For fistula repair, patients usually see a gynecologist, urogynecologist, or colorectal surgeon. Doctors trained in women’s reproductive disorders treat vaginal fistulas, and doctors with special training in the treatment of colon and rectal problems treat other various fistulas.
There are many approaches to treat fistulas depending on the location, size, and condition. Following the diagnosis of a fistula, the medical professional will then decide the best plan of treatment. Sometimes this means controlling symptoms with a catheter, while other times it means surgery. Surgeons will recommend different approaches contingent upon the location of the fistula.
Before recommending surgery, your physician may suggest one of the procedures below to see if it alleviates the fistula. Most of these methods are most effective in the early stages of a fistula.
- Catheter. As their primary function, a catheter can be used to help drain a fistula. Using a catheter offers a clean and hygienic method for removing bacteria-ridden material that can invite infections.
- Seton Placement. A seton (silk string or rubber band) is employed in a couple of different manners. In the first, the seton used to create scar tissue around part of the sphincter muscle before cutting it with a knife. This tissue provides much needed protection for the delicate muscle. Another method is to allow the seton to slowly cut all the way through the muscle over the course of several weeks. This allows the body to repair the tissue as the seton cuts deeper. This has proven to be less traumatic than full surgery.
- Fibrin Glue or Collagen Plug. In some cases, fibrin glue, made from plasma protein, may be used to seal up and heal a fistula as opposed to cutting it open. The glue is injected through the external opening after clearing the tract and stitching the internal opening is stitched closed. A plug of collagen protein may also be used to seal and close the fistula tract.
- Fisulotomy. If the fistula is straightforward, a fistulotomy may be performed. This procedure involves connecting the internal opening within the anal canal to the external opening, creating a groove that will heal from the inside out. The surgeon first probes to find the fistula's internal opening. The tract is cut open and is scraped. Once the contents are flushed out, the sides are stitched to the sides of the incision in order to lay open the fistula.
A more complicated fistula, such as a horseshoe fistula,where the tract extends around both sides of the body and has external openings on both sides of the anus, is usually treated by laying open just the segment where the tracts join and the remainder of the tracts are removed. Due to the complexity of these types of fistulas, the surgery may be performed in more than one stage if a large amount of muscle must be cut.
- Advancement Rectal Flap - A surgeon may core out the tract and then cut a flap into the rectal wall to access and remove the fistula's internal opening then stitches the flap back down. This is often done to reduce the amount of sphincter muscle to be cut.
Pain after surgery is controlled with pain pills, fiber, and bulk laxatives. Patients should plan for time at home using sitz baths and attempt to avoid constipation that can be associated with prescription pain medication. Discuss with your surgeon the specific care and time away from work prior to surgery to prepare yourself for postoperative care.
As with most surgeries, your body is working incredibly hard to recover. The most important thing you can do is to do as little as possible to stress your body. Avoid lifting heavy objects. Slow the pace of your day. You are not at 100% and you should err on the side of caution. While it may seem tedious, it is best to wait longer to re-engage in activities that are normal to your life. Suffering a relapse or injuring yourself by rushing back will only exacerbate the problem. Slow and steady does win the race!
IS SURGERY FOR ME?
With the guidance of your physician, only you can make the final decision on whether to go through with surgery. You must weigh the risks versus the rewards and try to envision your life after surgery. Look past the short-term pain associated with the procedure and try to imagine the impact on your lifestyle. Once you review the pros and cons with your physician and understand the procedure to the best of your ability, only then can you make the decision right for you.