Overview of Fistula

A fistula is an abnormal connection between two organs, blood vessels or tissues that usually do not connect. It can develop due to infections, injuries, surgery or underlying medical conditions. Fistula disease can affect various parts of the body, such as the anus, blood vessels, digestive tract and urinary system.

Types of Fistula

1. Anal Fistula: Forms between the anus and the skin often due to an infection.

2. Arteriovenous (AV) Fistula: An abnormal connection between an artery and a vein commonly created for dialysis access.

3. Tracheoesophageal Fistula: A congenital defect connecting the trachea and esophagus.

4. Rectovaginal Fistula: An abnormal opening between the rectum and vagina.

5. Vesicovaginal Fistula: A connection between the bladder and vagina leading to urine leakage.

6. Bronchopleural Fistula: A connection between the bronchial tubes and pleural space.

7. Oroantral Fistula: An opening between the oral cavity and sinus.

8. Enterocutaneous Fistula: A connection between the intestine and skin.

9. Branchial Fistula: A congenital defect in the neck due to improper embryonic development.

Symptoms of Fistula

• Anal Fistula: Pain, swelling, pus discharge, irritation and bleeding.
• AV Fistula: Swelling, pulsating lump and reduced blood flow.
• Rectovaginal/Vesicovaginal Fistula: Uncontrolled passage of stool or urine from the vagina.
• Tracheoesophageal Fistula: Difficulty swallowing, coughing and respiratory infections.
• Bronchopleural Fistula: Severe coughing and difficulty breathing.

Causes of Fistula

• Infections: Long standing infections, such as abscesses, tuberculosis or sexually transmitted infections can lead to fistula formation.
• Inflammatory diseases: Conditions like Crohn’s disease and ulcerative colitis increase the risk of digestive tract fistulas.
• Complications from surgery: Post surgical healing issues can lead to unintended fistula formation.
• Injuries or trauma: Accidents, childbirth complications or radiation therapy can create abnormal connections between organs.
• Blocked glands: Blockage of anal or sweat glands can result in abscess formation leading to anal fistulas.
• Cancer or tumors: Some types of cancer, especially in the digestive, urinary or respiratory system, can cause fistulas.

Complications of Fistula

• Repeated infections: If left untreated, a fistula can lead to frequent bacterial infections and abscess formation.
• Sepsis risk: A severe fistula infection can enter the bloodstream which leads to life threatening sepsis.
• Malnutrition: Some digestive fistulas prevent the absorption of nutrients, causing weakness and weight loss.
• Uncontrolled leakage: Vesicovaginal and rectovaginal fistulas result in involuntary leakage, affecting daily life.
• Chronic pain: Persistent discomfort and pain can reduce a patient’s quality of life.
• Blood clot formation: AV fistulas can lead to clotting issues and increasing the risk of cardiovascular complications.

Risk Factors of Fistula

• History of infections: Patients with chronic infections, such as abscesses or tuberculosis are at higher risk.
• Surgical history: Those who have undergone abdominal, anal, or gynecological surgeries have a higher chance of fistula formation.
• Inflammatory bowel disease (IBD): Crohn’s disease and ulcerative colitis significantly increase the risk of digestive tract fistulas.
• Prolonged labor or childbirth trauma: Can lead to rectovaginal and vesicovaginal fistulas in women.
• Diabetes and weak immunity: Impaired healing increases the risk of chronic fistula development.
• Cancer treatment or radiation therapy: Can damage tissues, leading to fistula formation.

Preventions of Fistula

• Early treatment of infections: Seeking medical attention for abscesses and infections reduces the risk of fistula formation.
• Managing chronic conditions: Controlling Crohn’s disease and ulcerative colitis lowers the likelihood of digestive fistulas.
• Proper hygiene: Keeping the anal and vaginal areas clean can prevent abscesses and infections.
• Safe childbirth practices: Seeking skilled medical care during labor reduces the risk of obstetric fistulas.
• Regular check ups after surgery: Monitoring post surgical healing helps detect complications early.
• Maintaining a healthy diet: Proper nutrition helps improve tissue healing and prevents digestive fistulas.