Best way to diagnose a vaginal fistula?

I had a rectovaginal fistula and was passing a lot of gas through the vagina (nothing else thank god!) and my GI never told me to see an OBGYN, he just sent me straight for an MRI which is an excellent screening tool for fistula, they were able to see some small branches coming off of my fistula. I certainly wouldn't have wanted an OB inserting anything up there and possibly making things worse which is what I would have assumed but since your GI told you to go to an OB then maybe I'm wrong in that respect but I'm glad my GI just sent me right for an MRI which was about a months wait.

Humira put my CD and the fistula into remission...I had no idea though that when I flare again the fistula will likely reopen again which makes me angry beyond words....I don't ever want to feel any fistula again.

Awe lamb, that's terrible! You're on Humira and it hasn't helped your fistula? It must be quite a complex fistula, it's strange that for most others biologic's help and for some it doesn't in regards to fistula healing.

An MRI will be able to detect fistula.

I suffered with active crohn's colitis (CD affecting the colon) for 23 yrs straight and ended up developing my rectovaginal fistula (never had any abscess to date thank goodness!!) but chances are, if you're feeling gas/air coming out of your vagina, it's definitely a fistula because there's really nothing else that can cause that to happen...it sucks but the sooner you get it looked after, hopefully the sooner they can help you with it.

Very depressing to know that you've been on Humira since 2008 and are now dealing with a fistula...do you have any other symptoms, is your CD in remission as far as you can tell?

Actually, an MRI may not be able to detect a fistula. Most likely it will, but sometimes they won't. However, it is more likely to show than a vaginal exam (which won't be much worse than pap smear, if even that "bad"). Whatever you do, don't let them do a barium x-ray unless you absolutely have to. Worst experience I've ever had, and that's saying a lot. I have had a RV fistula for several years now. Remicade did not heal it, unfortunately. If you have gas passing through, I almost guarantee you have one. I'm sorry. You will want to find a really good colo-rectal surgeon. Don't go to a regular surgeon; a good one will just refer you to CR and a bad one won't know what he's doing.

Please keep us updated once you find out! We can break down types of surgeries, setons, etc. But if it makes you feel any better, I seriously don't even notice my fistula at all! You get used to gas going through, and if I am doing a colonoscopy prep I have to wear a pad because holding back that liquid of D will make it leak through. But seriously, even intimacy with my husband is pretty normal by this point and I don't even notice.

It's interesting what about this disease stresses us out! For me, I would much rather have my RV fistula than to have an ostomy. Then again, I have a 2 1/2 year old, so trying to have a bag with her climbing all over me would be really rough.

cupcakespinkgal - sorry to hear that your surgery did not have good results. Ever since I was diagnosed I have been afraid of developing a fistula, it just seems like a complication that is very difficult to deal with for some.

At this point, after having a resection and hoping for a more normal life, the thought of a fistula makes me want to cry or break something. I can't even string together more than 2 weeks without diarrhea, and that is with remission.

Three years ago, I got a perianal abcess. After a lot of medication, it was claimed to have cleared based on the results of an MRI. A year later, my GI suspected a fistula and I had the worst thing, dynamic MRI, as I was very constipated and they found no fistulas. This year, due to rectal discharge, I had an MRI, which showed a perianal fistula. So, I would recommend you have the MRI.
As others mentioned, the pain of an abcess is not comparable even the pain I get from my fistula because of the discharge, the pain of proctitis and fissures is not as bad as that of an abcess.