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Fistula: Causes, Symptoms and Treatment.

A fistula is an abnormal connection or passageway that connects two organs or vessels that do not usually connect. They can develop anywhere between an intestine and the skin, between the vagina and the rectum, and other places. The most common location for a fistula is around the anus.

Fistulas may occur in many parts of the body. They can form between:

  • An artery and vein
  • Bile ducts and the surface of the skin (from gallbladder surgery)
  • The cervix and vagina
  • The neck and throat
  • The space inside the skull and nasal sinus
  • The bowel and vagina
  • The colon and surface of the body, causing feces to exit through an opening other than the anus
  • The stomach and surface of the skin
  • The uterus and peritoneal cavity (the space between the walls of the abdomen and internal organs)
  • An artery and vein in the lungs (results in blood not picking up enough oxygen in the lungs)
  • The navel and gut

TYPES OF FISTULAS:

ANAL FISTULAS/PERIANAL FISTULAS.

Abnormal connection between the epithelialized surface of the anal canal and the perianal skin.

  • Anorectal Fistula occurs between the anal canal and the skin around the anal opening.
  • Rectovaginal or Anovaginal Fistula occurs when a hole develops between the rectum or anus and the vagina.
  • Colovaginal Fistula occurs between the colon and the vagina.

URINARY TRACT FISTULAS.

Abnormal openings within a urinary tract organ or an abnormal connection between a urinary tract organ and another organ.

  • Vesicouterine fistula occurs between the bladder and the uterus.
  • Vesicovaginal fistula is where a hole develops between the bladder and the vagina.
  • Urethrovaginal fistula is between the urethra and the vagina.

OTHER TYPES.

  • Enteroenteral fistula occurs between two parts of the intestine.
  • Enterocutaneous or Colocutaneous fistula occurs between the small intestine and the skin or the colon and the skin respectively.

CAUSES OF FISTULA

Crohn’s disease and diverticular disease are well known to cause fistula formation. In addition, those who are undergoing radiation therapy are at greater risk for a variety of fistulas. 

Most anal fistulas develop after an anal abscess. One can develop fistula if the abscess does not heal properly after the pus has drained away.

Less common causes of anal fistulas include:

  • Crohn’s disease – a long-term condition in which the digestive system becomes inflamed
  • Diverticulitis – infection of the small pouches that can stick out of the side of the large intestine (colon)
  • Hidradenitis suppurativa – a long-term skin condition that causes abscesses and scarring
  • Infection with tuberculosis (TB) or HIV
  • A complication of surgery near the anus

WHAT ARE THE SYMPTOMS OF FISTULAS?

Depending on the type of fistula, here are some of the signs and symptoms:

  • Constant urine leakage from the vagina
  • Irritation in the external female genital organs
  • Frequent urinary tract infections (UTIs)
  • Leakage of gas and/or feces into the vagina
  • Fluid drainage from the vagina
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain

Patients can have different symptoms depending on which parts of the body are connected by the fistula.

Fistula between the small and large intestine

  • Diarrhea
  • Passage of undigested food

Fistula between the intestine and the bladder

  • Urinary tract infection
  • Burning with urination
  • Cloudy urine or blood in the urine

Fistula between the intestine and the vagina

  • Passage of gas or stool through the vagina

Fistula from the intestine to the skin

  • Can initially present as a painful bump or boil
  • Skin abscess that is open and draining fluid or stool

If you have one or more of these symptoms, be sure to promptly discuss them with a your Doctor, Dr. Majid Bassuni, at our clinic in Dubai.

FISTULA TREATMENT OPTIONS

Following the diagnosis of a fistula, the medical professional will decide the best plan of treatment based on its location, size, and condition. One treatment path may simply be controlling symptoms with a catheter. More severe fistula repair may require surgery.

MANAGEMENT

Non-invasive Treatment

  • Fibrin glue. A specific medicinal adhesive used to seal fistulas.
  • Plug. This is usually a collagen matrix used to fill the fistula.
  • Catheters. Used to drain fistulas, catheters are usually employed on small fistulas to manage infection.

SURGICAL TREATMENT

  • Transabdominal surgery. The fistula is accessed through an abdominal wall incision.
  • Laparoscopic surgery. This is a minimally invasive surgery that involves a tiny incision and the use of cameras and small tools to repair the fistula.

PHARMACEUTICAL TREATMENT

Antibiotics or other medication may also be used to treat any infection associated with the fistula. Yet there is no pharmaceutical solution to eradicate fistulas at this time.

While fistulas pose a serious threat to your body, high treatment success should encourage you or someone dealing with fistulas to seek immediate help.

Ask Your Doctor

  • What are my options for fistula removal?
  • What preparations will I need to make before my fistula removal surgery?
  • What are the potential complications from surgery?
  • What kind of restrictions will I have after my surgery?
  • How long will it take me to recover from fistula removal surgery?
  • How will the surgery affect my diet and bowel movements?
  • If I require an ileostomy, how do I care for my ostomy pouch and keep it clean?
  • What supplies will I need at home?
  • Will I need additional surgeries?

Should you require additional information or would like to make an appointment with our Consultant General/Colorectal Surgeon, Dr. Majid Bassuni ,please call us or e-mail us at info@westminsterclinic.ae

Reference:

  • crohnscolitisfoundation.org
  • nhs.uk
  • American Society of Colon and Rectal Surgeons (ASCRS)
  • National Association for Continence (nafc.org)

Disclaimer: All contents on this site are for general information and in no circumstances information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility of any damage done by the misuse or use of the information.

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