After extensive pelvic cancer surgery, some people notice gas, stool, or foul-smelling discharge passing through the vagina. An abnormal channel between the rectum and the vagina is called a rectovaginal fistula. It sometimes appears for the first time weeks or months after a temporary stoma is reversed: while the stoma diverted stool away, a weak point at the surgical join was never under pressure, and once the normal flow returns, the problem becomes visible.
The causes are not all the same. A tiny leak at the bowel join can become infected; a deep pelvic abscess can tunnel into neighboring tissue; tissue that received pelvic radiation may have reduced blood supply and heal poorly; and, less commonly, recurrent tumor can invade the wall. Because each of these leads to a different plan, care teams usually work out why it happened before deciding how to close it.
It is not unusual for CT scans and endoscopy to confirm that a communication exists without pinpointing its size or exact location. A thread-thin tract, one hidden in a fold, or one masked by inflamed tissue can escape both. Additional tools a team may choose include pelvic MRI, contrast studies using water-soluble agents, examination under anesthesia, dye tests with a vaginal swab, and biopsy when recurrence is a concern. These are options a team selects, not a checklist for patients to request.
Two different clocks run at once. The urgent one: fever with chills, worsening pelvic or lower abdominal pain, a sudden increase in foul discharge, reduced urine output, dizziness, marked weakness, or confusion can signal spreading infection and needs prompt medical attention. The surgical clock usually runs slower. Inflamed, swollen tissue does not hold stitches well, so infection is controlled and nutrition improved first, often with a wait of several months before definitive repair. A team may recommend a new diverting stoma during this period. That is not a step backward; it lowers pressure on the area and improves the odds that the eventual repair will heal.
A history of pelvic radiation changes the plan considerably. Irradiated tissue may not heal with simple suturing, so surgeons sometimes bring healthy, well-perfused tissue from elsewhere to sit between the rectum and vagina. For that reason, what matters is less a single famous name than whether colorectal surgery, gynecologic oncology, and, when needed, plastic surgery are planning together.
This also explains why another patient's success story does not transfer directly. The location and size of the tract, radiation history, tissue quality, and whether tumor remains all differ from person to person. When seeking a second opinion, documents carry more weight than impressions: the operative report, the final pathology report, a radiation summary (site, total dose, number of sessions), original imaging discs rather than only the written reads, endoscopy images and findings, recent blood work, and a symptom diary noting when it began, whether gas alone or stool passes, how often, any fever, and weight changes.
While waiting, perineal skin exposed to stool breaks down quickly, so gentle cleansing with lukewarm water, careful drying, and a barrier product usually help. Anything inserted vaginally, including douching or tampons, should be cleared with the team first, and adjusting anti-diarrheal or laxative medicines on your own can shift bowel flow in unhelpful ways. Recording temperature, discharge volume, and weight by date gives the clinic a trend to read. Protein and fluid intake matter too, since the strength to tolerate surgery is built before the operating room.
This article is general information and does not replace individual diagnosis or treatment. Symptoms and plans differ from person to person, so please discuss your situation with your own medical team.