A fistula is a canal or duct that connects two organs or one organ to the surface of the skin. It arises artificially, for example as part of an inflammation. As a rule, it is used to drain the secretion, e.g. of pus.
Anal fistulas, which start at the transition between the colon mucosa and the anal canal and extend to the skin around the anus, are particularly common. There are also fistulas that connect two intestinal loops in the abdomen or one intestinal loop with another organ. This can lead to pain.
Internal fistulas are unfortunately unspecific in terms of their symptoms. Sometimes they are completely asymptomatic.
Typical symptoms, however, would be:
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Further complaints can occur depending on the location. Symptoms of anal fistulas are:
Fistulas that connect two loops of intestine are often accompanied by the following symptoms:
A fistula can also connect the intestines to the vagina or bladder. The contents of the intestine, i.e. stool and air, escape through the bladder or vagina. Furthermore, there is inflammation in the corresponding organs, as bacteria can pass through the stool.
A clear symptom that speaks for a fistula emanating from the intestine on the navel is the leakage of stool from the navel. Frequently, however, symptoms that are less clear-cut appear, which may indicate a fistula from the intestine, but do not yet prove it. A purulent inflammation on the navel should be mentioned here, which can manifest itself as pain, redness and foul-smelling discharge on the navel. In any case, such complaints about the navel should be clarified by a medical examination.
Some fistulas do not connect two hollow organs, but end blindly in the tissue. This causes them to form an abscess. However, abscesses can also occur in fistulas that connect two hollow organs.
In the case of very large fistulas that connect the intestine to the skin, electrolyte shifts in the body can also occur.
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In rare cases a fistula finds its way to the bladder and thus connects it to the intestine. Among medical professionals there is one enterovesical fistula spoken. It is a serious complication.
The leading symptom of an enterovesical fistula is Pneumaturia. This means that air from the intestines is released through the urine. Not only intestinal gases but also intestinal bacteria and stool reach the bladder via the fistula. On the one hand, this makes urination difficult or painful, and on the other hand, the urinary bladder becomes more susceptible to inflammation.
The intestinal bacteria can lead to a chronic urinary tract infection. This is accompanied by a burning sensation when urinating. This inflammation can spread from the bladder, e.g. in the renal pelvis. In the worst case, the bacteria pass into the bloodstream. Life-threatening sepsis (blood poisoning) is the result. For this reason, a doctor should be consulted immediately if air or stool passes through the urine.
A urachus fistula is to be differentiated from a bladder fistula, in which urine emerges from the bladder via the navel.
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The cause of a fistula between the vagina and the intestine - usually the rectum - are perineal tears with poor perineal incision care. Because of the poor medical care, fistulas between the vagina and intestine are particularly common in Africa. Other possible causes are chronic inflammatory bowel disease, Crohn's disease, local inflammation, diverticular disease (protrusions of the intestinal wall) or rectal surgery.
As with a fistula between the bladder and the intestine, intestinal gases leak through the vagina, and in some cases stool. In addition, mucus is excreted through the vagina. The intestinal bacteria can cause inflammation in the vagina, which is accompanied by itching and burning. The symptoms depend on the size of the fistula.
In some cases, the stool or inflammation can cause unpleasant smells.
You can read more information about fistulas in the genital area in our article: Fistula in the genital area - everything you should know
The causes for the development of a fistula are varied:
Anal fistulas, in particular, develop as part of an abscess, a pus cavity in the anal area. In order for the pus to drain from this cavity, a channel, a fistula, is formed.
Fistulas are just as common as a result of inflammatory bowel disease such as Crohn's disease. This creates fistulas especially between the intestinal loops. Fistulas can also develop in the abdominal cavity during other inflammatory processes.
Furthermore, cancerous ulcers can be the cause.
Complications after surgery or organoscopy can also lead to fistulas.
Finally, fistulas can basically be congenital without a cause being identified.
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Read more about the topic here: Fistula on the anus
The diagnosis of fistulas that are connected to the surface of the skin is in some cases a simple visual diagnosis when the fistula outlet is visible. A fistula passage through the skin can be palpated as a hard strand.
Anal fistulas are assessed through a digital rectal examination (palpation of the rectum). As part of the further examination, the anal fistula will be probed if possible. A thin probe is pushed into the canal to follow the course of the fistula.
Internal fistulas whose exit point is not visible must be diagnosed using imaging techniques. Depending on the location, ultrasound or CT (computer tomography) is used for this. In some cases, the organ also needs to be mirrored.
More on this: Colonoscopy - preparation and procedure
Fistulas between the intestine and the bladder or vagina must always be treated surgically. In most cases, anal fistulas are also operated on because of the risk of abscesses. During the operation, the fistulas are scraped or split. Sometimes an artificial anus is necessary temporarily.
In some cases, anal fistulas are also treated with thread drainage. A thread is pulled through the fistula canal and remains there for several weeks or months. This keeps the fistula open and thus prevents the accumulation of secretions and promotes the drainage of secretions.
In the case of fistulas with accompanying inflammation, antibiotic therapy is also carried out. Conservative therapy is recommended, especially for Crohn's disease patients, who frequently develop fistulas. Here, drugs are administered that suppress the immune system.
In any case, it is important to gain early therapy in order to prevent further branching of the fistula.
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Intestinal fistulas do not heal on their own.
A doctor should always be consulted because of the accompanying symptoms, such as fever or fatigue. This can be the cause, e.g. an inflammation, identify and treat. If such inflammation is not treated, the fistula cannot heal. It is not advisable to use home remedies alone to treat a fistula in the intestine.
Intestinal fistulas can usually be successfully treated with surgery.
Fistulas that arose as part of an inflammation usually heal very well after the cause of the inflammation has been eliminated. In rare cases, however, an intestinal fistula can persist for several years despite attempts at treatment or recur in chronic diseases such as Crohn's disease.