vaginal fistula opening. Printed with permission from Dr. Andrew Browning.