What is a fistula?

Written by: Professor Richard Cohen
Published: | Updated: 18/09/2019
Edited by: Bronwen Griffiths

The word ‘fistula’ refers to a channel between two parts of the body, and the Latin root for the word actually means ‘pipe’ or ‘flute’. You can develop fistulas in different parts of the body, but they will often form from an abscess that has not healed properly. Professor Richard Cohen is an experienced colorectal surgeon with particular expertise in treating fistulas, and here he provides a quick summary about them.

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What is a fistula and are there different types?

A fistula is an abnormal connection between two areas in the body. They can occur in different parts of the body:

  • An anal fistula is an abnormal connection between the inside of the anal canal and the skin next to the anus
  • A rectal fistula is an abnormal connection between the rectum and the skin
  • A recto-vaginal fistula is an abnormal connection between the anus/rectum and the vagina

These connections are like “mini tunnels” between the two parts of the body. The “tunnels” can vary in size and, indeed, the larger the “tunnel” the worse the patient symptoms.

How serious is a fistula?

A fistula is not inherently dangerous but they can give rise to unpleasant symptoms, such as discharge and pain.

Is a fistula a sign of cancer?

No. Fortunately, malignant (cancerous) change in a fistula track is vanishingly rare.

What are the different types of fistula?

As described above, the fistula can be classified according to the parts of the body they connect. They are also classified according to their exact anatomical location in relation to the anal sphincter complex.

The simplest classification is into “simple” and “complex” fistula. The former is easy to treat and the latter can be extremely difficult to treat.

Can a fistula be cured?

A fistula can normally be cured, but it is the consequence of the cure process that your surgeon will discuss with you in detail.

I have studied anal and recto-vaginal fistula for my entire consultant career and have seen many new and clever techniques for treatment with minimal adverse consequences proposed and developed. Each treatment has its own potential chance of success and its own potential for adverse consequences.

Your surgeon will guide you through the choices and come up with a plan for your particular fistula.

The more complex fistula may require more than one operation to deal with them.

Some fistulas are associated with an underlying disease of the local tissues, such as Crohn’s disease. These require a multidisciplinary approach with a gastroenterologist and surgeon working together for the added benefit to the patient.

Read more: Anal fistula surgery

By Professor Richard Cohen
Colorectal surgery

Professor Richard Cohen is a leading colorectal and general surgeon based at the Cleveland Clinic in London. He is an expert on open and minimally-invasive laparoscopic colorectal surgery, colorectal cancer, and irritable bowel disease (IBD). Currently, Professor Cohen serves as a clinical professor of surgery, consultant surgeon, and honorary senior lecturer at University College London (UCL). He is renowned as a pioneer of introducing new techniques in the United Kingdom. 

After receiving his medical qualification from Combridge with distinction in 1987, Professor Cohen continued his training as a surgery registrar in Northwest England, and later as a senior registrar at Guy's and St Thomas' Hospital surgical training programme. Whilst undergoing his training, Professor Cohen also accomplished to carry out research at Yale University, USA, for his Master's thesis.

Professor Cohen joined UCL in 2005, where he has since helped to develop the colorectal service. Here and within his private practices, Professor Cohen maintains his expertise in open and minimally invasive colorectal surgery. Beyond his advanced surgery techniques, he focuses on colorectal cancer, benign colorectal disease, and management of ulcerative colitis, Crohn's disease, and IBD. He is a leading example for his practice fellows and other surgeons in his field.

Following his expertise in such subject, Professor Cohen continues to do research on topics of interest. These include pelvic floor disorders (incontinence and constipation), Crohn's disease, and colorectal cancer in Ashkenasi Jews. Research has persisted to be a passion of his, and subsequently he has had many papers published in peer-reviewed journals. Professor Cohen extends his involvement in colorectal surgery by also training young surgeons and lecturing nationally and internationally.

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