P0352Living with a rectovaginal fistula; stories told through patient interviews

Background Rectovaginal fistulae (RVF) are poorly understood and treatments are often unsuccessful. Symptoms can be profound but qualitative analysis has been limited. We explored the impact of living with an RVF through unstructured interviews, aiming to understand the impact and symptomatic burden this condition has on daily living. Methods Patients with RVF were identified from our tertiary referral centre database. Semi structured purposive interviews were audio-recorded and transcribed verbatim. Interviews explored symptoms, hygiene, social and psychological impact, sex life, stigma and self-perception, as well as the impact on parental bonding and aspirations in the case of obstetric RVF. Results Fifty qualitative interviews were conducted (n = 50, mean duration 53 minutes, median age 43.5, range 33-69) until themes saturated across patient groups. Aetiology of RVF were: 15-obstetric injury, 1-perianal infection, 17-Crohn’s disease, 1-gender affirmation surgery, 1-congenital-malformation, 9- iatrogenic injury and 6- cancer/radiotherapy. Patients described living in isolation, social avoidance, depression, self-blame and ‘feeling unattractive’. Women dreaded sexual intercourse, unable to initiate, engage or reach satisfaction. Common fears were deterioration and requiring a stoma. The worst aspect of an RVF was often the uncontrolled passage of flatus stool per vaginam and ‘endless showers’. Many expressed absent support channels, particularly in the post-operative period, suggesting a need for improved 225 documented information, specialist nurses or helplines. Some felt they may ‘never be normal again’. Conclusion These descriptions highlight a diminished sense of self-worth, whilst suffering in silence. Clinicians should better understand these patients, providing support along the way. Psychological support and improved perioperative information would benefit patients and should be offered in RVF repair centres. Conflict of interest: Ms. Sackitey, Charlene: No conflict of interest Al Rubaiy, Laith K Qassim: No conflict of interest Vaizey, Carolynne: No conflict of interest Hart, Ailsa: No conflict of interest Tozer, Philip: No conflict of interest