Fistula between digestive tract and uterus?

[vart]

For the past 3 years, I've experienced gas discharge (without an odor) from the vagina at varying frequencies. I've noticed a correlation between uncomfortable bloating and gas in the digestive tract and gas discharge from the vagina. This issue often occurs due to a formation of a connection between the intestines & the uterus or vagina (which mostly occurs in women who have experienced childbirth or had surgery). I'm currently 27 years old, and have not experienced a pregnancy or had any surgery or trauma.

Approximately 2 years ago, the gas discharge increased in frequency (2 or three times a week), in span of discharge (60 to 90 seconds), and in intensity. After pulling a culture of my urine & vaginal wall, my gynecologist found Klebsiella in my urine sample. He prescibed Levaquin, an antibiotic, which helped alleviate the symptoms temporarily, for both vaginal discharge of gas and bloating in the digestive tract. Unfortunately, I wasn't told that I should be replacing the "good bacteria" that also die from antibiotics by consuming yogurt. When symptoms appeared again, I was prescribed Levaquin again, and the problem disappeared temporarily. When it reappeared, I was prescribed Bactrim, also with temporarily results. When it recurred again, I visited another physician, and was prescribed Diflucan, an antifungal, as yeast was found in my vaginal culture. The problem is now worse than ever, the gas discharge is very frequent, and so is the bloating. What should I do next? My physicians are just as confused as I (due to my age and absence of surgical or pregancy history).

Some details that may or may not be relevant are that I've had symptoms of PCOS and have been taking orthocyclen for the past 5 years.  Also, I've had a dull pain in the lower left side of my abdomen that has happened a few times and it lasts for a few weeks (I haven't seen a correlation between the 2 problems).  I also was prescribed to Metformin about 2 years ago, which I took for about 8 months.  I'm not overweight and pursue healthly eating habits with attention to fiber intake.  My mother also experiences symptoms of IBS.

[Kevin Pho, MD]

It sounds like you may be describing a colovaginal fistula.  Most cases occur after surgery, cancer or radiation treatment.  

Medical therapy is rarely successful in these cases, and a surgical opinion should be sought.  Options can include a gynecological surgeon in conjunction with a colorectal surgeon.  

Complicated cases can be referred to a major academic medical center.

These options should be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com

[MLWTR]

If it is indeed a fistula, there are three main causes: trauma (usually obstetric, as you point out), radiotherapy (for cancer in the pelvic region), and Crohn's disease (a form of inflammatory bowel disease). If you have a history of digestive symptoms, Crohn's disease may be a possibility. An MRI can be useful to look for the presence of a fistula.

[kimbacat]

it's normal to pass some gas vaginally.  some of us do it daily without even being aware of it from air that get trapped from regular activities.  

if you are concerned, you might want to get an upper gi with a small bowel follow through which might show a fistula.  MRIs are pretty good for perirectal fistulas, but I don't know how good they are for recto-vaginal or colo-vaginal fistulas.  "normally" with vaginal fistulas, there is passing of some, even if only a little, feces through the vagina even if only periodically.

a low tech way my gi checks is to have me take charcoal and use tampons for the next day or 2.  if there is a fistula, the charcoal will show up on the tampon.  but talk to your doc first before attempting this.  

at the very least, I would suggest that you start on a good probiotic to help replenish what was depleted from the antibiotics.  that in itself can help with abdominal gas and bloating.  

take care

[DrMonkey]

I'm suddenly having this same problem.  I'm 44.  No kids, no recent surgeries.  An abortion about 10 yrs ago, without complications.  I have a general increase in gas by mid-day, and gas is coming from both the rectum and vagina.  I can control release of the "normal gas" but not from the vagina.  I teach, so this is a problem!

It isn't like the typical, post-coital varts-  I've had those too.  

Have you learned anything?

[DrMonkey]

I'm suddenly having this same problem.  I'm 44.  No kids, no recent surgeries.  An abortion about 10 yrs ago, without complications.  I have a general increase in gas by mid-day, and gas is coming from both the rectum and vagina.  I can control release of the "normal gas" but not from the vagina.  I teach, so this is a problem!

It isn't like the typical, post-coital varts-  I've had those too.  

Have you learned anything?