Fistula Treatment

Overview

An abnormal connection between two body parts, such as organs or cavities, is known as a "Fistula". It can occur in any part of your body, but the anus (the opening of the rectum to the outside of the body) and rectum (the part of the large intestine that ends at the anus) are the most common sites since they are more prone to infection. It most often occurs due to bacterial infections, injury, cancer or congenital (present by birth) defects. 

Symptoms of a fistula include pain, constipation or diarrhea, fever, weight loss, nausea, and tiredness. Fistula treatment depends on the severity of the condition and includes medications. But if it fails to respond, surgical treatment might be needed.

What is a Fistula

A fistula is an abnormal passage between two organs or cavities within different parts of your body. It can be seen developing among men and women over the age of 40 and may cause various symptoms depending on its location. 

The different types of fistula are mentioned below:

Based on the nature 

Blind

• This fistula is open at one end and closed at the other.

Complete 

• A complete fistula has an opening present both outside and inside the body.

Horseshoe

• This fistula connects the anus to the skin surface after encircling the rectum.

Incomplete 

• This appears as a tube from the skin that is closed on the inside and does not connect any internal structure.

Based on the location

Anal fistula 

• This is the most common fistula that connects the anus to different organs such as the rectum, vagina, and colon.
• They are further classified into anorectal, colo-vaginal, and anovaginal fistula.

Intestinal fistula

• This type of fistula develops between the small intestine and the skin or colon and the skin surface.

Bladder or urinary tract fistula

• A bladder or urinary tract fistula is formed between the bladder and other organs or the skin.
• It is either enterovesical (when the bladder opens into the bowel) or vesicovaginal (when it opens into the vagina).

Gastrointestinal fistula

• It is an abnormal opening into the stomach or intestines that leads to leakage of contents.
• It is classified as enteroenteric (the leakage passes through a part of the intestine), and enterocutaneous (where the leakage passes through the skin surface) fistula.

Obstetric fistula

• An abnormal connection is formed between the genital canal (birth canal) and the urinary tract or rectum.
• This most often forms due to obstructed labor during childbirth. 

Vaginal fistula

• It is an abnormal opening that connects the vagina to other organs like the bladder, colon, or rectum.

What Causes a Fistula

Depending on the type and location, there could be different reasons for the occurrence of a fistula. It can occur naturally or be an end-effect of surgery or injury. 

Several risk factors could increase your probability of developing a fistula. 

• Gastrointestinal disorders like Crohn's disease (a type of inflammatory bowel disease)
• Diverticular (digestive) diseases occur when small sacs form and push outward through weak spots in the colon's wall.
• Radiation therapy for cancer treatment
• Certain infections, such as HIV (Human Immunodeficiency Virus) and tuberculosis
• Prolonged or obstructed childbirth, or injury due to pelvic surgery
• Certain surgical treatments can lead to fistula formation as a post-procedure complication like gallbladder surgery
• Therapeutic use such as kidney failure dialysis. 

What Are The Symptoms of a Fistula

A fistula can present with some telltale symptoms depending on the location, which include:

Fistula between the small and large intestines

• Passage of undigested food
• Diarrhea (frequent loose, watery stools)
• Abdominal pain, nausea, and vomiting
• Weight loss 

Fistula between the intestine and the bladder

• Repeated urinary tract infections (UTIs) may cause high-grade fever (>103 ?), chills, and body aches.
• Pain and burning sensation during urination
• Urinary retention (inability to pass urine that leads to urine accumulation in the bladder)
• Cloudy urine or blood in the urine (hematuria)
• Pain around the anus

Fistula between the vagina and the intestine

• Abnormal passage of gas or stool through the vagina.
• Constant urine leakage from the vagina.

A fistula that forms from the intestine to the skin surface

• Initially presents as a painful boil or lump
• Gradually forms a skin abscess (a pocket of pus) that may drain fluids or stool

How Fistulas Diagnosed

A fistula can cause various symptoms, as mentioned before; hence, contact a healthcare professional for further evaluation. 

Medical history

• Your doctor will record your medical history to evaluate your symptoms and assess your overall health.
• He/she will rule out other medical conditions like asthma, diabetes (increased blood sugar levels), hypertension (high blood pressure), any history of previous surgeries, cancer therapy, injuries, or allergies. These conditions could be the risk factors predisposing you to the development of a fistula.

Physical examination

• Your doctor may conduct a pelvic exam using a special instrument known as a “Speculum”.
• Your doctor will physically examine you to check for any visible opening seen at the skin surface, or the presence of any anal lump or boil.

Medical tests

• These tests help to confirm the diagnosis, which includes the following:
  • Urine test: A urine sample will be taken to check for urinary tract infections.
  • Complete blood count (CBC): A blood sample will be taken to measure several blood components like red blood cells, white blood cells, etc, to detect the presence of infection.
  • Anoscopy: It is an examination of the anal canal using a special scope to detect the presence of a fistula.
  • X-ray scan: A fistula causes tissue damage at the infection site that can be evaluated through X-ray images.
  • MRI (Magnetic Resonance Imaging): An imaging test that uses a magnetic field to capture images of the organs affected to confirm the presence of a fistula.
  • Endoscopy: A thin, flexible tube called an endoscope (consisting of a light source and camera) will be inserted to detect the presence of a fistula within organs or cavities. It helps detect gastrointestinal fistulas.
  • Fistulogram: A special type of X-ray that uses a dye that will be injected into the fistula to provide detailed imaging.
  • Intravenous pyelogram: A type of X-ray commonly used to detect bladder fistulas.

How Are Fistulas Treated?

Once your doctor confirms the presence of a fistula, the treatment depends on the type and location. The different treatment modalities of a fistula are as follows:

Medications

• Antibiotics that help fight bacterial infections.
• Anti-inflammatory drugs control the worsening (inflammation) of the existing fistula and prevent the formation of new ones.
• Immunomodulatory drugs help modify the activity of your immune system, by decreasing the inflammatory response.
• Pain relief medications reduce the pain and discomfort caused by the fistula.

Surgical treatment

• When medications fail to provide relief, surgical treatment is recommended. These include:

Fistulotomy

• It is the most effective and common surgical procedure to treat anal fistulas. 
• It involves cutting or incising along the whole length of the fistula to open it and allow it to heal as scar tissue. 

Transabdominal surgery

• It is a simple procedure used for a rectovaginal fistula.
• The fistula is dissected (cut open) and divided to separate the rectum and the vagina.
• These organs are later closed without bowel resection.

Laparoscopic surgery

• It is a minimally invasive (does not involve extensive cuts and bleeding) procedure.
• Here a special device known as a laparoscope, consists of a light source and a tiny camera. 
• This device is inserted through keyhole-sized incisions made to access the fistula.
• Small surgical instruments are inserted through other incisions for fistula repair. 

Endorectal flap procedure

• This procedure is used for complex fistulas.
•  A tension-free flap is taken from other parts of the body to cover the fistula's internal opening. 

Ligation of the intersphincteric fistula tract (LIFT)

• It is a 2-stage treatment for complex anal fistulas.
• The fistula is accessed between the sphincter muscles (ring-shaped muscles that relax or tighten to open or close a passage in the body).
• A silk or latex string is inserted into the fistula to widen it over a period of time. 
• Once widened, the infected tissue is removed and the internal fistula opening is closed. 

Laser fistula surgery

• It is a painless procedure to shut the fistula.
• A beam of laser is targeted that generates heat energy to destroy the fistula lining.

Non-surgical treatment

• These treatments are most often used for small and simple fistulas. These include:

Fibrin glue

• It is a simple, painless procedure that uses a special medicinal adhesive (glue).
• This adhesive forms a fibrin (a fibrous protein) clot to seal the fistula tract.

Collagen plugs

• In this procedure, simple fistulas are closed by plugging collagen (a primary building block of the bone, skin, muscles, ligaments, and other connective tissues) into the opening of the fistula.

Seton technique

• The surgeon treats the fistula by placing a drainage tube (Seton).
• This helps drain the infection and allows the tunnel (opening) to heal.

Complications Associated With Fistulas

A fistula is an abnormal passage, which, when left untreated, can cause serious complications. 

Sepsis

• Is a life-threatening complication of a severe bacterial infection.
• This can lead to the formation of an abscess, which may eventually cause pus discharge.

Bowel incontinence

• A term that refers to abnormal leakage of fecal contents from the rectum.
• This mostly occurs due to damage to the anal sphincter muscles.

Fistula recurrence 

• Sometimes, even after surgery, there is an increased risk of fistula recurrence. 

Bowel obstruction

• Damage to the anal sphincter muscles can cause bowel obstruction and constipation.

How to Prevent Fistulas?

Fistula is easily preventable, and the risk of certain types of fistula can be lowered by the following preventive measures.

• Maintain good personal hygiene by washing after every bowel movement.
• Eat a healthy, balanced diet that should include fiber-rich foods (fruits, vegetables, and whole grains) to soften your stool and aid in easy bowel movements. Avoid foods like spicy (chilies, peppers) and junk foods (pizza, burgers) that upset your stomach.
• Hydrate yourself with 1 to 2 liters of water daily to flush out toxins from your body and prevent intestinal blockage.
• Use pillows when you need to sit for long hours. This avoids extra pressure on your back, butt, and legs.
• Strengthen your immune system with foods rich in Omega-3 fatty acids (fish, olives) and vitamin C (citrus fruits). 
• Exercise regularly to maintain proper bowel movements.
• Manage other medical conditions that increase your chances of a fistula.

Why Choose Medfin?

Surgery can be a daunting aspect, and feeling anxious is absolutely normal. The massive amount of information you can get from the internet may confuse you even more. This is where Medfin can help. Leave us the hefty task of finding the best hospital, the finest doctor, and the latest procedure at the lowest cost. Let us take charge while you sit back and focus on your health and recovery. Think surgery! Think Medfin!