Diagnosis

The diagnosis of fistulas that are connected to the skin surface is in some cases a simple gaze diagnosis when the fistula exit is visible. A fistula passage through the skin can be palpated as a hard strand. Anal fistulas are assessed by a digital-rectal examination (palpation of the rectum).

During the further examination, the anal fistula is probed if possible. A thin probe is inserted into the canal to follow the course of the fistula. Internal fistulas whose exit point is not visible must be diagnosed using imaging techniques. Depending on the location, ultrasound or CT (computed tomography) is used for this purpose. In some cases, a mirror image of the organ is also necessary.

Therapy

Fistulas between the bowel and the bladder or vagina must always be treated surgically. Anal fistulas are also operated in most cases because of the danger of abscesses. During surgery, the fistulas are scraped or split.

Sometimes an artificial bowel outlet is temporarily necessary. In some cases, anal fistulas are also treated by a suture drainage. In this procedure, a thread is pulled through the fistula canal and remains there for several weeks or months.

This keeps the fistula open and thus prevents the accumulation of secretion or promotes the drainage of secretion. Fistulas with accompanying inflammation are additionally treated with antibiotics. Especially for Crohn’s disease patients, in whom fistulas frequently occur, conservative therapy is initially recommended.

Here, drugs are administered which suppress the immune system. An early gain in therapy is important in any case to prevent further branching of the fistula. Intestinal fistulas do not heal on their own.

Because of the accompanying symptoms, such as fever or fatigue, a doctor should always be consulted. This doctor can identify and treat the cause, e.g. an inflammation. If such an inflammation is not treated, the fistula cannot heal. It is not advisable to use home remedies alone to treat a fistula in the bowel.