A rectovaginal fistula: Poop Talk & Infections

A spirited day for my aunt today. A happy mix of mistaken identities, reality and hope. She is planning a big BBQ for when she heads home, even though she ‘knows its going to be awhile’. 

Ok to drastically, I am saying drastically, change subjects: recto-vaginal fistula. An intrusive subject for me to discuss about my aunt. But, critical to discuss beyond saying be on the look out for UTI’s. 

When my aunt was admitted into the hospital back in April 2010, she was hypothermic, near death, and in the grip of a massive infection. She had been, according to my mom (who was as you recall in the final stages of hospice), talking gibberish, imagining being chased by creatures and hearing voices. I recall standing in a hallway and having a doctor asking me about a deviated rectum. Whoa! I barely knew the girl let alone knew about her rectum. I called home and talked to my mom. She knew her sister had ‘some problems down there’ but couldn’t say much more.

The doctor explained my aunt’s heart was stalled out. She was hypothermic (no heat in the house) and she was probably fighting a massive infection because of a deviated rectum. In effect, her bowel movements were being diverted into her vaginal cavity resulting in an infection.

Today the care giver, quietly, shyly mentioned that whether it was an ‘accident’ or planned bowel movement, it seemed to her too much feces was ‘up front’…every time. This required frequent, extensive cleanups and the concern they might not be adequate. Of course, this will inevitably result in an infection and the attendant complications. 

A recto-vaginal fistula: As you can see the bowel/rectum appears to bypass the normal exit point and moves into the vaginal area and in some instances upward to some degree. No wiping to the rear is going to help alleviate this complication in this care setting.

“In medicine, a fistula (pl. fistulas or fistulae) is an abnormal[1] connection or passageway between two epithelium-lined organs or vessels that normally do not connect.” Wiki

You may not even know this exists in a loved one, so personal is the topic. I certainly wouldn’t save for the doctor quizzing me about my aunt. And, I did not think to share this with the poor care providers who have had to provide extensive cleanups for my aunt. At least they would understand the why’s and how’s of what they have been seeing. And, the UTI connection, which I have just assumed as a possible problem (why, because I knew of the problem and thought I had shared it back in June). 

Yeast Infection Spores...Itch Itch

My aunt has commented more than once on the quite detailed cleanups she endures and now it makes more sense. 

“Recto-vaginal fistula may be extremely debilitating. If the opening between the rectum and vagina is wide it will allow both flatulence and feces to escape through the vagina, leading to fecal incontinence. There is an association with recurrent urinary and vaginal infections.” Wiki

Ok sorry for the topic. But, my hoarding aunt had a severe problem with this when living alone in less than sanitary conditions. My hoarding mom had a similar problem: eventually she closed off the access to the washer and dryer. She blocked off the access to the bathroom. Sanitation suffered. My mom moved to the use of disposable diapers. Additional problems: no garbage service. She didn’t cook. Who needs garbage pickup? Well all those disposable diapers. She used them longer than she should have to cut costs. Of course, that resulted in infections. She disposed of those in mounds of disposable diapers in a corner of the basement. Mind boggling to know, to find, to cleanup, to imagine. When my mom was at her lowest point, on her own, she had hallucinations, fungal infections of the lungs, a UTI and 103 degree temp. The sanitation conditions of hoarding contribute to mind altering disease. 

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