A new ray of hope for a young lady!!!!

A 32-year young lady presented to us with a physical discomfort of passing flatus/stools through her vagina for two months. She was in severe emotional distress and with low self esteem, that she started avoiding intimacy and socialization. She was also not able to perform her daily chores.

She had consulted at a known corporate hospital in Coimbatore and was diagnosed to have “Ano-Vaginal fistula”, a medical condition wherein there is an abnormal connection between her anal canal and her vagina, allowing bowel contents like motion and flatus to escape into her vagina and soil her clothes.

Considering the unusual nature of her presentation, we dwelled into her past and found that she had visited native practitioner two months back for treatment of hemorrhoids. Apparently he had inserted a chemical into her anus to burn the piles {chemical cauterization}. This chemical had probably burned through her bowel wall and into the vagina.

At the corporate hospital, she was suggested to undergo a standard procedure called Colostomy – where a segment of her large intestine is disconnected and anchored to the skin of her tummy and the stools are collected into a bag tied there. This is a common procedure for colon cancer. The young lady was scared of this morbid procedure and hence visited us. After thorough examination, we felt colostomy would be a major procedure for this patient.

We adapted a novel procedure called LIFT, where the fistula tract is isolated and disconnected and vaginal flap closure with a sheet of collagen is interposed to augment the healing process. The wound went on to heal well within a month and since then there is no leak of motion/flatus into the vagina.

The patient, her husband and family are very happy to get this condition resolved without an undue colostomy.

Brief discussion about Ano-vaginal fistula:0

Ano-vaginal fistula is an abnormal connection between anal canal and vagina. Bowel contents can leak through the fistula, allowing gas or motion to pass through vagina.

Ano-vaginal fistula may result from:

1.Injury during childbirth

2.Crohn’s disease or other inflammatory bowel disease

3.Radiation treatment or cancer in the pelvic area

4.Complication following surgery in the pelvic area

The condition may cause emotional distress and physical discomfort, which can impact self-esteem and intimacy.

Symptomatology:

The presentation will be late because of social stigma. The symptoms vary from fecal soiling of undergarments to urogenital sepsis in elderly and bed ridden patients.

1.Passage of gas, stool or pus from vagina

2.Foul-smelling vaginal discharge

3.Recurrent vaginal or urinary tract infections

4.Irritation or pain in the vulva, vagina and the area between vagina and anus (perineum)

5.Pain during sexual intercourse

We conclude with the opinion that by choosing an optimum and innovative surgical procedure (interposing collagen sheet) for this patient it was possible achieve full recovery and a morbid procedure like colostomy was avoided. Females are more prone for perineal diseases such as stress incontinence, prolapse, ano vaginal fistulae as a result of prolonged labour and perineal tears. We advise that such patients should avoid social stigma and seek professional help as earlier as possible to prevent chronic complications. Doing perineal exercises or Kegel’s exercises on regular basis not only help to improve perineal muscle strength but also keep such chronic problems at bay. We would also stress to consult a specialist for any medical related problems rather than going to quacks which invariably result in undue complications and suffering.