Fistula Symptoms: A Guide to Managing Internal Openings

Fistula Symptoms: Types, Causes & Diagnosis

A fistula refers to an abnormal connection or passageway between two unrelated parts of the body. It connects different vessels or organs and develops in the anal area. Anorectal fistula symptoms are common and affect 2 out of 10,000 men in India, whereas 2.2% of women suffer from obstetric fistula. Fistulas can also develop in hollow organs, such as between blood vessels and between the intestines and skin.

Did you know that obstructed labour causes 8% maternal mortality in developing countries? During childbirth, an abnormal opening takes place between the genital and the urinary tract or rectum. This serious injury, also known as obstetric fistula, occurs due to prolonged and obstructed labour.

It is crucial to talk to an expert healthcare provider when symptoms start to appear. Otherwise, untreated fistulas can cause pain, infection, indigestion and problems with urination. To learn more about the symptoms of fistula, causes, diagnosis and treatment, read this blog.

What are the Symptoms of a Fistula?

Fistulas occur in the internal organs and tissues, which is why these are not visible. However, the symptoms cause redness, swelling and drainage of fluid from the skin.

In men, when the rectum connects to the skin surrounding the anus, it is an anal fistula. Both obstetric and anal fistulas are common in India. Researchers believe that the reasons for obstetric fistula prevalence are a lack of awareness, a shortage of quality healthcare options and so on.

Based on the type of fistula, the symptoms vary. The following table shows different types of fistulas and their symptoms:

What are the Different Types of Fistula?

Different types of fistulas are as follows:

1. Anal Fistula: An anal fistula occurs when an abnormal passageway gets created due to an infection or inflammation between the anus and the outer surface of the skin. Sometimes patients with Crohn's disease develop anal fistula.
2. Arteriovenous (AV) Fistula: An abnormal connection between the artery and vein with separate routes is formed. Injuries are the common cause of arteriovenous fistula. These are not harmful but are used for patients with kidney issues who require dialysis.
3. Perilymphatic Fistula: Perilymphatic fistula is a hole that takes place in the membrane that separates the inner and middle ear. Through this hole, fluids easily pass from the inner ear to the middle ear, causing pressure changes and hearing disruptions.
4. Aortoenteric Fistula: When the aorta and small intestine connect, it becomes life-threatening. Aortic aneurysm is one of the reasons why aortoenteric fistulas occur. This condition requires the emergency intervention of an expert.
5. Tracheo-oesophageal Fistula: The connection between the oesophagus and trachea causes tracheo-oesophageal fistula. It is a congenital condition and is diagnosed during infancy. Sometimes, cancer patients can also develop this condition.
6. Vaginal Fistula: A vaginal fistula develops in the vaginal wall. This wall interconnects the vagina with the uterus, large and small intestine and rectum. There are many forms of vaginal fistulas, such as vesicovaginal, obstetric, rectovaginal and so on.
7. Cancer Fistula: Malignant fistulas may result from advanced cancers invading adjacent structures or as a complication of radiation therapy. It occurs when cancerous tissues invade surrounding organs. Sometimes, radiation therapy also causes this type of abnormal opening. Some of the fistula cancer symptoms include an unpleasant smell, leakage from the opening and sore skin.
    

Sometimes, to treat a specific condition, medical experts create fistulas. For example, a mucous fistula connects the large and small intestine. These help patients with colostomy or ileostomy.

What is the cause of fistula?

Depending on the fistula type, the causes vary. The following are some of the common causes of fistula:

1. Infection or abscess
2. Inflammation
3. Side effects of cancer treatment, like radiation therapy
4. Complications arose at the time of surgery.
5. Trauma or injury to a particular body part
6. Changes occurred during foetal development.

How is a fistula diagnosed?

Diagnosis of a fistula depends on the symptoms of the patient. The following are ways to diagnose a fistula:

1. CT Scan

In a CT scan using fistulography, a health expert takes a series of X-rays and creates a 3D picture based on those. It helps in finding the fistulas. Sometimes, a special dye helps to see the fistula easily.

2. Methylene Blue Test

This type of test helps in diagnosing a fistula between the bowel and vagina. After placing a tampon in the vagina, blue dye is inserted using a catheter. After 10 to 15 minutes, if a blue stain occurs on the tampon, it confirms the presence of a fistula.

3. Contrast X-rays

In this type of test, a special dye named Contrast is applied. This dye helps doctors to visualise the fistulas clearly in X-rays. This type of X-ray helps during diagnosing cystograms, histograms, and vaginograms.

4. MRI Scan

Similar to a CT scan, an MRI provides a detailed image of a particular body part. But, instead of X-rays, it uses magnetism. Before scanning, doctors inject a dye into the vein to see things more clearly.

5. Endoscopic Ultrasound

This medical procedure creates a detailed image of the digestive tract and its surrounding organs using high-frequency sound. This helps to identify the fistula tract and its involvement with the sphincter muscles.

What are the Ways to Treat Fistula Symptoms?

The treatment of a fistula depends on multiple factors: its underlying cause, severity and location. The following are popular treatment options for fistula:

 1. Medications

Anti-inflammatory and antibiotic medicines reduce inflammation and infections caused by mild fistulas.

2. Lifestyle Modifications

Lifestyle modifications with nutrient-dense foods and regular exercise can prevent the recurrence of fistula. It can also help with faster recovery after surgery.

3. Surgery

Surgical intervention is required in cases of severe fistulas. Fistulotomy and fistulectomy have been proven to be popular surgeries to treat fistulas.

• Minimally invasive techniques

Various techniques, such as LIFT (ligation of the intersphincteric fistula tract) and VAAFT (video-assisted anal fistula treatment), help in treating the fistula. These cause minimal discomfort to the patients.
 

Final Words

Some fistulas are complex and require multidisciplinary care; treatment depends on type, location, and underlying cause. However, if it does not, it is necessary to talk to a medical professional right away. Sometimes fistulas recur; it is crucial to talk to a medical expert to learn whether to carry on with the previous treatment plan or start with a new treatment.