The term "fistula" refers to an abnormal connection that forms between two biological surfaces, such as an organ, vessel, or intestine. This abnormal relationship forms in the form of a channel and can be found in many locations and in a variety of variations, although the most common is the anorectal fistula. The most common method of treatment is surgery, although certain lifestyle changes will also make a difference. We'll cover your options below, starting with Step 1.
Step
Part 1 of 3: Changing Your Lifestyle
Step 1. Eat a balanced diet
Maintaining your diet will prevent the occurrence of symptoms of stomach and digestive ailments. Just avoiding spicy, fast food, and fatty foods will make your digestive system healthier and more resistant to disease. Choose whole grains, green leafy vegetables, fruits, and lean meats.
- Adding fiber and cereals to your diet will help soften stools and make bowel movements easier.
- Try to pay attention to the types of foods that you are allergic to or that make your stomach hurt. Keep in mind that this is not a fixed rule - everyone is different.
- Fatty discharge can increase the chances of blockage of the fistula tract and it can lead to the formation of a perianal abscess, a major cause of pain in people with fistulas.
Step 2. Drink more water
It is recommended to drink 1.5 L of water daily unless your doctor tells you otherwise. Stop drinking alcohol and soda; instead, drink plenty of water and fruit juices. This will help prevent constipation from putting pressure on your fistula.
- Excess water will make the stool softer and help cleanse the intestines; That's why if you drink a lot of water, you feel the need to go to the toilet more often.
- Water also prevents intestinal obstruction especially in patients with digestive diseases such as Crohn's disease, toxic megacolon, etc. In fistula patients, water will make the pus more watery thereby reducing the chances of an abscess forming.
Step 3. Use a pillow
If your job requires you to sit for long hours, avoid putting extra pressure on your back, buttocks, and legs, especially if you have an anal fistula. This can be done by sitting on a pillow, or “pillow donut,” rather than just a regular chair.
Use this mentality for everything; your comfort is paramount. Try to avoid situations where you can expect to be uncomfortable or bring a pillow or other help with you
Step 4. Use absorbent pads
If your fistula is causing an unfavorable discharge down there, using an absorbent pad will save you from worrying about oozing blood, pus, or any fluid from your fistula, as the pad acts as an absorbent surface.
Adult diapers also have the same function, only they are thicker and stigmatized. Absorbent pads are thinner and easier to handle
Step 5. Maintain personal hygiene
Make sure you clean yourself after urinating or defecating. Avoiding the remnants of bacteria that stick to your skin is the first step to avoiding infection. This also applies to public restrooms and when you are dealing with a discharge down there caused by a fistula.
- If you're away and can't do this, always carry a tissue with you to use until you get home. Your hands are exposed to the most germs, and therefore they must be kept clean.
- Change your underwear at least once a day. Change your towels too every time you shower. Both of these prevent the spread of germs and the growth of bacteria which can reduce perianal irritation and therefore will help relieve the annoying symptoms suffered by people with fistulas.
Step 6. Take painkillers
Ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID), is the pain medication of choice used to treat pain caused by fistulas. Anorectal fistulas are often accompanied by constant, throbbing pain that becomes very severe when sitting. To work around this, talk to your doctor about the right dose of painkillers for you.
- Pathologically, pain is a complication of obstruction of the fistula tract. The blocked duct will fill with pus, and the pus can't drain out - a process that will eventually lead to the formation of an abscess, or pocket of pus near the surface of the skin.
- The pain may also be accompanied by perianal skin irritation caused by the discharge of pus.
Step 7. Strengthen your 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, will help strengthen your immune system and reduce the level of inflammation you may have from a fistula. You can also take supplements if your doctor thinks it's a good idea.
Exercise, drinking plenty of water, getting enough sleep, and maintaining good hygiene are also good steps you can take to make yourself healthier. And if you have any bad habits - such as smoking - consider these reasons to quit the bad habit
Step 8. Stay active
If your condition doesn't prevent you from doing simple, light exercise like slow walking, do it to improve your health "and" help relieve stress. Stress can affect your general mood and can trigger problems and irritate your stomach. This will then affect your digestive system and your overall eating habits, which then becomes a bad cycle.
- Always stop and take a break if you feel sick or are unable to continue. It's your body's way of telling you that your body isn't strong enough to handle what you're doing.
- Ask your doctor about what types of exercise or light exercise you can do. Even at home, yoga is recommended by many doctors to clear the mind, relieve stress, and fight depression. Yoga also improves your mood and overall health.
Part 2 of 3: Getting Treatment
Step 1. Check with a doctor
Diagnosis is made by visual examination. A sigmoidoscopy should always be performed after a visual examination to make sure it is not Crohn's disease. However, to find out your case as a whole, your doctor will also perform one or more of the following tests:
- Computerized Tomography (CT scan). Especially in Crohn's disease patients, CT scan results can indicate the stage of inflammation prior to possible fistula formation, as well as showing abscess cavities to determine whether surgery is necessary.
- Magnetic Resonance Imaging (MRI). It is a very helpful method for diagnosing enteric fistulas by demonstrating the presence of inflammatory changes or accumulation of fluid in the fistula tract.
- fistulography. This is an X-ray method in which a contrast medium is injected into the external area of the fistula to clarify the path of the fistula and how deep the fistula penetrates the tissue, which will assist in selecting the appropriate treatment.
- Ultrasound. This method, combined with a physical examination, can be used to identify the presence of an abscess or fluid accumulation that may occur within the fistula tract.
- Cystoscopy. This is useful for “enterovesical fistulas” that connect the bowel to the bladder.
- Microbiological tests. To indicate signs of infection, especially in the presence of an abscess, a urine culture may be required in the presence of a colovesical fistula.
Step 2. Undergo surgery
The most common fistula treatment is surgical surgery, called a “fistulotomy.” This process removes the fistula and any pus or fluid that has accumulated in it. Fistulotomy is effective in more than 85% of cases.
- In fistulotomy for rectal fistulas, a procedure called an endorectal cap will be used. This is where the surrounding healthy tissue is inserted into the fistula cavity to prevent the fistula from being blocked by feces in case re-infection occurs.
- The seton suture (stitching a thread over the fistula to keep the fistula closed during drainage) is also used in fistulotomy. However, this usually requires many visits to the doctor until the stitches heal and eventually come off. There is a “Cutting Seton Treatment” known as “Kshar Sutra Therapy” which is proven to be very effective for all types of simple and complicated anal fistulas. Although it may take several months for complete healing, the chances of the fistula reoccurring after the Kshar Sutra Therapy are virtually non-existent.
Step 3. Be careful if you have a fistula near your esophagus
A fistula between the esophagus and the trachea-bronchial tree is considered life threatening and requires immediate and ongoing treatment. If left untreated, these fistulas can lead to chronic lung abscesses and deadly pneumonia. Treatment includes a number of medical procedures such as:
- Esophageal dilation. However, it is starting to become unpopular as it rarely lasts more than a few days.
- Flexible metal mesh stent. It is the most effective for maintaining the shape and structure of the esophagus.
- Plastic coated mesh stent. It can also be used to close a trachea-esophageal fistula; some are equipped with valves that prevent reflux if a fistula is found near the esophageal sphincter.
Step 4. Postoperative doctor's examination
It is very important to return to the doctor postoperatively, especially if you have an inflammatory disease such as Crohn's disease. In such cases, the fistula is only a side effect and the underlying cause needs to be addressed.
- There are other problems directly related to intestinal fistulas that the patient should be aware of and continue to monitor as well. Patients should avoid sepsis by treating any signs of infection, such as inflammation of the tissues surrounding the fistula, controlling fistula drainage, and taking good care of the skin to maintain the health of nearby tissues.
- Adequate nutrition can be achieved by providing total parenteral nutrition (intravenous) which is highly recommended for high discharge fistulas. This will prevent malnutrition.
Step 5. Take antibiotics with the doctor's permission
The use of antibiotics can help minimize the chance of infection in the fistula area, especially in enteric fistulas. An elevated white blood cell count indicates the presence of an infection that may need to be treated with appropriate antibiotics.
- Antibiotics should not be taken spontaneously unless your doctor feels the need to prescribe them; This is because the majority of fistula patients suffer from major colonic diseases/disorders, some of which are caused by irresponsible use of antibiotics.
- Antibiotics should only be considered for treating fistula infections and for relieving symptoms such as extreme pain with or without an abscess, skin irritation “redness,” and fever persisting for more than 24 hours.
- Fistulas can be treated initially with combined treatment of metronidazole and ciprofloxacin or vancomycin. Mitronidazole is taken 250-500 mg every 8 hours; Vancomycin is taken 125-250 mg every 6 hours, or three times a day one hour before meals.
Part 3 of 3: Understanding Fistula
Step 1. Know the causes and risk factors for fistulas
Most cases are associated with chronic inflammatory diseases such as Crohn's disease and tuberculosis. Other cases may be due to diverticulitis, tumors, or chronic trauma. A surgical operation or injury can lead to fistula formation as well, as in the case of biliary fistula or arteriovenous fistula.
- Recto-vaginal fistulas can also be caused by Crohn's disease, obstetric injury from childbirth, radiation therapy, or cancer.
- Fistula in children or infants is mostly a congenital disease that is more common in boys than girls.
Step 2. Recognize the signs and symptoms of a fistula
Any fistula is usually accompanied by the following symptoms:
- Persistent discharge (pus)
- Pain (related to infection)
- One or more openings
- Bleeding
- Pain in stomach
- Diarrhea
- Loss of appetite
- Weight loss
- Nausea and vomiting
Step 3. Know the different types of fistulas
A fistula, by definition, is a tubular canal with two openings: one primary opening leading to the other exterior opening called the secondary opening. Many types of fistulas are known, but 90% of all fistulas are anorectal fistulas. Physically, the forms of fistulas can be as follows:
- Dead Fistula: A connection between two surfaces; one end is closed, and the other end is open. It can develop into a complete fistula if left untreated.
- Imperfect Fistula: A joint that has only one external opening.
- Complete Fistula: A junction between an internal opening and an external opening.
- Horseshoe Fistula: A U-shaped joint, between two external openings around the anus.
Step 4. Know the complications of an anal fistula
Unfortunately, fistula symptoms are not the end of the problem - they can also lead to their own complications. These complications include:
- Secretions that cause inflammation around the anal area
- Crohn's disease
- anal canal tumor
- Radial fungus disease
- Chlamydia infection
- Exposure to severe trauma
- Cracks around the anal area
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Gastrointestinal infections
Therefore, it is highly recommended that you clean your anus properly after using the toilet, observe the rules of general safety and personal hygiene, and use a tissue after using the toilet and dispose of it immediately after each use
