Digestive Health Inflammatory Bowel Disease Related Conditions Fistula Types, Diagnosis, Treatment, and Prognosis By Amber J. Tresca facebook twitter linkedin Amber J. Tresca is a freelance writer and speaker who covers digestive conditions, including IBD. She was diagnosed with ulcerative colitis at age 16. Learn about our editorial process Amber J. Tresca Medically reviewed by Medically reviewed by Jay N. Yepuri, MD, MS on May 26, 2020 facebook twitter linkedin Jay Yepuri, MD, MS, is board-certified in gastroenterology. He is a partner with Digestive Health Associates of Texas and a medical director at Texas Health Harris Methodist HEB Hospital. Learn about our Medical Review Board Jay N. Yepuri, MD, MS Updated on May 26, 2020 Print Table of Contents View All Types Symptoms Diagnosis Potential Complications Treatment Prognosis A fistula is defined as an abnormal connection of two body cavities (such as the rectum and the vagina), or as the connection of a body cavity to the skin (such as the rectum to the skin). One way a fistula may form is from an abscess—a pocket of pus in the body. The abscess may be constantly filling with body fluids such as stool or urine, which prevents healing. Eventually, it breaks through to the skin, another body cavity, or an organ, creating a fistula. Fistulas are more common in Crohn's disease than they are in ulcerative colitis. Up to 50% of people with Crohn's disease develop fistulas within 20 years of diagnosis. Fistulas are typically treated with surgery or with wound care. Types Fistulas often occur in the area around the genitals and anus (known as the perineum). The four types of fistulas are: Enterocutaneous: This type of fistula is from the intestine to the skin. An enterocutaneous fistula may be a complication of surgery. It can be described as a passageway that progresses from the intestine to the surgery site and then to the skin.Enteroenteric or Enterocolic: This is a fistula that involves the large or small intestine.Enterovaginal: This is a fistula that goes to the vagina.Enterovesicular: This type of fistula goes to the bladder. These fistulas may result in frequent urinary tract infections or the passage of gas from the urethra during urination. Symptoms Symptoms of fistulas can include pain, fever, tenderness, itching, and generally feeling poorly. The fistula may also drain pus or a foul-smelling discharge. These symptoms vary based on the severity and location of the fistula. Verywell / Nusha Ashjaee Diagnosis Fistulas are usually diagnosed through the use of a physical exam, a computed tomography (CT) scan, and, if needed, other tests such as a barium enema, colonoscopy, sigmoidoscopy, upper endoscopy, or fistulogram. During a fistulogram, a dye is injected into the fistula, and X-rays are taken. The dye helps the fistula to show up better on the X-rays. The dye is inserted into the rectum, similar to an enema, for fistulas that are in the rectum. The dye must be 'held' inside during the procedure. With a fistula that opens to the outside of the body, the dye is put into the opening with a small tube. X-rays will be taken from several different angles, so a patient may have to change positions on the X-ray table. As with any other kind of X-ray, remaining still is important. When it's suspected that a patient has an enterovesicular (bladder) fistula, an intravenous pyelogram (IVP), another type of X-ray, may be performed. Prepping for this test may include a clear liquid diet or fasting because stool in the colon can obstruct the view of the bladder. The dye (contrast material) is injected into the arm, and several X-rays are taken. How Do You Know When Your Bowel Prep Is Complete? Potential Complications A fistula may cause complications. In some cases, fistulas might not heal and become chronic. Other potential complications include fecal incontinence, sepsis, perforation, and peritonitis. Sepsis is a life-threatening illness that results from the body's response to a bacterial infection. Symptoms of sepsis include: chillsconfusiondisorientationfeverrapid breathing and heart raterash Peritonitis is an inflammation or infection of the peritoneum, the tissue on the abdominal's inner wall that covers the abdominal organs. Symptoms of peritonitis include: abdominal pain and tendernesschillsfever,joint painnauseavomiting Peritonitis: Symptoms, Causes, Diagnosis, and Treatment Treatments Treatments for fistulas vary depending on their location and severity of symptoms. Medical treatments include Flagyl (an antibiotic), 6-MP (an immunosuppressant), or certain biologic therapies (including Remicade and Humira). An enteral diet may be prescribed for enterovaginal, enterocutaneous, and enterovesicular fistulas. An enteral diet is liquid nutrition that is taken by mouth or given through a feeding tube. Liquid nutrition formulas replace solid food and contain vital nutrients. With no solid food, there is less stool passing through the anus, which helps the fistula heal and maybe even close. Many fistulas will not respond to any of the above therapies and will require surgery and/or wound care. If the fistula is in a healthy part of the intestine, it may be removed without taking out any part of the intestine. If the fistula is in a very diseased part of the bowel, a resection may have to be performed. A resection may result in a temporary ileostomy. Stool is diverted through the ileostomy, giving the part of the intestine with the fistula time to heal. This type of surgery is most often done on rectovaginal or enterovesicular fistulas. What to Expect During a Fistulotomy Prognosis The location and severity of the fistula play a major role in determining treatment. A fistula is a sign of serious inflammatory bowel disease (IBD), and without proper care, it can lead to serious complications. Seeing a gastroenterologist on a regular basis and taking medication as prescribed is vital to the management and prevention of IBD complications. How Can a Gastroenterologist Help You? Was this page helpful? Thanks for your feedback! We're providing tips on how to take better care of your gut. Sign Up You're in! Thank you, {{form.email}}, for signing up. There was an error. Please try again. What are your concerns? Other Inaccurate Hard to Understand Submit Article Sources Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Schwartz DA, Tagarro I, Carmen Díez M, Sandborn WJ. Prevalence of fistulizing Crohn’s disease in the United States: estimate from a systematic literature review attempt and population-based database analysis. Inflammatory Bowel Diseases. 2019;25(11):1773-1779. doi:10.1093/ibd/izz056 Stanford Health Care. Conditions treated by fistula repair. University of California San Francisco. Enterocutaneous fistula. Scozzari G, Arezzo A, Morino M. Enterovesical fistulas: diagnosis and management. Tech Coloproctol. 2010;14(4):293-300. doi:10.1007/s10151-010-0602-3 NIH National Institute of Diabetes and Digestive and Kidney Diseases. Colonic & anorectal fistulas. Updated August 2019. Medline Plus. Intravenous pyelogram (IVP). Johns Hopkins Medicine. Anal fistula. MedlinePlus. Sepsis. National Kidney Foundation. Peritonitis. Gold SL, Cohen-Mekelburg S, Schneider Y, Steinlauf A. Perianal fistulas in patients with Crohn’s disease, part 1: current medical management. Gastroenterology & Hepatology. 2018;14(8):470-481. Yan D, Ren J, Wang G, Liu S, Li J. Predictors of response to enteral nutrition in abdominal enterocutaneous fistula patients with Crohn's disease. Eur J Clin Nutr. 2014;68(8):959-963. doi:10.1038/ejcn.2014.31 Crohn’s & Colitis Foundation. Small and large bowel resection. Crohn’s & Colitis Foundation. Fistula removal. Additional Reading Cleveland Clinic. When fistula interferes with your life, get help. Updated July 15, 2015. Cleveland Clinic. Anal fistula: diagnosis and tests. Updated February 14, 2019. Crohn’s & Colitis Foundation. Fact sheet. Updated January 2015. de la Piscina PR, Duca I, Estrada S, et al. Effectiveness of infliximab in the treatment of perianal fistulas in ulcerative colitis: report of two cases. Annals of gastroenterology. 2013;26(3):261-263. Hamadani A, Haigh PI, Liu IA, Abbas MA. Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess? Diseases of the Colon & Rectum. 2009;52(2):217-221. doi:10.1007/DCR.0b013e31819a5c52 IBD relief. Fistulas and inflammatory bowel disease (IBD). Tabry H, Farrands PA. Update on anal fistulae: surgical perspectives for the gastroenterologist. Canadian Journal of Gastroenterology. 2011;25(12):675-680. doi:10.1155/2011/931316 Timbol ABG, Co VC, Djajakusuma AV, Banez VP. Duodenocolic fistula diagnosed by endoscopy: a rare complication of colon cancer. BMJ Case Reports. 2017. doi:10.1136/bcr-2016-218050 University Health Network. Toronto General Hospital. What to expect when having a fistulogram. Updated July 2017. University of California San Francisco Health. Enterocutaneous fistula diagnosis. University of Florida Health. Peritonitis — spontaneous bacterial.