Treating fistulas successfully – this is how it works!

Treating fistulas successfully – this is how it works!

Fistulas can have various causes – they often arise when an abscess has formed in the body, or a purulent inflammation has developed in a body cavity. They can appear in the mouth after tooth infection, as well as on the coccyx and in the anal area, among other things. They are often caused by chronic intestinal diseases 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 tubular connection between a hollow organ and another organ or the body surface. Depending on whether the fistula is entirely 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 just one duct – sometimes, a whole network of fistula ducts can develop. Such a structure is referred to as a “fox burrow”. A burrow often occurs with anal fistulas caused by Crohn’s disease.


fistula and abscess

Fistulas are usually not naturally occurring connections. They can be caused by acute or chronic inflammation but can also be caused by external influences, such as an accident or childbirth. In the case of a fistula on the coccyx, the symptoms can also be triggered by an ingrown hair. 

In acute inflammation, pus can form in a closed body cavity, or an abscess can form in the body. This is a pus-filled cavity inside the body. If the pressure increases due to the ongoing production of pus, the body creates a way to transport the pus out of the tissue: a fistula develops. 

If the inflammation persists, more and more pus is produced. As a result, the pus duct has no opportunity to heal. 

Fistula in the mouth and coccyx

Fistulas can form in a wide variety of places in the body. They are ubiquitous in the mouth on the gums, tailbone and anus. Especially in the anal area, fistulas are uncomfortable for those affected, as they often do not dare to go to the doctor with their complaints.

However, the symptoms do not go away independently: if the inflammation is not treated, the fistula may spread further. 


What are the typical symptoms of a fistula?

Depending on the location and type of fistula, a wide variety of symptoms can occur: 

  • Many fistulas become noticeable through swelling, which can hurt but does not have to.
  • In addition to swelling, the tissue may also become red and overheated.
  • Fatigue and fever are other symptoms that can occur. 

If the fistula connects to the outside, it can be seen as a small dot on the body’s surface. That is why it is often confused with a pimple at first. It is characteristic of a fistula that, in contrast to a pimple, pus repeatedly leaks out of it. 

Signs of an anal fistula

In the case of an anal fistula, anal itching, pain after defecation and faecal incontinence are among the possible symptoms. If the fistula tract is in contact with the body surface, there will also be weeping in the anus region. As a result, there are often traces of pus and faeces on the underwear. Sometimes, there is also an unpleasant odour in the intimate area

treat fistulas

In the case of a fistula, an operation is unavoidable – this usually does not heal on its own. Because the body encapsulates the source of infection to protect itself from the bacteria, although this prevents the bacteria from spreading, they cannot be effectively combated by administering drugs such as antibiotics.

Treatment with medication can, therefore, not lead to healing of the fistula. Only in Crohn’s disease patients are drugs with the antibody infliximab used in the event of fistula formation. 


Various operational procedures

There are various surgical procedures to choose from to treat a fistula. The fistula is split open, exposed, and cleaned in a fistulotomy. Once the source of infection has been eliminated, the fistula can heal on its own. However, it is essential for a split that the fistula does not run through the sphincter muscle or another vital structure. 

In the case of anal fistulas that run through the sphincter, the fistula is not split but excised. Almost the entire pus duct is cut out of its surroundings. Only the part that runs through the sphincter is scraped out. The muscle is then sewn back together.

thread drainage

In the case of an anal fistula that is connected to the anus, a thread drainage can also be placed. A thin thread is inserted into the anus through the outer fistula opening. The two thread ends are then knotted together from the outside. 

The thread always keeps the fistula open, and it is possible to prevent secretion build-up and abscess formation. Many patients initially find the thread unfamiliar but no longer feel the foreign body after a few days. However, the exit area must be cleaned several times a day. 

Thread drainage is often left in the body for several weeks or months. In some cases, secondary passages – in rare cases, even the entire fistula – can heal due to the drainage that has been placed. As a rule, the thread drainage must be considered as preparation for a subsequent operation. In patients with an impossible operation, thread drainage can also represent a long-term therapy.


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