There are many types of fistula, most of which healthcare professionals can surgically remove. Types of surgery and recovery times vary, but surgical success rates are high, and most people recover fully.
Fistulas are a fairly common but severe complication of conditions such as Crohn’s disease and some surgeries.
Fistulas can have a significant impact on a person’s health and well-being. The most common type of fistula is an anal fistula.
Some fistulas are treatable with antibiotics and other medications. If these options do not work, fistula removal surgery may be necessary.
This article explores what to expect from fistula surgery and recovery.
A fistula is an abnormal tube-like connection that forms between two organs or vessels inside the body.
Fistulas are usually the result of infection or inflammation due to injury or surgery. They can occur in many parts of the body, but the most common types of fistula are:
Anal or perianal fistulas, which form between:
- the anal canal and anal opening
- the rectum or anus and vagina
- the colon and vagina
Urinary tract fistulas, which form between:
- the bladder and uterus
- the bladder and vagina
- the urethra and vagina
Gastrointestinal fistulas, which form between:
- two parts of the intestine
- part of the gastrointestinal tract and the skin
- part of the intestine and another organ in the body, such as the bladder
Aortoenteric fistulas can form between the native aorta and the duodenum or jejunum or between a prosthetic aortic graft and any portion of the gastrointestinal tract.
Although people can usually manage the other types of fistula listed above as an outpatient on an elective basis, aortoenteric fistulas are surgical emergencies.
People will experience different symptoms depending on where in the body their fistula is located.
Symptoms of anal fistulas include:
- skin irritation around the anus
- throbbing pain
- unpleasant smelling discharge near the anus
- passing blood with a bowel movement
- swelling and redness around the anus
- a high temperature, if an abscess is also present
- difficulty controlling bowel movements
Symptoms of urinary tract fistulas include:
- abdominal pain
- irritation in the vulva
- discharge or urine leaking from the vagina
- unpleasant smelling gas or discharge from the vagina
- feces leaking into the vagina
- frequent urinary tract infections
- passing gas through the urethra during urination
Symptoms of gastrointestinal fistulas include:
Symptoms of aortoenteric fistulas include bloody diarrhea or vomit and sudden-onset low blood pressure.
Fistulas usually form following some kind of injury or inflammation inside the body.
Inflammation causes ulcers to form that can expand to reach another surface inside the body. This creates a channel that helps drain pus from an infected area.
Common causes of fistulas include:
Some fistulas may heal with the help of antibiotics and other medications, but most require surgery.
The main options for surgical treatment of an anal fistula are fistulotomy and seton surgery.
Fistulotomy refers to when a surgeon cuts a fistula along its whole length so that it heals into a flat scar. During seton surgery, a surgeon will place a piece of thin surgical thread inside the fistula to help drain any infection and allow it to heal.
Other treatment options include:
- endoscopic ablation
- LIFT procedure
- advancement flap procedure
anal fistula plugto close the fistula and allow it to heal medical glueto close the fistula
All procedures for treating fistulas have different benefits and risks. A person should discuss these with their surgical team so they can be sure of what to expect during surgery.
Most people will not need to stay in the hospital overnight following fistula surgery.
Surgery for an anal fistula usually takes around an hour, but a person will need to spend some time in the hospital before and after to prepare and recover.
If the fistula is small and shallow, a person may only need a local anesthetic during the procedure. Otherwise, a surgeon will put them to sleep using a general anesthetic.
During the fistulotomy, the surgeon will make an incision to open up the fistula.
For an anal fistula, this procedure usually takes around 1 hour, but it can vary depending on how complex the fistula is. A person will be asleep throughout the procedure.
After the surgeon has placed the seton in the fistula, they will cover it with a light, padded dressing.
As long as the surgery has been straightforward and without complications, a person can usually go home the same day.
Surgical teams often perform seton placement surgery in stages, so a person may require further operations to adjust or replace the seton.
Following the surgery, the fistula might continue to drain for several weeks.
How long it takes to recover from fistula treatment depends on the type of procedure a person underwent and how complex it was.
A person’s surgical team can give tailored advice about how best to recover.
Most wounds should heal within 6 weeks.
General advice about undergoing a form of fistula surgery includes:
- Take over-the counter pain relievers, such as paracetamol or ibuprofen, for pain relief.
- Keep the wound clean by washing it several times per day. Dry it carefully by patting it, not rubbing it.
- Change the wound dressing regularly. A nurse should demonstrate how to do this.
- Use an extra gauze pad over the wound to prevent discharge from leaking onto clothes.
- Avoid sexual intercourse for the first few weeks after surgery.
- Exercise gently to avoid irritating an unhealed wound.
- Seek support from people who have been through similar treatment.
With any surgery, there is a risk of complications.
Common complications from fistula surgery include infection, bleeding, and adverse reactions to the anesthetic.
Specific complications of anal fistula surgery include:
- losing control of one’s bowel
- taking a long time for the wound to heal
- the fistula coming back
- narrowing of the anal canal, making it difficult to have a bowel movement
If a person experiences severe pain or difficulty with their bowel movements, they should contact a doctor.
Following fistula treatment, a person may experience the following side effects:
- soreness around the site of the wound
These side effects should wear off after a few days, once the body begins to heal.
Living with a fistula can have a big impact on a person’s quality of life.
With so many surgical treatment options available, living with a fistula is rarely permanent.
The process of diagnosing, treating, and recovering from a fistula can be slow and frustrating. However, there is a lot of support available for anyone going through this experience.
Anyone with a fistula should speak with a doctor or healthcare team about the best course of treatment.