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What Is a Fistula? Types and Treatments Explained

What exactly is a fistula? No, it’s not a kitchen utensil that resembles a spatula. Unless you’ve been diagnosed with a fistula, you’ve probably never heard of this medical complication. 

Fistulas are not very common in developed countries like the U.S., but they can occur for various reasons. About 35% to 50% of adults with Crohn’s disease will develop one at some point.

Keep reading for answers to some of the most common questions about fistulas, including symptoms, diagnosis and treatment options.

What is a fistula?

“A fistula is an abnormal connection or pathway between two organs that don’t usually connect,” said Christian Twiss, MD, a urogynecologist and urologist with Banner – University Medical Center Tucson. “These tunnels allow urine, stool or other matter to pass where they shouldn’t, which can lead to serious infections or other problems.” 

Fistulas form when sores caused by inflammation inside the body worsen to the point that they form a tunnel in internal tissues. These can occur after some type of injury to an organ, such as a complication from surgery, an injury or trauma or radiation therapy. They can sometimes occur as a result of having inflammatory bowel disease (IBD) like Crohn’s disease or ulcerative colitis.

Are there different types of fistulas?

Fistulas can occur anywhere in the body, between an intestine and the skin, between the vagina and rectum and in other places.

“The most typical locations, however, involve the urogenital tract (the urinary tract and genitals) and the reproductive system,” Dr. Twiss said.

Here are some types of fistulas:

Urinary tract fistulas
  • A vesicovaginal fistula is the most common fistula worldwide that involves the bladder and vagina. This occurs most often because of a previous hysterectomy or difficult labor.
  • A vesicouterine fistula occurs between the bladder and uterus.
  • A urethrovaginal fistula occurs between the urethra and vagina.
Anal and perianal fistulas
  • A rectovaginal or anovaginal fistula occurs when a hole develops between the rectum or anus and vagina.
  • An anorectal fistula occurs between the anal canal and the skin around the anal opening.
  • A colovaginal fistula occurs between the colon and vagina.
Other types
  • An entero-enteral fistula occurs between two parts of the intestine.
  • An enterocutaneous or colocutaneous fistula occurs between the small intestine or colon and skin.

What are the symptoms of a fistula?

Symptoms can vary based on the location of the fistula and just how severe your fistula has become, but in most cases, symptoms can be very embarrassing and uncomfortable.

“In virtually all cases, symptoms can be devastating for patients and can lead to isolation and a substantially reduced quality of life,” Dr. Twiss said.

Depending on the type of fistula, symptoms might include:

  • Fluid, feces, gas or urine leaking from the vagina
  • Pain or irritation in the external female genital organs, especially when you sit down, move around, go to the bathroom or cough
  • Frequent urinary tract infections
  • Nausea and/or vomiting
  • Skin sore that is open and draining fluid or feces
  • Diarrhea
  • Stomach or pelvic pain

How is a fistula diagnosed?

If you have one or more of these symptoms, discuss them with your provider so they can rule out other causes and treat them appropriately.

Your provider may use a number of tests to determine the location and severity.

“Typically, diagnosing external fistulas is relatively simple, since your provider can see it,” Dr. Twiss said. “For internal fistulas, your provider may perform an endoscopy to see inside or perform an ultrasound, CT scan or X-ray to locate the fistula.”

Other tests may include:

  • Urine sample
  • Blood test
  • Excretory urogram to look at the urinary tract
  • Retrograde pyelogram to look at the vagina and ureter
  • Dye test to look at the bladder

How are fistulas treated?

Very tiny fistulas may heal on their own with medications and conservative (non-invasive) measures, but most will require surgery to restore the normal function of the affected organs.

“Fistula removal surgery may be necessary to close the fistula and remove damaged tissue, followed by a period of drainage to allow proper healing,” Dr. Twiss. “For example, it is customary to wear a bladder catheter for about two weeks after repairing a vesicovaginal fistula.”

Healing times for a fistula can vary, but a surgical wound can generally take several weeks or months to heal.

Can you prevent fistulas?

In developed countries like the U.S., most fistulas are iatrogenic, meaning they are caused by complications from surgery or radiation therapy. In most of these cases, you and your provider should be aware if you develop drainage that is unusual or any of the other symptoms described above.

“In the underdeveloped world, obstructed childbirth is the most common cause of vaginal fistulas,” Dr. Twiss said. “In these cases, women will labor for days, which causes a breakdown of the vaginal tissues leading to a fistula. The best way to avoid these types of fistulas is to provide women in these countries with better access to basic prenatal and obstetrical care.”

Although fistulas can’t be completely prevented, there are a few things you can do to lower your risk:

  • Eat a fiber-rich diet and avoid fatty foods
  • Drink plenty of water
  • Practice good bowel and urinary habits

Bottom line

A fistula is an abnormal opening that connects two organs that don’t usually connect. This can lead to infections and other medical complications.

Having a fistula can be an unpleasant and embarrassing condition, but there are a variety of treatment options.

If you’re experiencing any of the symptoms noted above, or if you think you have IBD or another digestive problem, contact your provider or a specialist, such as a urologist or gastroenterologist. To find a Banner Health specialist near you, visit bannerhealth.com.

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