Fistula Removal

Fistulas require immediate medical attention to prevent serious infections or other problems from developing. Treatment options include medications, surgery, or both.

Fistulas form when inflammation causes sores, or ulcers, to form on the inside wall of the intestine or nearby organs. Those ulcers can extend through the entire thickness of the bowel wall, creating a tunnel to drain the pus from the infected area.  An abcess, or a collection of pus, can also cause a fistula to form.

The most common types of fistulas in Crohn’s disease patients form between two parts of the intestine, between the intestine and another organ, such as the bladder or vagina, or through to the skin surface. Women with Crohn’s disease can also develop a fistula between the rectum and vagina, which may be difficult to treat. Surgical treatment depends on individual circumstances.

Fistulas sound scary, but they are treatable. About 35 to 50 percent of adults with Crohn’s disease will develop a fistula at some point.

Fistula Symptoms

Patients can have different symptoms depending on which parts of the body are connected by the fistula.

Fistula between the small and large intestine

• Diarrhea

• Passage of undigested food

Fistula between the intestine and the bladder

• Urinary tract infection

• Burning with urination

• Cloudy urine or blood in the urine

Fistula between the intestine and the vagina

• Passage of gas or stool through the vagina

Fistula from the intestine to the skin

• Can initially present as a painful bump or boil

• Skin abscess that is open and draining fluid or stool

What You Should Know About Fistula Removal

While some fistulas can be treated with antibiotics and other medication, fistula removal surgery may be necessary if the infection doesn’t respond to medication or if the fistula is severe enough to require emergency surgery.

There are several surgical options to treat fistulas, including:

• A medical plug to close the fistula and allow it to heal

• A thin surgical cord, called a seton, placed into the fistula to help drain any infection and allow it to heal

• Opening up the fistula with an incision along its length to allow it to heal

• Medical glue to close the fistula

Ileostomy

Your stool will sometimes need to be diverted from the intestine while its healing from fistula surgery. This is done with an ileostomy, a procedure that brings the small intestine up through the abdominal wall so that waste can leave your body through a surgically created hole called a stoma.

• Feces are collected outside your body in an ostomy pouching system.

• An ileostomy is often used as a temporary solution to allow healing.

• You may require additional surgery to ensure the intestine is closed at the fistula location.

Anal Fistula Removal

An anal fistula is a tunnel that forms between the inside of the anus and the skin surrounding the anus. This is often repaired with a surgical procedure called a fistulotomy.

• The primary goal is to repair the fistula without damaging the anal sphincter muscles, which are necessary for fecal continence, the ability to hold fecal material in your rectum.

• Recurrence rates for anal fistulas are fairly low after surgery.

• Complications are rare and there is typically little impact on fecal continence.

Ask Your Doctor

• What are my options for fistula removal?

• What preparations will I need to make before my fistula removal surgery?

• What are the potential complications from surgery?

• What kind of restrictions will I have after my surgery?

• How long will it take me to recover from fistula removal surgery?

• How will the surgery affect my diet and bowel movements?

• If I require an ileostomy, how do I care for my ostomy pouch and keep it clean?

• What supplies will I need at home?

• Will I need additional surgeries?