Can you have pin-prick sized fistulas?

[juljul]

Hi,
Does anyone think it is possible to have a pin-prick sized fistula, as you sometimes get with a bicycle tire. When I am flaring with my "backside" and gut, I pass gas vaginally. After sigmoidoscopy I passed a stream of continuous gas that way and what seemed to be the remnants of my sigmoid - water (enema prep) and left over bits. Otherwise I only pass gas not stool thankfully. I also pass gas urethrally when I am flaring badly and when I have a UTI. Can there be some other explanation other than pin-prick fistulas? The gas spots vaginally on the CT scan were small - could be suggestive of a pin-prick sized fistula, could it not, if there is such a thing?The radiologist said they are too small to suggest a fistula. But why did I pass all the gas used to pump up my sigmoid vaginally after sigmoisoscopy?

Does anyone think an anorectal ultrasound would be the best way to look for one in the anus or rectum. What about to the bladder - how would they go about finding one?

Not diagnosed as yet.

Thanks for your input.

juljul xx

 

[Grumbletum]

Hi juljul, and a big warm welcome to the forum Sorry to hear you are having issues with your health. In short, yes you can get tiny microperforations or fistulae. Some people have had them show up in surgery, having had no evidence of them seen in scans.
I have to say that the passing and evidence of gas, and the fact that it sounds like you are having repeated UTIs sounds like you possibly do have one, either to the vagina or bladder. I had one from my TI to my bladder, and it showed up most clearly in an MRI scan. There are also tests of the bladder such as a cystogram.
Have you seen your GI since you had the CT?

 

[bozzylozzy]

Hi juljul. Welcome to the forum

Ive not had issues with fistulas myself.. but I dont see why it cant be tiny. After all they have to start small to get bigger if you know what I mean?

It may be worthwhile posting in the extra manifestations or the female/gynae will section? You might get some more responses regarding this issue

 

[juljul]

Hi bozzylozzy and Helen,
Thanks for your warm welcome...
Thanks Helen, I have seen a GI doc since my CT scan and had a water soluble enema. I have since found out from one study that the barium enema is only bout 34% sensitive so I assume the water soluble enema to be similar. You can't find a tiny puncture in a tire without inflating the tire - hence the challenge here I guess is what I am thinking. Was yours then bigger than a pin-prick sized one Helen? The GI doctor discharged me admitting some kind of defeat really but she is a brand new consultant and my case is way too complex I think because I have got many other things going on at the same time. Anyway, I have got a referral to a (more experienced I hope) GI doc/colorectal surgeon so I am keeping optimism.

Thanks Bozzylozzy - have not been down the gynaecological route yet but I know I ought to...have had many abnormal smears off and on over the years - perhaps explained by gas coming from my bowel? I know what my GP will say if I ask for a referral - wait. They always do - is why it has taken two years to get a rheumatologist referral lol. At least I know I have auto-immune disease now of some sort (got (rapidly) diagnosed with UCTD (sky high ANA...leaning towards Lupus (+ve antidsDNA). I know auto-immune diseases tend to cluster unfortunately; I don't know if the connective tissue disease is causing my bowel issues yet.

juljul xx

 

[xmdmom]

I'm no expert but...there is a dye test that could be helpful in identifying a rectovaginal fistula.

http://www.mayoclinic.com/health/rectovaginal-fistula/DS01065/DSECTION=tests-and-diagnosis
Blue dye test. This test involves placing a tampon into your vagina, then injecting blue dye into your rectum. Blue staining on the tampon shows the presence of a fistula.

 

[juljul]

Thanks xmdmom,
It sounds like a good idea. I think they would have to inflate me with gas though with that because I think mine is like a very small tire puncture. Like it is difficult to find a small tire puncture without inflating the tire. It is small enough not to bother me except when flaring when it seems to become evident lol. I might but methylene blue from the Internet and try the basic tampon test myself though... you never know

 

[Grumbletum]

Do you know, I never asked them how big it was. It gave me a lot of bother though - constant UTIs and lots of pelvic pain, plus as abscess on my bladder. It healed for a while, but opened again six months after I stopped Infliximab and rather than just gas like previously, I was passing fecal matter through it ( sorry if that's TMI )

 

[bigtruck]

I have a wound in my groin that occasionally passes gas, and discharges a creamy matter with no smell to it at all, it dries up for around a week then erupts again, it has never passed faecal matter or anything that resembles it, various ct and MRI scans can identify it, I am now on 6mp 100mg to try and heal it? My surgeon thinks its coming from active disease in the upper rectum but still no concrete evidence, it really is getting me so distressed worrying about it.

 

[juljul]

Hi Grumbletum and bigtruck,
Grumbletum - you have got me worried now...its not TMI, don't worry, thanks for your input.
Bigtruck....keep hope for closure of your fistula and try not to worry because worry = more stress and more inflammation. You could ask for an anorectal ultrasound because not sure but I thought AU can show bowel wall thickening, which would suggest past inflammation...and might also show active inflammation.

 

[bigtruck]

Just had a call from radiographer ct scan on thurs morn.

 

[juljul]

Good luck with your CT scan bigtruck..i hope you get some explanation.

 

[Grumbletum]

Hi Grumbletum and bigtruck,
Grumbletum - you have got me worried now...its not TMI, don't worry, thanks for your input.
Bigtruck....keep hope for closure of your fistula and try not to worry because worry = more stress and more inflammation. You could ask for an anorectal ultrasound because not sure but I thought AU can show bowel wall thickening, which would suggest past inflammation...and might also show active inflammation.

Sorry, juljul. Didn't mean to scare you. Just wanted to check if you had other, similar symptoms. I think your best bet is to see if they will give you an MRI.

 

[misunderstood]

Hate to give bad news. With my RVF, I begged the doctors to do the dye test. The closest thing I got was a Ct Scan with contrast that the tech screwed up and shot the dye into my muscle and then they wouldn't re-do the test. The only way my fistula was found was by a urologist doing vaginoscopy. That would sound like a happy ending but after I fought and fought for surgery the colorectal doctor missed the fistula. He removed a lot of damaged colon so there is no more soft watery feces falling out of my vagina. But occasionally, I still get some things coming out of the v. and know the fistula is still there.

I live in New York and would advocate for anyone going thru this FIGHT and would ask anyone to advocate for me. I think I am about 75% better but it is still there. This is after my lifelong fight with doctors who never listened to what my real problems were.

One thing we need to point out to doctors is that in other countries they seem to be handling this problem better than American doctors are doing.

 

[juljul]

Hi misunderstood,
I am sorry you are suffering. I am not sorted either, and had clueless Drs for two years until now. You are not alone. There are many more out there too with fistulas or suspected fistulas. Don't give up hope and keep praying because God does hear your prayers and will not abandon you. I'll keep you in my prayers inshallah. If you can get to Egypt you might be able to get sorted there, and at a fraction of the cost of the US. If you are dependent on insurance then that is something else. Keep fighting. Be assertive. Above all, stay strong and positive and don't let it get you down.

I never got listened to either. I told my GP many years ago about suspecting a fistula. Was not believed so I gave up. Two years ago I had to see Drs again because I was in agony by then. Still not sorted and back to square one re:investigations, but keeping hope.

Believe me, many UK doctors are clueless. The undiagnosed club here is testament to that.

May you feel peace inshallah.
xx

 

[misunderstood]

Thank you. I don't know how people would get thru all this without this board.

 

[DustyKat]

Although I have never experienced this exact situation my son did have an intra-abdominal fistula and abscess. the fistula was only very small and the result of a microperforaton. It was never big enough the be visualised by CT imaging alone. It was only able to be confirmed when the abscess was drained and then a sinogram performed, they injected dye through the drain to see if it tracked back up to the bowel, it did.

Good luck! I hope you get answers soon. :hug:

Dusty. xxx

 

[bigtruck]

Had dye injected into my abdominal wound today and it tracks to the sigmoid colon.

 

[juljul]

Thank you dustykat :kiss:
Good luck with your investigations and remedial solutions bigtruck, and misunderstood, and everyone going through this scenario. :ghug:
God be with us and our loved ones, inshallah, ameen (amen).....
juljul xx