The term "fistula" indicates an abnormal connection that occurs between two biological parts, such as organs, blood vessels or the intestine. This abnormal tubular connection can form in many ways and in many areas, although the most common are anorectal fistulas. The most common form of treatment is surgery, although some lifestyle changes can help. Read on to learn more.
Steps
Part 1 of 3: Making Lifestyle Changes
Step 1. Eat a balanced diet
Taking care of your nutrition helps keep your stomach and digestive system in check. Simply avoiding spicy foods, junk foods, and fatty foods will result in a healthier digestive system that is less prone to disease. Choose a diet based more on whole grains, green leafy vegetables, fruits and lean meats.
- Adding fiber and grains to your diet helps soften stool and facilitate bowel movements.
- Try to observe which types of foods you are allergic to or which ones disturb your stomach. Remember that there is not always a rigid rule: each person makes his own story.
- Harmful fats can more easily block the fistula tunnel and thus induce a perianal abscess, which is the main cause of pain in people with fistulas.
Step 2. Drink more water
You should drink one and a half liters of water a day, unless otherwise directed by your doctor. Stop drinking alcohol and sodas; rather consume large amounts of water and fruit juices. This will help prevent any possible onset of constipation, which puts pressure on the fistula.
- Drinking plenty of water makes the stool soft and helps cleanse the intestines; this is why if you drink a large amount of water you feel the need to go to the bathroom more often.
- Water also prevents the intestines from getting blocked, especially in patients suffering from certain digestive diseases such as Crohn's disease, toxic megacolon and so on. In patients suffering from fistulas, water makes the pus more watery thus reducing the possibility of abscesses forming.
Step 3. Use the pillows
If you are forced to work sitting for many hours, avoid putting extra pressure on your back, butt and legs, especially if you have an anal fistula. You can help yourself by sitting on a cushion or "donut cushion" instead of your normal chair.
Keep this mental approach to everything - comfort is imperative. Try to avoid situations where you might be uncomfortable, or bring a pillow or other support with you
Step 4. Use sanitary pads
If the fistula causes you unpleasant leakage in the anal area, wearing soft pads can reassure you about any loss of blood, pus or other liquids from the fistula.
- Adult diapers also work well, they are just a little bulkier and psychologically more difficult to accept. Sanitary pads are thinner and much easier to manage.
- Change your sanitary pads frequently, also because the leaks don't smell good.
Step 5. Maintain good personal hygiene
Make sure you wash each time after you have defecated or urinated. Eliminating bacteria that may remain on the skin is the first step to avoiding an infection. This is even more true if you go to public restrooms and are having leaks.
- If you are away from home and you cannot wash yourself, always carry wipes with you to use instead of water, until you return home. Hands are always exposed to the maximum amount of germs, so they need to stay clean.
- Change your underwear at least once a day. Also replace towels every time you take a bath. Both of these actions prevent the spread of germs and the growth of bacteria, as well as reduce perianal irritation, thus helping to eliminate the annoying symptoms associated with the fistula.
Step 6. Take some pain relievers
Ibuprofen, a non-steroidal anti-inflammatory drug (NSAID), is the main pain reliever you can take to manage the pain of the fistula. Anorectal fistulas are often accompanied by constant, throbbing pain that is severely worse when sitting down. To soothe it, talk to your doctor and ask for the right dosage for you.
- Pathologically, pain is a complication of blocked fistula tunnel. A blocked tunnel fills with pus rather than emptying - a process that will eventually lead to the formation of an abscess or a lot of pus near the surface of the skin.
- Pain may also be accompanied by an irritating sensation of the perianal skin due to pus drainage.
Step 7. Strengthen the immune system
Maintaining a healthy diet and eating foods rich in omega-3, omega-6 and vitamin C - such as fish, olive oil and citrus fruits - help strengthen the immune system and reduce the levels of inflammation caused by the fistula. You can also take supplements if your doctor sees fit.
Exercise, drinking plenty of water, sleeping well, and maintaining good hygiene are all steps you can take to stay healthier. And if you have bad habits, like smoking, consider anal fistula as a good excuse to quit smoking
Step 8. Stay active
If your condition allows for simple, gentle exercise like slow walking, do it for your health and to help reduce stress. Stress can affect the general mood, trigger problems and irritate the stomach. As a result, the digestive system and your eating habits in general suffer, creating a vicious circle.
- Always stop and catch your breath for a while if you experience any pain or can't continue. It is your body telling you that it cannot handle the effort you are making.
- Ask your doctor what kind of sport or light exercise you can do in your condition. Many recommend yoga, also practiced at home, to clear the mind, eliminate stress and fight depression. It also improves mood and health in general.
Part 2 of 3: Undergo the Treatments
Step 1. See your doctor
The diagnosis is made with a visual examination. A sigmoidoscopy should always be done thereafter to rule out Crohn's disease. However, to know all aspects of your case, the doctor will also perform one or more of the following tests:
- Computed tomography (CT). Especially in patients with Crohn's disease, a CT scan indicates the inflammatory phase before the possible formation of a fistula, as well as showing the cavities of the abscess to determine if surgery is required.
- Magnetic resonance imaging (MRI). This is a useful method for determining any enteric fistulas, also revealing inflammatory changes or fluid accumulation in the fistula canal.
- Fistulography. It is an X-ray method in which a contrast medium is injected into the external site of the fistula to show its path and depth through the tissues, in order to identify the most appropriate treatment.
- Ultrasound. Combined with physical examination, it can be done to identify any abscess or fluid buildup in the fistula canal.
- Cystoscopy. This test is useful for the "enterovesical fistula" that connects the intestine to the bladder.
- Microbiological tests. To identify any sign of infection, especially in the presence of an abscess, a urine culture may be necessary in the case of colo-bladder fistula.
Step 2. Undergo surgery
The most common treatment for fistulas is surgery, called a "fistulotomy". This process removes the fistula and any pus or fluid collection present. The intervention has proved effective in more than 85% of cases.
- In fistulotomy for rectal fistulas, a procedure called the endorectal flap is used, in which surrounding healthy tissues are placed inside the fistula cavity to prevent stool blockage in case of recurrent infections.
- A seton point is used during the fistulotomy (a cord is passed through the fistula to keep it closed during drainage). This surgery usually requires several check-ups by the doctor, until you achieve healing and the stitches come off.
Step 3. Be cautious if you have a fistula near the esophagus
Fistulas between the esophagus and the tracheo-bronchial tree are considered life-threatening and require immediate and continuous treatment. Left untreated, they can lead to chronic lung abscesses and fatal pneumonia. Treatment occurs through a number of medical procedures such as:
- Esophageal dilation. This technique is losing popularity because it is rarely effective for more than a couple of days.
- Flexible metal mesh stent. This is most effective in maintaining patency and esophageal structure.
- Plastic coated stent. This too can be used to occlude trachea-esophageal fistulas; some are fed with a valve that prevents backflow when the fistula is near the esophageal sphincter.
Step 4. Get regular checkups
It is extremely important to have a post-operative check-up, especially if you have a chronic inflammatory disease such as Crohn's disease. In this case the fistulas are only a side effect and the real causes must be addressed.
- There are also other aspects directly related to intestinal fistulas that the patient must be aware of and must follow. It is important to avoid septicemia by treating for signs of infections, such as inflammation of the tissues surrounding the fistula, checking the drainage of the fistula, and maintaining good skin care to ensure surrounding tissues remain healthy.
- Adequate nutrition can be achieved by administering total parenteral nutrition (one drip), which is highly recommended for particularly large fistulas. This way you avoid any possibility of malnutrition.
Step 5. Take antibiotics with a doctor's consent
Taking antibiotics can help minimize infections at the site of the fistula, especially if it is enteric. Elevated levels of white blood cells indicate the presence of an infection that needs to be treated with a suitable medication.
Fistulas can be treated initially with metronidazole and ciprofloxacin or vancomycin treatment. Metronidazole can be taken in doses of 250-500 mg every 8 hours; vancomycin in doses of 125-250 mg every 6 hours, or 3 times a day an hour after eating
Part 3 of 3: Knowing the Fistulas
Step 1. Know the causes and factors responsible for fistulas
Most cases are related to chronic inflammatory diseases such as Crohn's disease and tuberculosis. Other cases can result from diverticulitis, cancer, or chronic trauma. Surgery or injury can also lead to the formation of a fistula, such as biliary or arteriovenous fistula.
- Rectovaginal fistulas can be side effects of Crohn's disease, injuries during childbirth, radiation therapy, or cancer.
- Fistulas in children or infants are mostly congenital and affect boys more than girls.
Step 2. Know the signs and symptoms
Any fistula usually comes with these symptoms:
- Constant discharge (pus).
- Pain (related to infections).
- One or more openings.
- Bleeding.
- Abdominal pain.
- Diarrhea.
- Loss of appetite.
- Weight loss.
- Nausea and vomit.
Step 3. Learn about the different types of fistulas
A fistula, by definition, is a tubular tunnel with two openings: one primary leading to another external opening called a secondary. Many types are known, but 90% of all fistulas are anorectal ones. Physically, they can take the following forms:
- Blind fistula - a connection between two surfaces; one end is closed while the other is open. This can turn into a complete fistula if left untreated.
- Incomplete fistula: a connection with only one external opening.
- Complete fistula: a connection between an internal and external opening.
- Horseshoe fistula: a U-shaped connection, between two external openings around the anus.
Step 4. Learn about the complications of an anal fistula
Unfortunately, the problem of a fistula does not stop at the symptoms, but can also lead to complications. Here are what they are:
- Secretions that produce inflammation around the anal area.
- Tumors of the anal canal.
- Fungal diseases.
- Exposure to severe trauma
- Injuries around the anal area.
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Infections of the digestive tract.
For these reasons, it is highly recommended to clean the anus after using the toilet, to respect the rules of public and personal hygiene and to use the wipes after using the bathroom (and throw them away after using them)
