Fistulas can have various causes – they often occur when an abscess has formed in the body or a purulent inflammation has developed in a body cavity. Among other places, they can occur in the mouth after an inflammation of the teeth, as well as on the coccyx and in the anal area. Here they are often caused by chronic intestinal disease such as Crohn’s disease. We reveal which symptoms indicate a fistula and what treatment options are available.
What is a fistula?
A fistula is a tube-shaped connection between a hollow organ and another organ or the surface of the body. Depending on whether the fistula is located completely inside the body or has a connection to the outside, a distinction is made between internal and external fistulas. A fistula does not always consist of only one duct – sometimes an entire network of fistula ducts can develop. Such a structure is called a “Fuchsbau.” A foxhole often occurs in anal fistulas caused by Crohn’s disease.
Fistula and abscess
Fistulas are not usually naturally existing connections. They can be caused by acute or chronic inflammation, but they can also be caused by external factors – such as an accident or childbirth. In the case of a fistula on the coccyx, the discomfort can also be caused by an ingrown hair. In the case of acute inflammation, pus may form in a closed body cavity or an abscess may develop. This refers to a cavity inside the body filled with pus. If the pressure becomes greater and greater due to the continued production of pus, the body creates a way to drain the pus from the tissues: A fistula develops. If the inflammation persists, more and more new pus is produced. As a result, the pus duct has no way to heal.
Fistula in the mouth and coccyx
Fistulas can form in the body in a wide variety of places. They are particularly common in the mouth at the gums, the coccyx, and the anus. Especially in the anal area, fistulas are unpleasant for those affected, as they often do not dare to go to the doctor with their complaints. But the complaints do not disappear on their own: if the inflammation is not treated, the fistula may even spread further.
What are typical symptoms of a fistula?
Depending on the location and type of fistula, a wide variety of symptoms may occur:
- Many fistulas are noticeable by swelling, which may or may not hurt.
- In addition to the swelling, there may also be redness and overheating of the tissue.
- Other symptoms may include fatigue and fever.
If the fistula has a connection to the outside, it can be seen on the surface of the body as a small dot. That is why it is often initially confused with a pimple. Characteristic of a fistula is that, unlike a pimple, pus is always leaking from it.
Signs of an anal fistula
Possible symptoms of an anal fistula include anal itching, pain after defecation, and fecal incontinence. If the fistula tract is in contact with the surface of the body, there is also oozing in the anal region. As a result, traces of pus and feces are often found on the underwear. In some cases, an unpleasant odor also develops in the intimate area.
Treat fistulas
In the case of a fistula, surgical intervention is unavoidable – as a rule, it does not heal on its own. This is because the body encapsulates the focus of infection to protect itself from the bacteria. This prevents the bacteria from spreading in the body, but it also means that they cannot be effectively combated by administering medications such as antibiotics. Therefore, treatment with medications cannot cure the fistula. Only in Crohn’s disease patients, drugs containing the antibody infliximab are used to treat fistula formation.
Various surgical procedures
Several surgical procedures are available to treat a fistula. In a fistulotomy, the fistula is split, exposed, and cleaned. Once the source of infection has been removed, the fistula can then heal on its own. However, it is important for a split that the fistula does not pass through the sphincter muscle or any other important structure in the body. In the case of anal fistulas that pass through the sphincter muscle, the fistula is not split but cut out.Almost the entire pus duct is cut out of its surroundings. Only the part that passes through the sphincter muscle is merely scraped out. The muscle is then sutured back together.
Suture drainage
In the case of an anal fistula that is connected to the anus, a suture drainage can also be placed. In this procedure, a thin thread is inserted into the anus through the outer fistula opening. The two ends of the thread are then knotted together from the outside. The thread keeps the fistula open at all times and can prevent a buildup of secretions and the formation of abscesses. Many patients initially find the thread unfamiliar, but after a few days they no longer feel the foreign body. However, the exit area must be cleaned several times a day. A suture drain is often left in the body for several weeks or months. In some cases, the placed drainage can heal side ducts – in rare cases even the entire fistula. As a rule, however, suture drainage should be regarded as preparation for subsequent surgery. In patients in whom surgery is not possible, suture drainage may also represent a permanent therapy.