A fistula develops when there is an abnormal passageway between two organs that are not usually connected. It generally develops between one of the intestines and the nearby skin, between the rectum and the vagina, and in other nearby organs. While the causes of a fistula depend on its type, they are usually associated with inflammatory conditions such as Crohn’s disease. Fistula treatment typically involves repairing and removing the abnormal connections through various procedures.

Common types of fistula
One of the most common types of fistula is perianal or anal fistulas. These develop as abnormal connections between the perianal skin and the epithelialized surface of the anal canal. There are several other types that one should know about.

• Anorectal fistulas: These typically develop between the skin around the anal opening and the anal canal.
• Rectovaginal fistulas: Also known as anovaginal fistulas, these are vaginal fistulas that result from the development of a hole between the vagina and the anus or rectum.
• Colovaginal fistulas: These develop between the vagina and the colon.
• Vesicovaginal fistulas: When a hole develops between the vagina and the bladder, these forms of vaginal fistulas occur.
• Urethrovaginal fistulas: These occur between the vagina and the urethra.

Management options for fistula
Usually, surgical intervention is the only way to get rid of fistulas. But, the treatment generally depends on the cause, location, and complexity of the fistula. For most treatment and management options, the objective is to repair the fistula completely so that it does not occur again and the sphincter muscles are protected from further damage. In most cases, there are no quick remedies for fistulas since there is always the risk of repeated infections and abscesses. But one can follow a routine of eating well-balanced healthy meals, staying hydrated, and avoiding unhealthy food options to ensure the most effective results for these procedures.

1. Fistulotomy
This form of treatment for a fistula is used when there are only a few muscles involved around the anal region with any additional connections. A fistulotomy is one of the easiest and most effective methods of treating anal fistula. It has to be done only once to get rid of the fistula. During this procedure, a healthcare professional, such as a colorectal surgeon, cuts through the upper portion of the fistula so that it fills in from the bottom towards the top. Only a little bit of muscle is incised to avoid the risk of damaging the bowel system. The infected tissue is also removed during this procedure.

2. Seton drain
In the case of complex fistulas, the seton drain procedure is used. A seton is a kind of surgical thread that is not absorbed over time but has to be removed. The seton is looped through the fistula so that it is opened for a sufficient amount of time to let out all the discharge. In addition, the seton also helps to cut across the tract of the fistula. As a result, the tissue starts to heal as the seton goes through the muscle. Also, the seton prevents local tissue scarring. This way, the wound does not pull apart later on, avoiding the risk of infection and recurring fistula. In most cases, the seton drain is removed by the surgeon, and the fistula is closed with another procedure, such as a fistulotomy. But if the fistula has resulted from chronic conditions such as IBS, the drain is left inside indefinitely.

3. Endorectal advancement flap
Often, complex fistulas need multiple surgeries. Along with the seton drain, a surgeon may also use endorectal advancement flap procure to treat fistulas. This procedure does not involve cutting through the roof of the fistula. Because of this, the sphincter muscles remain intact. Instead, the tissues that have been infected near the opening of the fistula are removed. Then, a flap of healthy tissue from within the rectum is pulled down to cover up this opening. When this is done, the fistula drains out from the outside opening. At the same time, it starts to heal from within.

4. LIFT procedure
Known as ligation of intersphincteric fistula tract, this procedure is generally done after a seton drain procedure. It involves using stitches to close off a part of the fistula that connects two sphincter or intersphincteric muscles. Once this is done, the surgeon removes the entire tract of the fistula from this area. In addition, the infected tissue that is within is also removed.

5. Temporary colostomy for fistula repair
This procedure is generally used for the treatment of vaginal fistulas, specifically in the case of rectovaginal fistulas. The surgery is done to close the opening that is larger than normal. During this procedure, a diversion is created to move stool away from the rectum and large intestine to allow the fistula to heal. An opening called a stoma is created surgically through the abdomen for the stool to leave the body. A bag and tube are connected to the stoma where the stool gets collected. These need to be changed frequently. Once the fistula heals, another procedure is done to close up the stoma and reconnect the intestines.

Other treatment options
Besides the options mentioned above, one can choose other treatment options to manage and repair fistulas.

• Endoscopic ablation
• An anal fistula plug to close up the fistula to give it time to heal
• Medical glue to close up the fistula