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What to do if a fistula appears

Fistulas are a common complication of Crohn’s disease. These are atypical tunnels that form on the walls of the intestine or other organs. People with Crohn’s disease can see fistulas in different parts of the intestine, involving another organ like the bladder, or down to the surface of the skin.

People with fistulas can experience unwanted side effects, such as:

– Diarrhea
– Pains
– light pain

An anal fistula is the most common type of fistula. Symptoms include a tender swelling or bump around the anus that may leak, and pain that gets worse with movement. Read this article to learn more about the different types of fistula, including symptoms, causes, and treatment options.

types of fistulas

Fistulas are very common in people with Crohn’s disease, affecting 1 in 3 people with the condition. A fistula is a narrow passage that occurs when sores or ulcers form from inflammation. These passages can connect one organ to another or to the outer surface of the body.

Different types of fistulas can occur in different places in the body. Here are a few :

– Anal (perianal): This fistula connects the anal canal or rectum to the surface of the skin near the anus.

– Vaginal: There are different types of vaginal fistulas that can atypically connect the vagina to the bladder, rectum, colon or small intestine.

– Colovesical (intestine to bladder): An infrequent pathway between the colon and bladder that can allow fecal matter to appear in the urine.

– Gastrointestinal (gut to gut): This fistula connects the gut to an adjacent organ or surface.

– Enterocutaneous (intestine to skin): An atypical fistula between the intestinal tract or stomach and the skin.

Diagnose types of fistula

Diagnosis of fistula varies by type. A doctor needs to collect information such as

– the place where the fistula opens
– course of the fistula
– the number of existing tunnels
– if the fistula crosses the sphincter
– if there is an infection

anal fistula

An anal fistula is a small tunnel that develops between the end of the intestine and the skin near the anus.

Symptoms of an anal fistula are:

– Irritation of the skin around the anus
– a stabbing pain that may get worse with movement, a bowel movement or coughing
– a smelly discharge near the anus
– Discharge of pus or blood
– Swelling and redness around the anus
– Difficulty controlling bowel movements.

These symptoms are more likely to occur in people with Crohn’s disease. Other causes can be as follows:

– Diverticulitis
– Complications of operations near the anus
– Tuberculosis or HIV infection

diagnosis

To diagnose this type of fistula, a doctor will perform a physical exam of the skin around the anus, since fistulas often appear as small holes or red bumps. He may also press on the skin to see if there is any pus or feces coming out. Doctors can perform the diagnosis under general anesthesia so the area is completely relaxed. Sometimes doctors use a probe to determine the course of the fistula and determine if it passes through the sphincters. Several tests can also attempt to determine this, including

– a pelvic MRI
– an endoanal ultrasound
– Fistulography, which uses a dye in the anus to find signs of leakage.

Vaginal fistula

A vaginal fistula is a passage or hole that has opened up from the vaginal wall and connected to another organ in the body. The most common types of vaginal fistula are:

– vesicovaginale, a canal that connects the vagina and the bladder
– Rectovaginale, a fistula connecting the vagina and rectum
– Colovaginale, a tract that connects the vagina and large intestine
– enterovaginale, a fistula connecting the vagina and small intestine.

Symptoms may include discharge of fluid from the vagina, smelly discharge of gas from the vagina, or an infection in the genital area.

The fistula itself must not cause any pain or discomfort. However, urine, stool, or air can pass through the vagina, which can lead to incontinence problems. Constant leakage in the vaginal area can also lead to infection or pain.

A fistula usually develops as a result of trauma to the area, such as:

– Operations on the vagina, anus or rectum
– hysterectomy
– Inflammatory bowel disease (IBD), mainly Crohn’s disease
– Radiation therapy for pelvic cancer
– Birth injuries such as B. a tear or an infection.

diagnosis

Symptoms are most helpful in helping doctors diagnose a vaginal fistula. A doctor will discuss the symptoms and any surgery, trauma, or illness that may be causing them. During the physical exam, a healthcare professional will use a speculum to examine the vaginal walls. As with an anal fistula, diagnostic tests include an MRI, ultrasound, and a fistulography, which involves adding a dye to the vagina.

intestinal fistula

A cystic fistula, or colovesicular fistula, occurs when an opening forms between the bladder and another organ or the skin. The most common types of bladder fistulas occur between the bladder and bowel or between the bladder and vagina.

Symptoms include:

– Urine that looks or smells like stool
– Persistent urinary tract infections
– Gas from the urethra

This type of fistula can occur as a result of Crohn’s disease, injury or trauma to the bladder, colon or gynecologic cancer, or radiation therapy.

diagnosis

To detect this type of fistula, the urologist performs a physical exam and takes a medical history. Doctors can place a long, thin camera in the urethra to see the bladder — a procedure called a cystoscopy. X-rays or CT scans can also be used to check the bladder and surrounding areas.

Intestinal-to-intestinal fistula

A gastrointestinal (GI) fistula, or gut-to-intestinal fistula, connects the gut to an adjacent organ or surface. Digested food cannot flow properly through the body when a person has a gastrointestinal fistula. The fistula can also cause fluid leakage. Symptoms can include:

stomach pain
dehydration
Diarrhea
Fever
malnutrition
Vomit
About 85-90% of gastrointestinal fistulas are due to surgical complications. Other possible causes are

Infections such as diverticulitis
Crohn’s disease
an ulcer in the intestine
an abdominal injury
Cancer

diagnosis

A doctor may take an X-ray of the upper and lower intestines. He will give barium orally or by enema before doing the X-rays. If there are signs of leakage in the intestine, this confirms the presence of a fistula. A fistulogram, which involves injecting dye into the area of ​​the fistula where the skin is open and leaking, can help reveal blockages.

intestinal fistula to the skin

An enterocutaneous fistula or cutaneous fistula is an atypical connection between the intestinal tract or stomach and the skin. This connection allows the contents of the stomach or intestines to drain onto the skin. Symptoms include diarrhea, dehydration, and malnutrition. These fistulas usually appear after bowel surgery, but other causes are also possible:

perforated gastric ulcer
Crohn’s disease
an abdominal injury or trauma, such as B. a stab or shot.

diagnosis

Tests like a CT scan or a fistulogram can also help doctors diagnose this type of fistula. A barium test, in which barium is swallowed or taken as an enema before an X-ray, can help confirm the presence of a fistula.

treatment options

Treatment for a fistula depends on the type of fistula present and whether or not the person is being treated for another bowel condition. Most fistulas can be treated with medication, surgery, or a combination of both.

medication

There are several medications that doctors prescribe for people with fistulas. These include:

– antibiotics
– biological drugs
– steroids
– Laxatives, usually for anal fistulas.

Non-surgical treatment

Fibrin glue is currently the only non-surgical treatment for anal fistula. It consists of the surgeon injecting glue into the fistula under general anesthesia. The glue helps seal the fistula and promotes its healing. This treatment is generally less effective than surgery and results may not last. It can be a useful option for fistulas that cross the anal sphincters because they don’t need to be cut.

Surgical intervention

Doctors can remove fistulas through a variety of surgical procedures, including:

Fistulotomy: This is an effective strategy for treating most fistulas. However, doctors cannot perform this procedure if the fistula passes through the anal sphincters.

Transanal mucosal advancement flap: In this method, the fistula is removed and the hole is covered with a flap of tissue from the rectum. However, this procedure has a lower success rate than fistulotomy.

Intersphincteric tract ligation (LIFT): The doctor makes an incision in the skin over the fistula and moves the sphincters apart. Although LIFT has shown promising results so far with fistula closure rates of 57-94%, more research is needed to determine its short- and long-term success.

Laser surgery: In this treatment, the fistula is closed with a small laser beam. There are uncertainties about its effectiveness, but there are no major safety concerns.

Seton Placement: A common treatment for anal fistulas in which a seton, a thin rubber drain, is placed in the fistula to allow the tunnel to heal slowly. Doctors often use several over time to achieve gradual healing.

What to expect from the procedures

Currently, none of the fistula procedures have a guaranteed success rate. However, the success rate of many of these procedures is generally high, with one in three people experiencing a recurrence of the fistula. This means people may need more than one surgery to try to treat their fistula.

* Presse Santé strives to convey health knowledge in a language accessible to all. In NO CASE can the information given replace the advice of a doctor.

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