If your bowels and urinary tract are like a plumbing system, a fistula is like an untrained plumber. It connects things that should not be connected.
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Fistula is a condition in which organs or vessels in your body form abnormal passageways. For example, a connection forms between the anus and vagina or the bladder and vagina.
Fistula symptoms are unpleasant at best and life-changing at worst. You may have leakage of urine or feces, drainage, chronic infections (painful urinary tract infections are common), irritation, and nausea and diarrhea, for example.
The good news: Fistula is less common that it was in the past because doctors are better prepared for it. And it is typically treatable.
Childbirth is not the only cause
There are as many as 50,000 to 100,000 new cases of fistula each year, according to the World Health Organization.
People often associate it with childbirth, which is a major cause. Childbirth causes tears in the vaginal lining. When these tears go all the way through to the rectum, a fistula may form.
That is still a concern in Africa and other parts of the world. But obstetricians in the U.S. are much better prepared to prevent fistulas before they happen.
There are other risk factors, though. People with bowel disorders such as Crohn’s disease and diverticulitis — especially left untreated — have a higher risk of fistula. Fistula can happen to people without bowel disorders, too, although it is rare.
Sometimes the glands inside your anus get blocked and then infected, for example. Then, your body’s usual “flow” gets disrupted. In turn, an abnormal passageway, or anal fistula, opens up to give your body’s waste a place to go.
How we treat fistula
If you have fistula, you need to see a specialist. A gynecologist or colorectal surgeon can help, depending on the location and type of fistula.
Your doctor or surgeon will propose any number of options:
- Antibiotics to treat infections. This usually comes first. To treat you successfully, we have to knock out any infections.
- A seton stitch, which is a special type of stitch that helps infections drain.
- Catheters that drain fistulas.
- Special glues that seal up fistulas.
- Plugs made of collagen that close abnormal passageways.
- Surgery to repair or remove the fistula. Several types are available, including minimally invasive options.
The best treatment truly depends on your case; it’s not one-size-fits-all. For example, I use collagen plugs selectively for patients who want the least invasive procedure possible. They won’t work for everyone.
Another example: If you have had past issues with bowel control — such as chronic diarrhea or irritable bowel — we want to decrease your risk of future episodes. So we might choose an option that puts less stress on the sphincter. If you don’t have such a concern, though, we might recommend surgery to remove the fistula altogether.
No matter the best option for you, see someone about your fistula. The short-term symptoms can really hamper your quality of life. And, if left alone, a fistula can lead to nerve damage, organ failure and a chronic cycle of infections.