In medicine, a fistula is an abnormal channel that creates an open passageway between two bodily structures that do not normally connect.
Fistulae can occur in the gastrointestinal tract. Fistuale of the rectal area are often the result of chronic infection, or diseases like Crohn's disease or ulcerative colitis.
Treatment for fistulae varies depending on the cause and extent of the fistula, but often involves surgical intervention combined with antibiotic therapy. Typically the first step in treating a fistula is an examination by a doctor to determine the extend and "path" that the fistula takes through the tissue. Surgery is often required to assure adequate drainage of the fistula (so that pus may escape without forming an abcess). Various surgical procedures are commonly used, most commonly fistulotomy, placement of a seton (a cord that is passed through the path of the fistula to keep it open for draining), or an endorectal flap procedure (where healthy tissue is pulled over the internal side of the fistula to keep feces or other material from reinfecting the channel). Surgery for anorectal fistulae is not without side effects, including recurrence, reinfection, and incontinence.
It is important to note that surgical treatment of a fistula without diagnosis or management of the underlying condition, if any, is not recommended. For example, surgical treatment of fistulae in Crohn's disease can be effective, but if the Crohn's disease itself is not treated, the rate of recurrence of fistula is very high (well above 50%).