A fistula is an abnormal connection that forms between two organs or vessels, or between an organ and the skin. This unnatural passage can disrupt normal bodily functions. While surgery is frequently the primary treatment, understanding the complexities of living with an untreated fistula is important.
What a Fistula Is
A fistula is a tube-like connection that should not exist in the body. These passages can develop in numerous locations, including the gastrointestinal tract, urinary system, or connecting internal structures to the skin. For instance, an anal fistula forms between the anal canal and the skin near the anus.
Fistulas often arise from an infection that leads to an abscess. When an abscess drains, it can create a persistent channel through tissues. Other factors contributing to their formation include chronic inflammatory conditions like Crohn’s disease, injury, or previous surgical procedures.
Why Surgery is Often Recommended
Surgery is commonly recommended for fistulas as it offers the most effective pathway to complete healing. The primary goals of surgery include closing the abnormal connection, eliminating infected tissue, and preventing recurrence. Surgical procedures provide a high chance for symptom resolution and restoration of normal function.
The specific surgical approach varies depending on the fistula’s location, complexity, and involvement of surrounding structures like sphincter muscles. For example, a fistulotomy, where the tract is opened to heal from the inside out, boasts high success rates. Techniques designed to preserve muscle function are employed for complex fistulas.
Risks of Not Treating a Fistula
Fistulas generally do not heal on their own and can worsen over time. Living with an untreated fistula carries several significant risks to health and quality of life. One common consequence is persistent drainage of pus, blood, or other bodily fluids, which can cause ongoing discomfort and skin irritation. This chronic drainage often leads to skin breakdown and hygiene challenges.
Untreated fistulas are prone to recurrent infections and the formation of new abscesses, as the abnormal channel provides a pathway for bacteria to persist. These infections can cause increasing pain and may lead to more severe systemic infections, such as sepsis. The constant inflammation and infection can also cause the fistula to enlarge and develop more complex branching channels, making future treatment more challenging.
Depending on the fistula’s location, serious functional impairments can develop. For example, untreated anal fistulas can damage the anal sphincter muscles, potentially leading to fecal incontinence or difficulty controlling bowel movements. In some cases, chronic inflammation can result in the formation of anal strictures, narrowing the anal canal and causing painful bowel movements or obstruction. Rarely, long-standing, untreated fistulas have been associated with an increased risk of developing certain types of cancer due to chronic tissue irritation.
Non-Surgical Approaches and Considerations
While surgery is often the definitive treatment, non-surgical approaches are sometimes considered. These alternatives may be explored for very small, simple, or superficial fistulas, or when a patient has other serious health conditions that make surgery too risky.
Medical management often includes antibiotics to control infection and reduce inflammation, though they rarely close the fistula on their own. For fistulas associated with inflammatory bowel diseases, immunosuppressant medications, such as biologics, may be used to reduce inflammation and promote healing. Other techniques involve injecting fibrin glue into the fistula tract to seal it, or placing a bioprosthetic plug to encourage tissue growth and closure. Success rates for these methods can vary, with fibrin glue ranging from approximately 39% to 50%, and plugs from 50% to 80%.
Another non-surgical consideration is the use of a seton, a surgical thread placed through the fistula to allow continuous drainage and promote healing. Laser treatment aims to close the fistula opening, with reported success rates varying depending on the specific technique and fistula characteristics. Lifestyle adjustments, such as dietary modifications, proper hygiene, and warm sitz baths, can help manage symptoms and promote a healing environment. While non-surgical options exist, they are often limited to specific cases and require careful medical supervision.