Date:
Patient:
Reason for Visit:
Follow-up for rectovaginal fistula (RVF)
Assessment of symptoms (discharge, fecal incontinence)
Evaluation of fistula location, size, and drainage
Monitoring for complications
History:
Presenting Illness:
Onset and duration of symptoms:
Vaginal discharge (purulent, fecal)
Fecal incontinence (continuous leakage or with passing stool)
Vaginal pain or discomfort
Past history of pelvic surgery, childbirth, infections, or trauma (potential risk factors)
Past Medical History (PMH):
Underlying conditions (inflammatory bowel disease, Crohn’s disease, diverticulitis)
Prior pelvic surgeries or radiotherapy (risk factors)
History of vaginal infections
Social History:
Sexual history (risk factor for some fistula types)
Physical Exam:
General: Assess for signs of infection (fever, malaise).
Pelvic: Evaluate for external signs of inflammation or skin breakdown.
Speculum exam: Visualize vaginal opening of the fistula, purulent drainage, or signs of inflammation.
Digital rectal exam: Locate rectal opening of the fistula, assess sphincter tone, and purulence.
Diagnostic Tests (may be ordered depending on clinical presentation):
Fistulagram: X-ray imaging with contrast injected into the rectum or vagina to identify the fistula tract location and course.
Endoscopy (colonoscopy or sigmoidoscopy): May be used to visualize the internal rectal opening of the fistula and rule out other rectal pathology.
Pelvic MRI: Can provide a detailed picture of the fistula tract and surrounding tissues, helpful for complex cases.
Assessment:
Type of RVF: Based on location and cause (traumatic, obstetric, Crohn’s disease-related, etc.).
Severity of symptoms: Impact on daily life and hygiene.
Fistula size and drainage characteristics: Purulent discharge, fecal incontinence pattern.
Presence of complications: Cellulitis, abscess formation.
Plan:
Treatment approach depends on severity, fistula type, and patient factors.
Conservative management (may be considered for small fistulas without significant symptoms):
Stool softeners or laxatives to manage constipation.
Sitz baths for hygiene and discomfort relief.
Antibiotics (if infection is present).
Surgical intervention (most common definitive treatment):
Various surgical techniques available depending on fistula complexity (fistula plug placement, advancement flap surgery).
Fecal diversion (may be necessary in some cases to divert stool away from the fistula and allow healing).
Referral to a colorectal surgeon: For definitive management and surgical intervention.
Referral to a wound care specialist: For post-surgical wound care and management.
Patient education: Provide information about RVF, causes, treatment options, and potential complications.
Discuss post-surgical care instructions, hygiene practices, and signs and symptoms to watch for (worsening pain, fever).
Follow-up:
Schedule for follow-up appointments based on the severity and treatment plan:
Close follow-up after surgery to monitor healing and address any complications.
Less frequent visits for patients with successful closure and no symptoms.
Monitor for recurrence of symptoms, assess healing progress, and provide ongoing support.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of rectovaginal fistula.