Information on Fistulas

You can get a fistula as a result of an infection or an abscess (collection of pus). It can also be caused by conditions that affect the bowel such as Crohn’s disease. If you are diagnosed with a fistula, you will also be tested for Crohn’s, as unfortunately the two go hand in hand. Crohn’s sufferers are more prone to developing fistulas.

Fistulas most often occur as a result of one or more perianal abcesses. A perianal fistula is a collection of pus under the skin next to the anal canal (back passage). It is usually caused by an infection of the glands of the anal canal. This presents as a painful lump in the area and may be associated with a fever. The treatment involves drainage of the pus usually by operation. Some of these infections go on to form a longstanding fistula (a track running from the skin near the anus to the inside of the anal canal). These intermittently swell and discharge pus and blood. The treatment involves surgery to either open the track to the skin or close the inside opening.

So in laymans terms, a fistula is a tunnel that connects two organs or vessels that normally wouldn’t be connected. The fistulas need to be treated and closed off with surgery. There are different techniques used in surgery to do this. But before a fistula can be closed off, it needs to be kept open to ensure that all infection and pus from the abcesses has been drained. To keep the fistula open, surgeons will insert a seton under general anesthetic. A seton is a surgical cord that is run into the fistula opening, through the fistula track, out the anus and then tied together, so essentually it runs around in a loop. This stops the fistula opening closing up and allows the pus to drain out over time so that there is no longer any infection inside the fistula.

If you have a ‘shallow’ fistula that is close to the surface of the skin and doesn’t run through any muscle, the surgeons are usually able to tighten the seton over time until it eventually comes out altogether as the fistula heals. However, if you have a more complicated fistula that runs through muscle and is not close to the surface, you will then need corrective surgery.

Fistula sufferers live each day with the seton in their body. You could even have more than one seton, depending on how many fistulas you have. At first they are difficult to live with, it can be uncomfortable to sit down, walk and go to the toilet. However, like everything, you will get used to living with a seton and will work out your own ways to deal with it. There are some tips on living with setons on the ‘ Tips and Advice’ page.

Seton Diagrams:

There are a few different surgery methods used to heal fistulas. Once the fistula has been drained using the seton, you will be ready for corrective surgery. This could take 6 weeks, or it could take over a year, it all depends on the severety of your fistula/s.

Advancement Flap surgery is common, this has around a 50% chance of working and involves cutting into the tissue where the fistula connects, folding the tissue back over itself and holding in place with disolvable stitches. It is simular to a graft and closes the hole off where the fisula connects to an organ or vessel. With plenty of rest, no exercise or heavy lifting and a healthy lifestyle, the chances are the advancement flap will take and the tissue will attach itself. This procedure can only be done twice.
Other methods include Fistula plugs and Fibrin Glue, if all fails, the setons are placed in again.