A fistula is the abnormal formation of a connection between two internal organs, between the vagina and the intestine for example, between an organ and the surface of the body, as between the rectum and the skin, or between two blood vessels, as between arteries or veins.
There are different types of fistulas depending on where they are. The most common are:
The anal fistula: abnormal communication between a gland present inside the anus and the skin in the area near the anus (rarely inside the rectum). The fistula is most often caused by the infection of this gland that causes an abscess.
The f rectovaginal istule: abnormal connection between the vagina and rectum. The contents of the intestine can pass through the fistula to get into the vagina. A rectovaginal fistula can result:
- Injury during childbirth.
- Of Crohn’s disease.
- A disease or infection of the colon or rectum.
- Cancer in the pelvic area or following radiation therapy for cancer treatment.
- Complications following surgery of the pelvic area.
The f istule arteriovenous: abnormal connection between an artery and a vein usually having in the legs.
Normally, the blood flows from the arteries to the capillaries, then to the veins. The nutrients and oxygen carried by the blood pass through the capillaries and are distributed in all the tissues of the body. With an arteriovenous fistula, the blood flows directly from the arteries to the veins without passing through certain capillaries. Thus, some tissues receive less blood.
An arteriovenous fistula can also be surgically created in the forearm in people with severe kidney disease to increase blood flow and facilitate dialysis treatments.
The f arteriovenous pulmonary istule: abnormal connection inside the lung between the artery and the pulmonary vein, which prevents the blood oxygenation process in the lung. This condition is caused by a genetic disease, Rendu-Osler-Weber disease, which causes the abnormal development of several blood vessels in the body, especially in the lungs.
The f obstetric istule (or vesico-genital fistula). Obstetric fistula usually results from prolonged (often several days) and difficult work, without timely obstetric (cesarean) intervention. The fetus then exerts excessive pressure on the internal organs (vagina, bladder, and rectum) and damages the tissues of the woman. In most cases, the baby dies. The woman suffers from severe incontinence that leads to ulcers, infections and sometimes even death.
A campaign to eliminate obstetric fistula
Every year around the world, 50,000 to 100,000 women experience obstetric fistula. In Africa and Asia, more than 2 million young women live with untreated obstetric fistula. These women most often live in poverty, in cultures where the status and respect of women are based on their marriage and ability to have children. In addition to causing serious health problems, obstetric fistula often leads to social isolation of women with the disease.
In 2003, the United Nations Population Fund launched a campaign to eliminate obstetric fistula. Several interventions were carried out in nearly 40 countries in sub-Saharan Africa, Asia and Arab regions.
This broad initiative aims to facilitate women’s access to obstetric treatment and to support women with obstetric fistula and help them resume normal life once they have received treatment.
Many other fistulas affect:
- The digestive system: gastric fistula (between the stomach and the skin), enter-vaginal fistula (between the intestine and the vagina).
- The respiratory system: estracheal fistula (between the esophagus and the trachea).
- The eye: lacrimal fistula (perforation of the duct of tears).
Causes of Fistula
A rectovaginal fistula can be congenital or caused by:
- Complications following surgery involving the vagina, perineum, rectum or anus.
- A wound. The recto-vaginal fistulas are often caused by an injury due to a difficult delivery, for example the tearing of the perineum to the intestine. In some countries that have experienced protracted civil wars, many women, who are repeatedly raped, have traumatic fistulas on the vaginal canal.
- An infection. For example an infection due to an episiotomy (an incision in the perineum to facilitate delivery through the vagina).
- A disease, such as Crohn’s disease (an inflammatory bowel disease).
- The cancer. A cancerous tumor in the region of the rectum, cervix, vagina, uterus or anal canal. Radiotherapy treatments in the pelvic area.
An arteriovenous fistula can be caused by:
- A skin injury, such as a stab or rifle bullet, where a vein and an artery are side by side.
- Complications following certain cardiac analysis techniques, such as cardiac catheterization.
A rectovaginal fistula can lead to:
- Hygiene problems.
- Recurrent vaginal or urinary infections.
- Irritation or inflammation of the vagina, perineum or skin around the anus.
- An abscess. An infected fistula can form an abscess, which can be dangerous if not treated.
- Recurrent fistulas
A large arteriovenous fistula can lead to:
- Heart failure.
- Blood clots in the legs may cause venous thrombosis.
- Leg pain
- Bleeding in the gastrointestinal system or in the brain.
An arteriovenous pulmonary fistula can lead to:
- A stroke (stroke).
Obstetric fistula is most prevalent in poor communities in sub-Saharan Africa and South Asia where access to obstetric care is limited. Nearly two million women live with obstetric fistula in developing countries and some 50,000 to 100,000 new cases occur each year.
Symptoms of a fistula
- Pain, redness or swelling (abscess) in the area around the anus.
- Purulent discharge sometimes with nauseating odor and pruritus (itching).
Depending on the size and position of the fistula, the symptoms may be minor or cause significant hygiene and incontinence problems.
- The passage of gas, stool or pus from the vagina.
- Nauseating losses from the vagina .
- Repeated vaginal or urinary infections.
- Irritation or pain in the vulva, vagina or perineum (the region between the vagina and the anus).
- Pain during sex.
- In addition to physical discomfort, rectovaginal fistula can cause emotional stress that can affect self-esteem and intimate relationships.
- Swelling and redness on the surface of the skin.
- Purplish and swollen veins visible on the skin, similar to varicose veins.
- Swelling of the arms or legs
- A drop in blood pressure.
- Heart failure.
Arteriovenous pulmonary fistula (a serious condition)
- Difficulty breathing, especially during exercise.
- A blueness of the skin.
A deformation of the fingernails.
People at risk for Fistula
- People suffering from digestive pathologies, such as Crohn’s disease or ulcerative colitis, favor the appearance of anal or recto-vaginal fistulas.
- The appearance of an anal fistula is not the result of poor hygiene or a particular diet.
Prevention of a fistula
|Measures to prevent complications|
|Good hygiene can reduce the discomfort caused by a rectovaginal fistula and reduce the risk of vaginal or urinary infections while waiting for a cure.
Medical treatment of a fistula
Some fistulas recto vaginal may close them, but most require surgery to correct abnormal connection.
Antibiotics. If the area surrounding the fistula is infected, antibiotics are needed before surgery.
Infliximab (Remicade) is a drug recommended to help cure fistulas in people with Crohn’s disease.
Before starting surgery, the doctor should make sure that the affected area is free from any signs of infection or inflammation.
The operation is most often performed under general anesthesia, but sometimes local anesthesia is performed. The surgery involves removing the abnormal duct and closing the opening by sewing the tissues.
An anal fistula is cured in two stages. First, the abscess in question is drained by an incision in the skin near the anus. Then, under local or general anesthesia, a doctor practices a fistulotomy. This operation sometimes involves cutting off part of the sphincter muscles of the anus.
Small arteriovenous fistulas can close on their own without any treatment.
- Embolization by catheter. This technique involves inserting a catheter (small flexible tube) into an artery near the fistula to inject a synthetic material or drug designed to close the abnormal connection. X-rays and medical imaging are used to guide the operation. This operation requires hospitalization of no more than 24 hours.
Ultrasonic guided compression. A probe is used to compress the fistula and block the blood flow in the vessels. The operation is guided by ultrasound. The technique is mostly used for leg fistulas. It lasts about 10 minutes but gives good results in only one third of cases.