Fistula

What is a fistula?

A fistula is a connection between two parts of your body that don’t normally connect. It often takes the form of a tunnel or passageway, and it may allow a bodily substance (like pus, poop or blood) to travel somewhere it shouldn’t.

Fistulas can form between two organs in your body or between two blood vessels. They can form entirely inside your body or lead from somewhere inside your body to the outer surface of your skin.

There are many types of fistulas that can occur in different areas of your body — including your digestive organs or genital area. Fistulas are typically abnormal, which means they need medical evaluation and treatment. But healthcare providers create some types of fistulas as a form of treatment (for example, a fistula between an artery and vein to support dialysis).

Fistulas can cause pain and other symptoms that disrupt your daily life. But they’re usually treatable, often with surgery. Sometimes, a fistula is a one-time issue that goes away and never comes back. But some people need treatments over months or years to manage fistulas that keep coming back or related complications. Your healthcare team will help you get the treatments and resources you need.

Types of fistulas

Most types of fistulas are abnormal and disrupt your usual body processes. Healthcare providers diagnose and treat these types of fistulas:

• Anal fistula. This is an abnormal passageway from the inside of your anus (butthole) to the outer surface of your skin. It typically results from an infection or inflammation (and related perianal abscess) in the glands surrounding your anus. Certain medical conditions, like Crohn’s disease, increase your risk of infections and fistulas.
• Arteriovenous (AV) fistula. An AV fistula is a direct connection between an artery and vein — two different types of blood vessels that normally take separate routes. Injuries are a common cause. But not all AV fistulas are harmful. Healthcare providers create such connections to help people with kidney failure who need dialysis.
• Aortoenteric fistula. This is a life-threatening connection between your aorta and your small intestine. It can lead to dangerous GI bleeding and death without timely treatment (emergency surgery). There are primary and secondary aortoenteric fistulas. Primary fistulas are commonly due to an aortic aneurysm, a tumor or an infection such as tuberculosis or syphilis. Secondary fistulas are a rare complication of some aorta surgeries.
• Perilymphatic fistula. This is a tear or hole in a membrane that separates your middle ear and inner ear. It allows fluid to flow from your inner ear to your middle ear, causing pressure changes that affect hearing and balance. Most people need surgery, while some may recover simply with bed rest.
• Tracheoesophageal fistula (TEF). This is a connection between your trachea (windpipe) and esophagus. It’s most commonly a congenital condition, which means babies are born with it. Healthcare providers typically diagnose and treat TEF in infants. But some adults develop TEF due to cancer or other medical conditions.
• Vaginal fistula. A vaginal fistula is an opening that forms in the wall of your vagina. It connects your vagina to a nearby organ such as your uterus, bladder, rectum, large intestine or small intestine. Your healthcare provider might use a more specific term to describe a vaginal fistula like vesicovaginal fistula (connection between your vagina and bladder) or rectovaginal fistula (connection between your vagina and rectum). The term obstetric fistula refers to a vaginal fistula that forms as a complication of childbirth.

Healthcare providers sometimes create fistulas to manage a certain medical condition. The fistula may be temporary or long-term. One example is a mucous fistula. This connects your small or large intestine to a stoma (a surgically created opening in the skin on your belly). A mucous fistula helps people who have a colostomy (opening of large intestine through the abdominal wall) or ileostomy (opening of small intestine through the abdominal wall).

What is a fistula for dialysis?

A dialysis fistula is technically an arteriovenous (AV) fistula because it connects an artery and a vein. But while other AV fistulas typically form accidentally, due to injuries, surgeons create dialysis fistulas to support dialysis care.

A surgeon connects an artery and a vein in your arm so that more blood than usual travels through that vein. The blood from your artery moves faster and at a higher pressure, so sending some of this blood into your vein forces the vein to get thicker and wider. And that’s a good thing — a strong, large vein can handle dialysis needles and send blood in and out of your body more quickly. 

If you need a dialysis fistula, your healthcare team will tell you the benefits and risks. They’ll also explain how to care for your fistula at home.

What are the symptoms of a fistula?

Fistula symptoms vary by type. The table below lists some symptoms you might experience according to the fistula type.

What causes a fistula?

The causes vary according to the type of fistula you have. In general, possible causes include:

• Inflammation and/or infection.
• Trauma or injury to part of your body.
• Complication of surgery.
• Side effect of treatment, like radiation therapy.
• Changes that occur during fetal development.

How is a fistula diagnosed?

Healthcare providers diagnose fistulas by:

• Talking to you about your symptoms.
• Doing a physical exam. This may involve looking for visible signs of a fistula or feeling certain areas of your body (with your permission).
• Running tests to learn more.

Tests to diagnose a fistula

Tests help providers learn more about what’s going on inside your body. They may suspect a fistula based on what you’re experiencing and what they can see. But providers can’t see fistulas that don’t connect to your skin’s outer surface. Various tests, including ones that take pictures of your internal organs, can tell providers more about:

• The type of fistula you have.
• Its exact location.
• How it’s affecting nearby tissues.

The specific tests you need depend on the type of fistula you have. Your provider can tell you more. But these are possibilities:

• Blood tests or urine (pee) tests to check for signs of inflammation or infection.
• X-rays, CT scans (computed tomography scans) or MRI (magnetic resonance imaging) to see various areas inside your body.
• Endoscopic ultrasound to see inside your digestive tract.
• Flexible sigmoidoscopy or colonoscopy to look inside your large intestine.
• Cytoscopy to look inside your bladder and urethra.
• Bronchoscopy or endoscopy to look inside your airways.
• Angiogram to check blood vessels for signs of disrupted blood flow.

What is the treatment for a fistula?

Medications and/or surgery are the typical treatments for fistulas. Your healthcare provider will tell you more about what’s appropriate in your situation.

For example, your provider may recommend medications to reduce inflammation or change your body’s immune response. Such medications can help treat the underlying cause of the fistula. If you have an active infection, you may need antibiotics. When medications aren’t an option or don’t do enough to help, you may need surgery.

What is fistula surgery?

Fistula surgery repairs an abnormal connection between two body parts to relieve your symptoms and prevent future problems. The exact details of the surgery vary widely according to the type of fistula you have — and its size and exact location. Some fistula surgeries are simple, while others are more complex. If you have a complex fistula, you might need several surgeries.

Your healthcare team can tell you more about what to expect, including surgery details, risks and recovery.

Can fistulas be prevented?

There’s nothing you can do to prevent most fistulas. They occur due to injuries or medical conditions you can’t do much to control.

Providers may be able to prevent obstetric fistulas — those that develop as complications of childbirth. This type of fistula can develop when you’re in labor for too long or don’t have access to emergency care (like a C-section). Healthcare providers in the U.S. closely monitor people during labor and delivery to prevent complications of prolonged labor, like fistulas.

Access to such care is unequal around the world. The World Health Organization (WHO) and others are working to prevent obstetric fistulas by increasing access to medical resources.

What can I expect if I have a fistula?

Fistulas are often easily treatable, but you need to see a healthcare provider to start the treatment process. Don’t try home remedies or wait for symptoms to go away on their own. If something doesn’t feel or look right, reach out to a provider right away.

Your provider will tell you what you can expect in your situation. Treatment might take care of the issue once and for all so you can put this chapter behind you. But fistulas or infections sometimes come back. You may need further treatment or another surgery. This can be frustrating. But your provider will walk you through each step and explain why it’s necessary.

How do I take care of myself?

Fistulas can be challenging to manage in your daily life. This is especially true when you have a complex fistula that requires multiple surgeries or when you have infections that keep coming back. It’s understandable that your attention is focused on your body right now. But don’t forget to take care of your mental health, too.

There are many reasons why you might feel stressed or anxious. You may:

• Wonder if treatment will work.
• Worry that the fistula will come back.
• Feel differently about your body.
• Think about how the fistula will affect your intimate relationships.

Give yourself permission to have these concerns, and remember your emotions are valid. But don’t carry it all alone. Talk to your healthcare provider about how you’re feeling. They may suggest resources, like counseling or support groups. Others who are living with fistulas understand what you’re experiencing and can help you navigate the way forward.

When should I see my healthcare provider?

Contact a healthcare provider if you have fistula symptoms or notice anything that’s out of the ordinary.

If you’re living with a fistula, call your provider if you have:

• New or changing symptoms.
• Questions about your treatment plan.
• New or returning symptoms after surgery.

What questions should I ask my doctor?

It may help to ask your provider:

• What type of fistula do I have?
• How can I manage symptoms at home?
• What are my treatment options?
• What are the risks of surgery?
• How long will it take to recover?
• What should I do or avoid as I recover?
• What are the chances that the fistula will come back?
• How can I prevent fistulas in the future?

A note from Cleveland Clinic

Maybe you’d never heard of a fistula before. But since you got diagnosed with one, it’s all you can think about. Fistulas can disrupt your daily routine and even your sense of self. Thankfully, treatment can help you regain control over the parts of your body that seem to have a mind of their own. Still, recovery might take some time. Your healthcare provider can tell you more about what to expect and share further resources.