What is a fistula?
A fistulotomy is a surgical procedure used to treat a fistula. A fistula occurs when two of your organs or vessels form an abnormal connection. These organs or vessels would otherwise not be connected.
Fistulas may be found in the:
- urinary tract
- intestines, which is known as enteroenteral fistula
Fistulas in the urinary tract occur when an abnormal connection forms from the urinary tract to another organ. These can include:
- vesicovaginal fistula, which forms when there’s a hole between the vagina and the bladder
- urethrovaginal fistula, which is formed when a hole develops between the vagina and urethra
Anal fistulas occur when your perianal skin, the skin around the opening of your anus, forms an abnormal connection with the surface of the anal canal. Anal fistulas may include:
- anorectal fistula, which forms between your anal canal and the skin surrounding your anal opening
- rectovaginal fistula, which occurs when a hole develops between the vagina and the rectum
- colovaginal fistula, when a connection forms between the vagina and the colon
What to expect during a fistulotomy
A fistulotomy is an outpatient procedure, meaning it likely won’t require an overnight hospital stay, performed to open a fistula. The actual procedure takes about an hour. You’ll also want to plan for additional time before and after the procedure.
If your fistula is small and shallow, your doctor may be able to perform the procedure in their office using local anesthesia. If the fistula is large, you may need to go to a hospital and have general anesthetic.
During the fistulotomy, your doctor will make an incision in your body to open up the abnormal connection between the two organs. This could potentially cause some complications following the surgery, including:
- bowel incontinence, if the anus or rectum is involved
- bleeding at the site
- abscess or recurrence of the fistula
This procedure differs from a fistulectomy. During a fistulectomy, the fistula is completely removed.
Your doctor will send you home with instructions to keep the wound clean and packed with gauze. Packing it with gauze will help prevent your skin from healing over the wound, which could cause another fistula to form. The wound needs to heal from the inside out. Your doctor will explain how to care for your wound, but feel free to ask any questions. Good home care will improve your recovery.
You’ll want to rest for the first 24 hours after the procedure, though you should resume your normal diet following the surgery. Ask family members or friends to help you out around the house, and plan to take at least a day off of work. You should avoid strenuous activities, including exercise and heavy lifting, for at least five to seven days. Your doctor may recommend waiting longer to resume all of your normal activities. Always follow your doctor’s recommendations.
You may have some cramping and nausea immediately following the procedure. You may also experience constipation as a side effect of your pain medications. If you experience this, talk to your doctor about using a stool softener, which can help you resume normal bowel function.
It may take 3-12 weeks to fully recover from a fistulotomy.
Is this procedure the only way to treat a fistula?
When you visit your doctor before the procedure, they’ll review your symptoms and perform a physical exam. If you’re experiencing severe pain and drainage near the area of the fistula, it may be a sign that you have an infection.
For anal-rectal fistulas, your doctor may use a scope called a sigmoidoscope to do an internal examination of the fistula. This will help your doctor determine the actual location and cause of the fistula. If your doctor finds that your fistula is caused by Crohn’s disease, surgery may not be necessary. You may be able to treat the fistula with medication instead.
Your doctor may also use any of the following diagnostic procedures to help determine a course of treatment:
- Endoscopic ultrasound: This ultrasound creates images of your pelvic floor and sphincter muscles to help your doctor identify the location of the fistula.
- Fistulography: For this procedure, a contrast solution is injected into the fistula and then an X-ray is taken of the area.
- Anoscopy: Your doctor may use this procedure to view your anal canal.
- MRI: This may help your doctor locate the fistula if it’s difficult to access during a physical exam.
- Fistula probe: Your doctor may insert this instrument into the fistula.
- CT scan: This procedure may allow your doctor to observe the flow of contrast dye between two areas of your body that shouldn’t be connected.
Questions to ask your doctor
Before having a fistulotomy, ask your doctor about alternative ways to treat and heal your fistula. You should also ask:
- If your fistulotomy requires local or general anesthesia.
- If you can eat anything before the procedure and, if not, how long before the procedure you’ll need to fast.
- About any side effects or complications you may expect following the fistulotomy.
- How long your doctor expects your recovery to last, and when you’ll be able to return to work and other activities, including exercise.
- About proper post-procedure wound care, and its duration.
- About pain management.
A fistulotomy is a surgical procedure, so it’s important to get as much information about it from your doctor as possible. Consider bringing a family member or friend to your appointment, especially if they’ll be helping you during your recovery. You may want to have someone else take notes during the appointment so you can focus on your conversation with the doctor. If you can’t find someone to come to your appointment with you, remember to bring a notebook so that you can write down any important information.
Your fistula may develop again after the procedure, and you may experience incontinence as a complication if the anus or rectum are involved. The long-term success rate of a fistulotomy is 92 to 97 percent.
Depending on the cause of your fistula, this procedure may not be the best treatment for you. Share all of your symptoms and health history with your doctor to help them make an informed diagnosis and treatment plan.
How soon after a fistulotomy can I resume sexual intercourse?
The answer depends on the type of intercourse you’re having. If you’re male and not having receptive anal intercourse, you may resume sexual activity as soon as you feel comfortable. If you’re a male who participates in receptive anal intercourse and had an anal fistula repair, refrain from intercourse for at least six weeks. Likewise, if you’re female and had a repair involving the vagina or rectum, you should refrain from vaginal or anal intercourse, depending on the location of the fistula, for at least six weeks. If you’re having significant pain, especially during intercourse, or any other problems after six weeks, consult your doctor before engaging in sex.Graham Rogers, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.