Non treatment of fistulas
- Thread starter Mattie
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I have had a fistula draining from my surgical wound on my stomach since april. My surgeon and gastro team are letting it heal on its own and it had been healing amazingly until last week when it started draining again. I can't have anymore surgery for a year because of the surgeries I've had recently and they don't think meds will do anything for it as its not a Crohn's related fistula (it appeared because I had a leak at my anastomosis site.)
So yeah, I'm seriously hoping this closes up on its own!
I guess other types of fistulas can't be left to their own devices, I had fistulas to my bladder and rectum which were surgically removed, they were making me really unwell.
So yeah, I'm seriously hoping this closes up on its own!
I guess other types of fistulas can't be left to their own devices, I had fistulas to my bladder and rectum which were surgically removed, they were making me really unwell.
PsychoJane
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Crohn fistulas that resolve on their own are rather rare... Since most of CD fistulae relates to inflammation, they generally won't resolve on their own and need medical or surgical approach to be taken care of. Bowel to bowel fistula can be left without treatment on occasion if the digestion is not compromised by it (ie fluids that would be too shortcuted from a part of a digestive system to another). Otherwise, if it is enterovesical,-cutaneaous or peri-anal fistula, they will generally be treated medically or mechanically/surgically.
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Thanks for the replies. I have a perianal fistula, and probably more than one, for which my Consultant is recommending a seton. I just feel rather queasy at the whole idea of it. I'm always someone who prefers to leave well enough alone and have read a number of stories of things not working out as planned. It drains and is painful but maybe rather this than incontinence? I shall have to make a decision soon though, but currently am thinking I shall leave it as it is unless it gets worse. Is this sensible?
I had fistulas, but didn't have any type of surgical interventions to try to deal with them. Instead I was put on Remicade, which cleared them up pretty darned quickly!
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I considered not treating mine (but I don’t have Crohn’s, so take what I say with a grain of salt)...my fistula drained only a yellowish discharge (as opposed to fecal material) and only occasionally gave me any pain. And I had never had any surgery, apart from wisdom teeth removal, and the idea of having surgery terrified me. However, once I started researching the problem, I decided it was worthwhile to try to repair it. Much of what I found advocated treating the fistula, because if left untreated, recurrent abscesses are likely, and these recurring abscesses can create complex tracts that become very difficult to treat. In short, not treating them can make the problem way worse.
From the American Society of Colon and Rectal Surgeons:
If left untreated, the external opening may temporarily close with a resultant recurrent abscess formation or formation of a more complex fistula. These complex fistulas often traverse deep to the external sphincter making operative repair more hazardous. Additionally, long-standing fistulas have a low but real risk of malignant transformation.
http://www.fascrs.org/physicians/education/core_subjects/2004/anal_fistula/
So I (reluctantly) chose to have it treated. I’m just out of surgery number 2, so I don’t know what the final outcome will be for me.
Good Luck in whatever decision you make!
From the American Society of Colon and Rectal Surgeons:
If left untreated, the external opening may temporarily close with a resultant recurrent abscess formation or formation of a more complex fistula. These complex fistulas often traverse deep to the external sphincter making operative repair more hazardous. Additionally, long-standing fistulas have a low but real risk of malignant transformation.
http://www.fascrs.org/physicians/education/core_subjects/2004/anal_fistula/
So I (reluctantly) chose to have it treated. I’m just out of surgery number 2, so I don’t know what the final outcome will be for me.
Good Luck in whatever decision you make!
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A regular seton ( non cutting) is just a plastic string through the existing track that stops your fistula from closing so it can drain. It does not involve cutting the muscle and should not be a danger for incontinence. Were they talking about laying it open or a cutting seton? That can be differant
Hi Mattie,
I also am a patient of Prof Hunter's. I had a peri-anal fistula just before being diagnosed with crohn's.
I had surgery to put a draining seton in the fistula straight away. The surgery itself is really nothing to be frightened of, it was really quite easy.
Soon after I discovered Prof Hunter and went on the elemental diet, and it was during this time that my seton was tightened up so that it became a cutting seton. I found this part quite painful I have to say, and my crohn's started to flare up again during this time. I'm not sure if it was a reaction to the cutting process, or the pain, or the fact I had stopped taking antibiotics about a week before. However, about a week after that I was seton free, the fistula tract had closed, and I have had no problems with the fistula since, and two years have gone by. All in all, from having the initial surgery until the tract closing up was a period of 3 months. I did mention that the crohns flared up when the seton was tightened, and it took a month for things to settle back down. Every case is different of course, but since your crohn's seems to be in such a solid remission, I don't see why the surgery shouldn't be successful for you also...
I also am a patient of Prof Hunter's. I had a peri-anal fistula just before being diagnosed with crohn's.
I had surgery to put a draining seton in the fistula straight away. The surgery itself is really nothing to be frightened of, it was really quite easy.
Soon after I discovered Prof Hunter and went on the elemental diet, and it was during this time that my seton was tightened up so that it became a cutting seton. I found this part quite painful I have to say, and my crohn's started to flare up again during this time. I'm not sure if it was a reaction to the cutting process, or the pain, or the fact I had stopped taking antibiotics about a week before. However, about a week after that I was seton free, the fistula tract had closed, and I have had no problems with the fistula since, and two years have gone by. All in all, from having the initial surgery until the tract closing up was a period of 3 months. I did mention that the crohns flared up when the seton was tightened, and it took a month for things to settle back down. Every case is different of course, but since your crohn's seems to be in such a solid remission, I don't see why the surgery shouldn't be successful for you also...
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Hi Helena
It's good to meet a fellow patient of Professor Hunter! I've had a perianal fistula for about two years now, but seeing that my Crohns is confined to my bottom it's not surprising. I have no Crohns symptoms at all - no diarrhoea, no cramping and none of the symptoms we all know and love so well. Provided I keep to my diet that is! If I don't I get full blown Crohns - so I keep to my diet.
But the fistula abscessed a couple of months ago which was painful to say the least. The Prof recommended an MRI and a seton if the MRI suggested it. But when I saw him after taking Augmentin for a week, he declared the fistula quiescent. We did a deal and I have agreed to have an MRI and possible seton if I get another abscess, so fingers crossed on that!
It's good to hear about successful treatment of fistulas though as there seem to be a lot of people who have to have repeat treatment for them, so thanks for that!
It's good to meet a fellow patient of Professor Hunter! I've had a perianal fistula for about two years now, but seeing that my Crohns is confined to my bottom it's not surprising. I have no Crohns symptoms at all - no diarrhoea, no cramping and none of the symptoms we all know and love so well. Provided I keep to my diet that is! If I don't I get full blown Crohns - so I keep to my diet.
But the fistula abscessed a couple of months ago which was painful to say the least. The Prof recommended an MRI and a seton if the MRI suggested it. But when I saw him after taking Augmentin for a week, he declared the fistula quiescent. We did a deal and I have agreed to have an MRI and possible seton if I get another abscess, so fingers crossed on that!
It's good to hear about successful treatment of fistulas though as there seem to be a lot of people who have to have repeat treatment for them, so thanks for that!
I had a fistula that I ignored for about 3 years, and then finally sought treatment when it got really bad. I wish that I had gone to the doctors to get it surgically fixed sooner, as it would have saved years of pain and other issues.
If getting treated is an option, I would go for it.
If getting treated is an option, I would go for it.
