Valerie’s search for expert rectovaginal fistula care leads her back to the worry-free life she thought was gone
For more than six years, Valerie Powell, of Pleasant Hill, Iowa, endured the distress and discomfort of a rectovaginal fistula. Valerie wanted all of her children to be delivered by vaginal birth, but she was advised that if she had the fistula repaired, any future births would require cesarean delivery.
Over the years, she dutifully managed her diet, activities, and bowel movements to minimize her symptoms in preparation for the day she could have the fistula repaired. Those symptoms included stool periodically leaking through her vagina.
It’s an isolating and debilitating condition for anyone. For a mother raising small children, it was even more disruptive.
After her third child was born, Valerie, 36, was finally ready to have the fistula repaired by a local colorectal surgeon, but the procedure failed. She was devastated.
Then Valerie’s obstetrician suggested getting a second opinion from the University of Iowa Health Care Urogynecology and Pelvic Reconstructive Surgery Clinic. She took that advice and met with UI urogynecologist Kimberly Kenne, MD, MCR.
Kenne performed surgery to successfully close the fistula. Valerie says Kenne returned her to the life she thought she might never have again.
“I’m completely back to normal,” Valerie says. “After seven years, it feels amazing.”
Patiently managing fistula symptoms while growing a family
Valerie’s long journey began in 2013, when the rectovaginal fistula developed during the birth of her first child.
“My condition was something not many people know about, and it was very lonely,” she says.
Rectovaginal fistula is an irregular connection between the rectum and the vagina. Along with the bowel control issues, primarily loss of stool through the vagina, rectovaginal fistulas can lead to other symptoms, such as pain and irritation and frequent urinary tract infections.
When her fistula was diagnosed, Valerie learned that if she had it repaired surgically, she would likely need to have a cesarean delivery anytime she gave birth again. She preferred vaginal birth, so she decided to manage the condition until she could finish growing her family.
I’m completely back to normal. After seven years, it feels amazing.
After her first surgery to repair the fistula failed in November 2019, she decided to try again. She was advised that this would require wearing an ostomy bag for six weeks, with no guarantee that the second procedure wouldn’t fail like the first one did.
Hopelessness set in as she continued living with the condition that she thought would be gone.
“I was in such a depressive mood following the failure,” Valerie says. “There was a lot of physical discomfort as well.”
Iowa’s only clinic dedicated to urogynecology care
Valerie did her research and found Kenne’s video profile on the UI Hospitals & Clinics website.
“I started crying,” Valerie says. “The way she talked, I felt like she was talking directly to me. She’s there to help women through these situations that a lot of people don’t know about.”
The clinic is the only one of its kind in Iowa. It focuses solely on urogynecology care and is staffed by board-certified and fellowship-trained urogynecologists. A urogynecologist is an obstetrician-gynecologist who has fellowship training in pelvic medicine and reconstructive surgery.
While rectovaginal fistulas like Valerie’s are fairly rare, many pelvic floor disorders—including incontinence, pelvic organ prolapse, and overactive bladder—are common among women. Still, few women feel comfortable discussing these conditions openly, even with their doctors.
“People just tend not to talk about them for many reasons,” Kenne says. “And so women tend to feel isolated when they have these problems.”
Successful fistula repair using a different approach
Valerie noticed Kenne’s patient-first focus immediately.
“The way she sat and talked to me and answered all my questions was amazing,” Valerie says. “She did not rush things at all.”
Because Kenne closed the fistula through the vagina, rather than the rectum, her approach did not require Valerie to use an ostomy bag during recovery.
Following the surgery, whenever Valerie had concerns, Kenne’s team invited her in for unscheduled check-ups.
“The follow-up care was awesome,” Valerie says. “A couple of times, I thought I was having symptoms, and they would say, ‘Come in and we’ll check things out.’ It was a long drive for me, but it was worth it, because I could tell they were really listening to me and my concerns.”
Now fully recovered from surgery and free of any dietary or activity restrictions, Valerie is enjoying a life without health worries for the first time in years and turning her full attention to caring for her children, ages 7, 5, and 2.
“I’m now symptom-free,” Valerie says. “My life is back to the way it was seven years ago.”