Fistulas can be physically and emotionally challenging. Your doctor and nurse specialist can offer advice and support.
You can often manage symptoms by taking medication and using barrier films or anaesthetic creams. Your doctor can also give you information about a special diet to help control your symptoms.
Fistulas can be caused by cancer treatment, inflammatory bowel disease, surgery, or injury. They may also occur in the urethra or bladder.
Pain
Fistulas can cause pain and sometimes they have a foul-smelling discharge that comes from the abscesses. They can also cause bowel movements that are painful and full of pus or blood. If these problems are not treated, they can lead to serious infections and damage your health.
Your doctor or nurse will help you find the best treatment for your fistula symptoms. This may include a special dressing to control the odor and keep the skin clean. This dressing contains silver and can reduce the number of bacteria in the wound. It can also be soaked with antibiotic gel to treat an infection.
If you have an anal fistula, you will probably be told to see a doctor called a colorectal surgeon. This specialist can look at the skin around your anus and gently insert a finger inside (a rectal examination). They can then tell if you have a fistula and recommend the right treatment for it.
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The type of fistula you have will determine the symptoms you get. For example, if you have an anal fistula, pain can occur when you pass a large or dry stool because it stretches the opening around your anus (the anal gland). You may also have pain and swelling in or around the anus. Pain can also happen if you have a fistula that opens near the anus and there’s a build-up of fluid or pus.
A fistula surgery can fix the problem and prevent it from getting worse. This is an operation to create a new connection between your artery and vein. It can be done in hospital or in your doctor’s clinic or practice. The aim of the operation is to create a large, strong vein that can handle the pressure from dialysis needles and drain urine and blood from your body.
You will need a general anaesthetic for a fistula surgery. This means you will be put to sleep and can’t feel any discomfort. You will need a partner or carer to come with you when you have this procedure. This person will need to stay with you in case you have any complications.
Abdominal Discharge
A fistula is a tube-like connection between two areas of your body that don’t normally connect. Most fistulas form between the bowel and the skin, but they can also form from an intestine to another part of the intestine or to other organs. Fistulas are often caused by complications after surgery, such as a C-section or hysterectomy, but they can also occur with long-term chronic conditions like inflammatory bowel diseases like Crohn’s disease and ulcerative colitis or after radiation therapy to your pelvic area for cancer.
Fistulas can be very painful and have a bad smell. Your doctor and nurse will tell you how to care for your fistula to reduce pain, infection and other symptoms. They may recommend you use barrier films to cover the opening of your fistula or a cream that will help protect your skin. They will also advise you to shower every day, but don’t rub the area – just wash it gently with warm water. They can prescribe antibiotic gels or tablets for any infections that occur.
When you have a fistula that opens directly on to your skin, your doctor may suggest using a bag to collect your bowel movements. This can be a temporary stoma until your fistula closes and then you’ll have an operation to remove it. Alternatively, your doctor may suggest you have a permanent stoma on the inside of your large intestine (rectum) or in your small intestine, known as an ileostomy.
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It can be difficult to diagnose an internal fistula, but your healthcare provider will look for signs of the problem with a physical exam and pelvic exam. They’ll ask about your symptoms and medical history and give you a complete blood count and urinalysis to see if you have an infection. They may also order a pelvic CT scan or an MRI to create 3D images of your pelvic area and the surrounding tissues. These tests can show the size and location of a fistula. They may inject a dye into your bladder before the scan to help it show up more clearly on the X-rays or images. They might also perform a test called a fistulogram, which involves placing hydrogen peroxide in your rectum. This makes bubbles and foam, which helps them find the source of your fistula.
Urinary Discharge
Symptoms from a fistula that involves the urinary system can include a smelly or cloudy discharge that oozes from around your anus. You might also have pain when you urinate. Your specialist nurse can help you cope with these symptoms by suggesting ways to manage them, such as using barrier films or creams. They can also prescribe painkillers or anaesthetic creams to ease the pain and discomfort.
Your doctor will do a physical exam of the affected area and check your blood pressure. They might stick a finger into your anus (called a fistula puncture) to look for oozing fluid or bleeding. They may also ask for other tests, such as a urinalysis to test your urine for signs of infection. They might also need a CT scan, which uses X-rays and computer technology to create 3D pictures of your body. They may inject dye (contrast) into a vein before the test to help the fistula show up more clearly on the images.
In a woman, if the fistula is between your bladder and vagina — called a vesicovaginal or TVF — you might notice leaking feces from your anus into your vagina. This can be uncomfortable and embarrassing. A TVF can be caused by a pelvic injury or surgery, Crohn’s disease or radiation treatment in the pelvic area for cancer. It can also occur after childbirth. A vesicovaginal fistula can also cause pain during intercourse.
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A rectovaginal or anal fistula can be difficult to find because it doesn’t have an outside opening like a cystoid or ureteral tube. To find it, your healthcare provider will use a lighted scope that has a camera on the end, like a flexible sigmoidoscopy or colonoscopy. They might also inject hydrogen peroxide into the external opening to look for bubbles or foam, which confirm the location of your fistula. They might do this in the operating room, under sedation. They can also use an MRI to see the fistula. The MRI uses magnetism to create detailed pictures of the area. These are often more comfortable than a CT scan.
Smelly Discharge
If you have a fistula in your rectum or genital area, you may have discharge from the site that smells bad. This smell comes from the pus and poop that builds up inside the abnormal passage (fistula) from time to time. This can be painful and cause swelling and itching.
Fistulas form when an infection in the tissue near your anus causes a blockage that can’t drain away. This creates a tunnel under your skin that connects the infected tissue to a channel in your body (fistula). Anal fistulas are the most common type. They occur most often from an infected anal gland that develops a pus-filled abscess around the anus. But they can also happen because of certain medical conditions like Crohn’s disease, hidradenitis suppurativa or tuberculosis. And they can also result from surgery or radiation to treat cancer in your pelvis or rectum, cervix, ovary or anus.
Symptoms of an anal fistula include pain and irritation when you poop, cough or sit for long periods. You also might have drainage of pus, poop or blood from the area (cellulitis).
Other fistulas are in other areas of your body, including your digestive tract and genitals. They can be caused by an injury or because of certain conditions, such as inflammatory bowel diseases or fibrosis. Some of these fistulas are created by healthcare providers as part of treatment, such as a connection between an artery and vein that is used for dialysis.
A colorectal specialist can diagnose a fistula by taking a medical history and doing a physical exam. He or she will check the site of the fistula, looking for an opening on the skin (fistula tract). Other tests include blood tests and a pelvic ultrasound.
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The main treatments for fistulas are medications and surgeries. These treatments can control pain, odor and other symptoms caused by your fistula. Your healthcare provider will talk to you about the best treatments for your situation. Some fistulas are one-time problems that go away after treatment. But others require months or years of treatment to manage pain, complications and other issues.
