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Treatment for a Rectal Fistula

A rectal fistula is an unnatural channel or passage between the interior of the rectum and the surface of the skin nearby. Fistulas often start with an ulcer, abscess, or infected anal fissure, but often the cause cannot be identified. A fistula often allows bacteria and pus to leak from the rectum onto the skin. Fortunately, there are many treatment options available.

  1. Treatment

    • A preliminary visit to a physician is usually required to help determine the best course of treatment. Some options that a physician will discuss may include surgery followed by antibiotics, cleaning and sanitation practices to promote healing, and preventing the recurrence of the fistula by treating the underlying problems through diet, behavior or lifestyle changes for patients with Crohn's or other diseases.

    Crohn's Disease

    • Fistulas are a common condition in patients with Crohn's disease, an inflammatory bowel disease. Fistulas occur as the result of ulcers that a Crohn's patient will suffer during symptomatic flare-ups of the disease. In these patients, preventative medicine is a large part of the treatment. To minimize the occurrence of ulcers and fistulas, a physician will suggest that a patient stop smoking, avoid stress and eat a diet that is higher in fiber.

    Surgical Options

    • Most anal fistulas develop an internal membrane that will not allow for spontaneous healing. The most common option is to surgically open the fistula and remove the membrane. Once this occurs, the fistula will heal on its own. However, this type of surgery is not without risk. Often the sphincter must be cut in order to open the fistula, which may result in bladder or bowel incontinence. To prevent this, a patient may have to undergo multiple surgeries to fully treat the fistula. A newer, alternative surgery involves covering the opening of the fistula with a flap.

    Postoperative Care

    • Once the fistula has undergone surgical treatment, it should heal within two to four weeks with proper care. This includes warm-water cleaning after bowl movements, analgesics to control pain, bacteriocins to prevent bacterial infection, and stool softeners and a high-fiber diet to prevent injury to the healing wound due to irregular bowel movements.

    Other Options

    • Because of the risks involved with surgery, some patients and physicians seek to close the fistula without using surgical means. This may be done by or by closing the fistula with a biologic plug (a collagen cone that is pulled through the fistula and sutured in place internally) or fibrin glue (a synthetic substance that clots and acts as an adhesive).

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