There are pathological, congenital and artificially created fistulas. A fistula is always a passage that serves the flow of fluid. It often forms during inflammation to drain pus. A pathological fistula usually requires surgical treatment.
What is a fistula?
Pathological fistulas commonly occur in the anal area in Crohn’s disease of the bowel. The cause of the pathological fistula is a purulent inflammation, usually caused by bacteria. A fistula is a tube-shaped connection between two hollow organs or between a cavity in the body and the body surface. There are several types of fistulas. Artificial fistula, such as feeding fistula, is surgically created to bypass part of the digestive tract and deliver food to the body through a tube. Congenital fistula results from prenatal (pre-natal) developmental abnormalities. Connections remain that should close before birth. In urachal fistula (bladder-navel fistula), a connection between the bladder and the umbilicus remains; in preauricular fistula at the ear, gill ducts have not closed. Pathological fistula develops in inflammatory processes either when an abscess (encapsulated collection of pus) has formed or when purulent inflammation has developed in an existing body cavity. Pathological fistulas often occur in the mouth during dental inflammation and in the anal region during Crohn’s disease of the bowel.
Causes
The cause of pathological fistula is purulent inflammation, usually caused by bacteria. Pus develops in a closed body cavity or a newly formed closed tissue cavity (abscess) forms because of the inflammation. Pus is a product formed during the defense reaction against germs. Since the pus cannot drain and the pressure from the pus production keeps increasing, the body forms a tubular duct to drain the secretion. The fistula runs either to a cavity in the body or to the surface of the body. There, it becomes visible as a small hole from which pus leaks. The cause of a congenital fistula is a disorder in prenatal development.
Diseases with this symptom
- Arteriovenous_Fistula
- Crohn’s disease
- Anal fistula
Diagnosis and course
A fistula that runs to the surface of the body usually presents as a small pimple filled with pus. Affected individuals experience pain and a feeling of pressure at the site of inflammation. The tissue over the focus of inflammation is swollen and pain radiates to the surrounding area. Sometimes the skin over the fistula also itches. Anal fistulas are initially noticeable only by oozing. The more secretion accumulates, the more noticeable the pressure and swelling. Usually, some of the pus empties when pressure is applied to the swelling. But after some time, the fistula, or the underlying abscess, fills up again. In the case of internal fistulas, i.e. pathological ducts between two organs, there is often fever and exhaustion. The doctor will recognize from the symptoms that a fistula may exist. However, other diseases with similar symptoms, such as furuncles, must always be ruled out. Ultrasound or X-ray can be used to obtain further information. To do this, the doctor fills the fistula with a contrast medium to make its course visible.
When should you go to the doctor?
A pathological fistula forms during inflammation to allow the fluid formed in the process, generally pus, to drain. A fistula is a tube-like connection located either between two hollow organs or otherwise between a body cavity and the body surface. In addition to pathological fistula, there is also congenital fistula and artificially created fistula. This section deals with the pathological fistula that requires urgent treatment by a physician. The cause of the formation of a fistula is often the purulent inflammation of a naturally existing body cavity. In addition, abscesses can lead to the formation of a fistula, as can dental inflammation and intestinal diseases such as Crohn’s disease. The purulent inflammation underlying the fistula is primarily caused by bacteria. Pus always represents a potential danger to the body. Therefore, a fistula should always be treated by a doctor.Since medical laypersons are often unable to recognize the symptoms of a fistula, it should be said here that a doctor should be consulted as a precaution even in the case of initially seemingly trivial health problems. A fistula with a connection to the body surface often manifests itself initially as an apparent pus pimple. Itching or oozing may also indicate a fistula. At the latest when you feel tired or have a fever, it is urgently time to go to the doctor. Fistula therapy is multifaceted.
Treatment and therapy
To remove a fistula, surgery is usually required. For fistulas that have formed from abscesses or inflamed hollow organs, the inflammation is treated with antibiotics. Abscesses must be surgically opened and drained. Larger abscesses are left open for some time, that is, a drainage tube is placed to the surface of the body so that any newly formed pus and wound water can drain away. Sometimes a tamponade soaked in antibiotics is placed in the abscess to speed healing. This is then removed after one to two days. Once the inflammation has healed, the fistula will regress on its own. In the case of anal fistula, a thread drain is placed in the fistula tract. This often needs to be left in place for weeks to months to allow the fistula to gradually dry out and heal. For congenital fistulas, treatment is based on the symptoms they cause. A bladder– umbilical fistula must be closed surgically because urine leaks from the umbilicus. A congenital ear fistula, on the other hand, often remains without symptoms and usually does not require treatment.
Outlook and prognosis
In most cases, surgery is necessary to remove the fistula. This usually does not result in further compilations or discomfort, resulting in an overall positive course of the disease. Often the fistulas are filled with pus and can burst open. In case of unhygienic treatment, inflammations and infections can develop. Fistulas in the anal region are very unpleasant for the patient. These often itch and swell, so that the quality of life of the affected person is greatly reduced. Most patients also suffer from fever and a general feeling of illness. Should the fistula occur, a doctor must be consulted. Treatment exclusively with home remedies is not recommended. Treatment by the doctor usually takes place with the help of antibiotics and leads relatively quickly to success. In case of abscesses, they are drained. After the inflammation has healed, the fistulas usually recede on their own, so that no further discomfort arises for the patient in this case. If the fistula is already congenital, no treatment is usually necessary. This also applies to congenital fistulas in the area of the ear.
Prevention
Fistula arising from inflammation can be prevented by treating the inflammation early. One avoids the formation of pus and thus one prevents the development of a fistula.
What you can do yourself
As a rule, a fistula must be surgically removed. However, there are numerous options available to prevent a fistula or to alleviate the discomfort. Extremely important is a balanced diet. Those affected should avoid spicy foods, convenience foods and fatty meals. The diet should be supplemented with fiber and cereals. They soften the stool and facilitate bowel evacuation. To prevent fistula, patients should drink plenty of water. The recommended amount is about two liters daily. Those affected should avoid alcohol and soda. Fruit juices are an excellent alternative. They help prevent constipation, which exerts strong pressure on the fistula. Moreover, the use of a pillow is advisable. A pillow is ideal, especially for sufferers who have to sit for numerous hours. This helps to avoid strong pressure on the back, buttocks and legs. In addition, absorbent pads are useful. This way, sufferers do not have to worry about blood, pus and wound secretion stains. Alternatively, diapers can also be used. However, these are thicker and stigmatized. Personal hygiene is of enormous importance. Affected persons should clean themselves after each visit to the toilet. Here it is important to avoid bacteria lingering on the skin. This is the only way to avoid infection. When out and about, sufferers can use moist wipes for a transitional period.
