Finding stool in the vagina means that there's an abnormal connection from the large intestines, the rectum, and the vagina. This condition is called rectovaginal fistula.
Stool in the vagina symptoms
Genital issues are never a comfortable topic of conversation, and stool in the vagina is an extremely uncomfortable symptom that you may feel too embarrassed to discuss with your healthcare provider.
However, it is important to know that stool in the vagina is never normal, and following-up with your healthcare provider is an important first step in finding a solution to this disconcerting and distressing symptom.
Common characteristics of stool in the vagina
The common characteristics of stool in the vagina are related to the presence of the stool in the vaginal canal. Pus passing out of the vagina may represent the presence of an infection.
- Foul-smelling odor that does not resolve (even with proper hygiene)
- Gas or pus passing out of the vagina
- Fecal incontinence: This is an uncontrolled loss of stool.
Common accompanying symptoms
Stool in the vaginal canal is often not the only symptom. Common accompanying symptoms of this problem include:
- Generalized pain
- Dyspareunia: This is pain during sexual intercourse.
- Dysuria: This is pain during urination.
- Recurrent vaginal or urinary tract infections
- Foul-smelling urine
Make an appointment with your healthcare provider promptly if you notice any of the symptoms above. This condition can cause both physical discomfort and emotional distress and requires follow-up with a medical professional.
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Stool in the vagina causes
The underlying cause for stool in the vagina is an abnormal connection between the rectum (lower part of the large intestine) and the vagina. This abnormal connection is called a rectovaginal fistula. See an image of a rectovaginal fistula here.
The specific causes of rectovaginal fistula and why it forms can be separated into congenital causes (at birth) and acquired causes that are due to a secondary process occurring later in life.
Acquired causes of stool in the vagina may include the following.
- Trauma: Traumatic injuries that occur during childbirth can result in rectovaginal fistulas. During childbirth, the perineum can tear, resulting in an opening between the vagina and rectum/anus. Using this image here, you can imagine how this could occur if the perineal body/perineal membrane was torn. If this tear does not heal properly a rectovaginal fistula can form. Furthermore, deliveries that last for a long time can cause too much pressure on the perineum and result in a condition known as pressure necrosis of the rectovaginal septum.
- Systemic disease: Systemic diseases that cause generalized inflammation in the body, especially the gastrointestinal tract, can put individuals at increased risk of developing rectovaginal fistulas.
- Iatrogenic: Iatrogenic refers to medically-related causes of a condition. In the case of rectovaginal fistula, surgery to the components of the pelvis (vagina, perineum, rectum or anus) or lower pelvic region in general can lead to the development of the condition. For example, during labor sometimes an episiotomy (a surgical incision to enlarge the perineum during vaginal delivery) is performed. The episiotomy may become infected or not heal properly leading to a rectovaginal fistula. Moreover, treatment for cancers in the pelvic region that involve radiation can put patients at risk for development of fistulas as well.
Congenital causes of rectovaginal fistula that are present at birth are rare and much less common than the acquired etiologies discussed above. This condition is known as a rectovaginal or rectovestibular fistula. The cause of this congenital condition is not completely known, but environmental factors such as drug use during pregnancy may play a role.
This list does not constitute medical advice and may not accurately represent what you have.
Diverticulitis is inflammation of diverticula, or sac-like outpouchings, in the wall of the colon (large bowel). Diverticulitis is a complication of diverticulosis, which is defined as the presence of div...
Intestinal inflammation (diverticulitis)
Diverticula are small pouches that bulge outward through the colon, or large intestine. Diverticulitis is a condition where the pouches become inflamed or infected, a process which can cause fever, nausea, vomiting, chills, cramping, and constipation.
Top Symptoms: abdominal pain (stomach ache), nausea, loss of appetite, diarrhea, constipation
Symptoms that never occur with intestinal inflammation (diverticulitis): pain below the ribs, pain in the upper right abdomen
Urgency: Hospital emergency room
Crohn's disease flare
Crohn's disease is a chronic inflammation of the digestive system. It is one of a group of diseases called inflammatory bowel disease. Crohn's can affect any area from the mouth to the anus, and may cause diarrhea and weight loss.
Top Symptoms: fatigue, nausea, stomach bloating, loss of appetite, abdominal cramps (stomach cramps)
Urgency: In-person visit
New onset crohn's disease
Crohn's disease is an inflammation of the bowel. It is caused by a faulty immune system response which makes the body attack the lining of the intestines.
The disease usually appears before age thirty and can affect anyone. Those with a family history may be most susceptible. Smoking is a known risk factor.
Aggravating factors include stress, poor diet, and nonsteroidal anti-inflammatory drugs such as ibuprofen and aspirin.
Early symptoms usually develop gradually, but can appear suddenly. These include fatigue, loss of appetite, fever, mouth sores, diarrhea, abdominal pain, and blood in stool.
Untreated Crohn's disease can cause ulcers throughout the digestive tract as well as bowel obstruction, malnutrition, and deteriorating general health.
Diagnosis is made through blood test and stool sample test. Colonoscopy, CT scan, MRI, endoscopy, and/or enteroscopy may also be used.
Crohn's disease cannot be cured, but can be managed through reducing the inflammation. Antibiotics, corticosteroids, and immune system suppressors may be tried. Excellent nutrition, vitamin supplements, smoking cessation, and reduction in stress can be helpful.
Top Symptoms: fatigue, stomach bloating, loss of appetite, constipation, abdominal cramps (stomach cramps)
Urgency: Primary care doctor
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Stool in the vagina treatments and relief
The primary treatment for rectovaginal fistula or congenital fistula is surgery. However, depending on the cause and extent of your symptoms there may be alternatives.
Some women with small fistulas or minimal symptoms may be able to control and manage their condition utilizing strategies that optimize bowel function or medications that reduce inflammation.
- Diet manipulation: Eating foods that minimize the number and quantity of bowel movements. For example, foods that are bland and do not aggravate the digestive system (like bananas, soda crackers, applesauce, and rice) can be helpful.
- Controlling diarrhea: Talk to your healthcare provider about taking medications that prevent diarrhea in the setting of your condition.
- Anti-inflammatory medications: These medications can help reduce inflammation and heal fistulas in individuals with systemic disease such as Crohn’s disease.
However, for most women, the symptoms are not manageable with strategies above and surgical repair is necessary.
When to see a doctor
Stool in the vagina and its associated symptoms should always be followed-up with a healthcare provider. The mainstay of treatment is to close and repair the fistula surgically. There are many surgical options that your healthcare provider may utilize:
- Tissue graft: This puts skin/healthy tissue over the fistula opening in order to close it.
- Sewing biologic tissue into the fistula: This allows tissue to grow into the repaired area and heal the fistula.
- Diverting colostomy: This type of surgery redirects the flow of stool through an opening in your abdomen instead of through the rectum/vagina.
When it is an emergency
Stool in the vagina is usually a condition that presents chronically (happens over time) rather than acutely (happens suddenly). As a result, you may not need to present immediately to an emergency room. Nevertheless, you should always see your healthcare provider for this condition and its associated symptoms.
Prevention of formation of rectovaginal fistula is targeted towards the acquired etiologies of the condition.
- Kegel exercises: These are exercises designed to strengthen the muscles of the pelvic floor which support the uterus, bladder, small intestine, and rectum. They can be done at any time. Studies have shown that women who performed pelvic floor training at least three times a week had less perineal lacerations than women who performed the exercises less than once per week.
- Targeted radiation: If you suffer from cancer in the pelvic region that requires radiation for treatment, your healthcare provider will make efforts to give the most targeted radiation that puts you at the least risk for developing a rectovaginal fistula.
FAQs about stool in the vagina
Why is there brown, foul-smelling discharge coming from my vagina?
If you are secreting brown, foul-smelling discharge from your vagina, you are most likely suffering from a rectovaginal fistula. A rectovaginal fistula is an abnormal connection between the rectum (lower part of the large intestine) and the vagina. Instead of stool going through the rectum to the anus, the stool passes through the fistula connection and is expelled from the vagina instead. This condition can cause both physical discomfort and emotional distress and requires follow-up with a medical professional.
Why does Crohn’s disease cause fistulas?
Studies and available data indicate that fistulas associated with Crohn’s disease occur due to an epithelial transformation of the skin caused by ongoing inflammation. The skin cells penetrate into deeper layers of the mucosa and skin causing tissue damage and formation of a tube-like structure that connects other organs together. These fistulas are extremely difficult to heal and treat because wound healing mechanisms do not function properly in patients with Crohn’s disease.
Will surgery fix my rectovaginal fistula?
Usually, surgery will completely close and repair the rectovaginal fistula and alleviate your symptoms. In some complicated cases, for example, Crohn’s disease associated fistula, the fistula may recur and surgery will need to be repeated.
What are Kegel exercises?
Kegel exercises are movements designed to strengthen the muscles of the pelvic floor which support the uterus, bladder, small intestine, and rectum.
Is a rectovaginal fistula an acute or chronic condition?
Stool in the vagina is usually a condition that presents chronically (happens over time) rather than acutely (happens suddenly). The triggering event, a perineal tear or prolonged delivery, may happen in the acute setting, but it will take time for the fistula to form.
Questions your doctor may ask about stool in the vagina
- Have you experienced any nausea?
- Have you lost your appetite recently?
- Any fever today or during the last week?
- When someone presses on your belly, does this person feel your muscles tense up?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Hello everyone. So I'm 14. I know. I'm young! Not the point! The point is. I woke up one morning and was brown stuff in my underwear. I thought it was strange but didn't think much after that. Then a day passed and I went to the restroom before I went to bed. It was even darker than the first time, and I was really worried. I thought that I just wasn't wiping correctly. So I was going to make sure I was all clean. That's when I found out that I was wiping just fine. It was in my vagina. So I was super worried at this point, I mean who wouldn't be! So I'm freaking out and I think I'm dying, so I did what we all do and I looked it up. Now I don't know what to think. I have some abdominal uncomfort, but nothing that's too bothering. I'm constipated, I don't eat great and I don't drink a bunch of water. If anyone know what's happening to me please let me know. I'm really freaked out and with Covid-19 going around. I don't want to be a pain to the healthcare people, and also I refuse to go to a obgyn. For my own reasons. And it's embarrassing to talk about. Soo if y'all could help me that would be amazing. Thank you. p.s I haven't had sex, definitely no kids and I don't have cancer. ( That me or my doc knows of). And no radiation treatments. Also, this just started. And I haven't had my . Yet.
- Debeche-Adams TH, Bohl JL. Rectovaginal fistulas. Clinics in Colon and Rectal Surgery. 2010;23(2):99-103. NCBI Link
- Congenital recto-vestibular fistula and recto-vaginal fistula. Cedars-Sinai. Cedars-Sinai Link
- Bo K, Fleten C, Nystad W. Effect of antenatal pelvic floor muscle training on labor and birth. Obstetrics & Gynecology. 2009;113(6):1279-1284. PubMed Link
- Scharl M, Rogler G. Pathophysiology of fistula formation in Crohn's disease.. World Journal of Gastrointestinal Pathophysiology. 2014;5(3):205-212. NCBI Link