NJK, in my own experience, fistulas sometimes open up a tiny bit and can mostly remain closed until something causes the need for another escape route for stool. If you have any particular pressure between your pouch and your rectum, such as from bearing down or from some measure of constipation (relative) that differs from normal consistency, it might cause a fistula that's present but not normally needed to open a bit more such that you have the symptoms you describe. At your period, you may have have slightly engorged tissues (internally) that exert slight pressure on the bowel and result in your symptoms. You could have adhesions, scar tissue, or partial obstructions that have resulted in the fistula but are not otherwise causing you difficulty, and either of the above sources could then result in the tract opening slightly. Prior to my permanent ileo, I had two vaginal fistulas, one very small and sometimes open and sometimes not. the other resulted in sufficient pain from fecal waste in a place it didn't belong that I was in misery. I hope that's not true for you - sounds like an inconvenience and something all of us would rather not deal with but not one that would force you into surgery. I had no choice, and when I did have surgery, many many adhesions had caused a partial bowel obstruction, painful in itself, and caused the fistulas to open to solve the obstruction. There's a perverse way in which a fistula is an incredible solution to obstruction, a means of survival, though of course they sometimes form in the absence of obstruction. It was months before a very small amount of drainage opened into a full fistula for me, so it can be hard to diagnose, but gas and fecal matter vaginally are NOT normal, and like me, I"m sure you know what you're finding and are not confused about your anatomy. To be told it's nothing is insulting. I didn't check to see where you'd had your surgery, but again, from my experience, most surgeons have an interest in reassuring themselves that their work is perfect, and less interest in either non-surgical solutions or other docs' work, or in much beyond Cipro (and I"ve had lots of surgery). I went to a gynecological surgeon (who obviously had NOT done any of my G I surgery), and would suggest that to you particularly if you are near a teaching hospital where such a person has seen complicated cases. The colorectal surgeon who did my permanent ileo also repaired the fistulas at that time. Maybe you'll hear from other women who've had vaginal fistulas.

NJK, so sorry to hear you're experiencing these symptoms. SF is right - passing gas and possibly stool from the vagina is NOT normal. Interesting that yours occurs only after your period. I don't know what that would mean.

Fistulas are sneaky and often cannot be seen on scope. They will better show up on an MRI. Even Dr. Shen had to work hard to find the opening inside me (but find it he did). I'm glad to hear you will be seeing him. He will do everything in his power to help you.

Long story short I now have a seton to keep the thing open and draining to avoid an abscess, and to assist in the healing.

I hope you find an answer soon - keep us posted.

Hi NJK,

I had a similar story earlier this year, only my symptoms were not 'monthly'. Had fistula-like symptoms, but EUA found nothing. Surgeon dismissed it as he couldn't see anything. Told me to come back if I have any more problems.

Ultimately, the symptoms have settled down to be light-to-non-existent, and because my pouch is pretty well functioning, I'm going to leave it be as a very minor inconvenience.

From what I've read (and I could be wrong) there does not seem to be much in the way of treatment, other than the more severe surgical interventions. I think antibiotics are sometimes prescribed (I had a dose of antibiotics for a throat issue, which may have helped my symptoms). I had no Chrohns indications, so those meds were not discussed. From there it seems you jump to setons and surgical fixes.

So for me, a well functioning pouch is not work risking with an aggressive treatment. But again, my symptoms are pretty minimal.

Hopefully the doctor will have some good answers for you. Please post back what the doctor says, at it's certainly helpful to others going through something similar.

Good luck, and I hope it ends up simple/treatable.