What is a fistula? - Signs and symptoms (2024)

The treatment you have for the fistula often depends on what caused it and how well you are. If the tissues around the fistula are healthy, it may be possible to have surgery to close the fistula.

If the fistula is caused by the cancer coming back, it may not be possible to have surgery. You may have other treatments, such as chemotherapyto shrink the cancer. Your doctor and nurse specialist will talk to you about treatments to help manage the symptoms.

Sometimes a fistula will close without surgery or other cancer treatments. While it is healing, it can be managed with treatment to control symptoms.

You may see different doctors. For example:

Fistulas can take weeks or months to heal. Unfortunately, some fistulas may never heal. But it is often possible to control the symptoms successfully. Your doctor or specialist nurse can discuss treatment options with you. If you are worried about your symptoms at any time, contact your doctor or specialist nurse for advice.

Surgery may only be possible if the tissue in the area around the fistula is healthy. Previous radiotherapy treatment to the area or scarring from previous surgery can affect the healing. In these situations, it may take longer to heal and sometimes it may not heal.

The type of operation depends on the areas of your body affected. You can discuss what the surgery will involve with your team of specialists. They can explain how the operation will affect you and the possible risks.

Often the surgeon will use your own body tissue to repair the fistula.

If the fistula involves part of the bowel, you may need an operation to bring an opening of the bowel onto the skin of the tummy (abdomen). This is called a stoma. The stoma is called:

• a colostomy if it uses part of the colon
• an ileostomy if it uses the small bowel.

A bag is worn over the stoma to collect bowel movements.

The stoma will be either temporary or permanent. You may have a temporary stoma to rest the bowel. This allows symptoms, such as infection and inflammation, to improve before an operation to repair the fistula. It can also allow the area to heal after surgery. Or, you may have a stoma to help control your symptoms.

Your surgeon and specialist nurse will talk to you about having a stoma if they think it would help.

If the fistula involves the urinary system, you may need a stoma to pass urine. This is called a urostomy. The urostomy may be temporary or permanent.

A small tube called a stent can be used to seal a fistula between the windpipe (trachea) and the gullet (oesophagus). You usually have a stent put in under a general anaesthetic. It can be placed in the gullet or in the windpipe, or sometimes in both.

The doctor places the stent using a scope, which is a thin, flexible tube with a light and camera at the end. They place the stent inside the gullet using an endoscope, or inside the windpipe using a bronchoscope.

The stent is folded flat when it is first inserted. As it comes out of the scope, it opens up like an umbrella. It pushes against the wall of the gullet or windpipe, sealing the hole from the fistula. The stent can stay in permanently.