Vaginal Rectal Fistula

A well known but seldom serious post-operative complication of feminizing vaginoplasty is a vaginal-rectal fistula or perforation of the low anterior rectal wall.

We have closed several intraoperatively and all have healed without incident.

Of those noted post-operatively following stent usage, everyone on conservative management also has healed without the need for diverting colostomy.  One patient did seek surgical consultation
in Missouri, her home state, and colostomy was performed and taken down (reversed) 3 months later and she did well.

Our belief is that if you seek surgical consultation, most likely a colostomy will be proposed as this is a time honored and conservative approach.  If you do elect consultation with a surgeon, please
advise and I will cheerfully confer with your chosen specialist.

My bias is… if you are not septic, or in pain, or do not observe any findings to suggest an abscess or intra-abdominal process, you may do very well with the following conservative measures:

1.  Please cleanse any fecal material noted with a gentle vaginal douche as described in your post-operative discharge instructions. To be repeated as needed.

2.  Stop stent usage unless I can personally see you at the office and review dilation technique. Seeing you at the office is recommended.

3.  Have a bathroom scale at home and take your weight every day or so, and chart this.  If you are losing appreciable weight, conservative treatment will no work, as patients in poor protein balance do not heal well.

4.  Stop all solid foods to reduce any stool formation.  Do ingest a minimum of 3 quarts of fluids daily.

5.  You should consider taking 10 cans of Ensure or similar protein shake everyday, throughout the day.  You can consume anything in the fluid family except alcoholic beverages. Ice cream and jello are also encouraged along with beef and chicken consomme.

6.  You will need to be on about a 2500 calorie diet. 

7.  Additionally, visit a nutriontal  store and get protein powder supplement.  Strive for 175 grams to 200 grams of protein daily.   Please advise if you have any kidney malfunction.  Protein granules may be whey or soy based.  Try a GNC store.

8.  Continue on Vitamin C 500 mg 3 times a day.

9.  Take Zinc supplements.  Zinc sulfate 125+ mg  tablets (or 45 to 60 mg of elemental zinc) 3 times a day

10.  Take arginine supplements which may be helpful.  2 to 3 grams, 3 times a day.

11.  The healing process, typically is first absence of stool in the vaginal area, then passage of vaginal gas only and finally no passage of vaginal gas whatsoever.

12.  Once this end point is achieved, wait an additional al 3 to 4 days, and start a low residue diet which does include some solid foods.

13.  Please  call me whenever concerns arise and periodically to update me on your progress.
Harold M. Reed, M.D.