Can Ulcerative Colitis Cause Fistulas?

Can ulcerative colitis cause fistulas?

Fistulas occur in about 3% of people with UC, according to Crohn’s & Colitis UK. They’re more common in people with Crohn’s disease.

In people with UC, fistulas are most common in those who’ve had ileoanal pouch anastomosis. This is a type of surgery that involves removing the large intestine and replacing it with a pouch so that a person can continue to pass stool as before.

According to a 2023 study, it’s the inflammation UC causes that increases the risk of a fistula. The UC itself isn’t the direct cause.

What types of fistulas can?ulcerative colitis?cause?

Older research has suggested that the most common area for a person with UC to develop a fistula is in the anorectal region. A fistula here connects the rectum to the anus. Newer research has backed up these findings.

Other possible types of fistulas that more commonly affect people with Crohn’s disease but are possible in those with UC include:

• rectovaginal fistulas, connecting the vagina to the rectum
• other anal or perianal fistulas that connect the anal canal or rectum to the surface of the skin near the anus
• fistulas connecting the bowel to the bladder
• bowel-to-skin fistulas in the abdominal area (typically after surgery)
• bowel-to-bowel fistulas that connect different parts of the gut

Ulcerative colitis fistula symptoms

The symptoms of a fistula in UC depend on the location of the fistula and the parts of your body it connects.

For example, you may experience stool passing from your large intestine through the fistula and out of your body (rather than through the anus) or into another organ.

Other possible symptoms include:

• swelling or a lump in the area around the anus
• pain or irritation in the area of the fistula, especially during a bowel movement
• passing gas (flatulence)
• urinary tract infections
• diarrhea
• unexplained weight loss
• abdominal pain
• dehydration
• fever

What does fistula pain feel like?

The sensations you experience may vary by the type of fistula you have.

For an anorectal fistula, for example, you may experience a persistent throbbing pain that may get worse when you sit, move around, cough, or have a bowel movement.

When to get medical help

If you have UC, it’s recommended to contact your doctor any time you have symptoms of a fistula. Your doctor can run tests to determine where it’s located and begin treatment.

Although not common, a fistula can lead to sepsis, which can potentially be life threatening.

Medical emergency

Sepsis is a medical emergency that can sometimes lead to organ failure. Go to the nearest emergency room if you experience:

• high temperature or fever, chills and shivering, or a low body temperature
• mottled or discolored skin
• lack of urination for a day or longer
• fast heartbeat or fast breathing
• sudden changes in your mental state
• slurred speech

How do doctors diagnose a fistula?

A doctor will likely start by:

• taking your full medical history
• asking about your symptoms
• performing a physical exam, which may include:
  • checking for openings in the skin
  • listening to your abdomen
  • checking for signs of pain, inflammation, and infection
  • feeling inside the rectum for any anomalies
  • viewing inside the anus and rectum using procedures like anoscopy, proctoscopy, or endoscopy

If your doctor suspects a fistula, they’ll likely order imaging tests to confirm the diagnosis. Imaging tests may include:

• ultrasound, CT, MRI, or X-ray scans to create images of the large intestine
• fistulography, in which a doctor injects a chemical into the fistula to provide clearer images on an X-ray

How are fistulas treated in someone with ulcerative colitis?

You can manage fistulas with bowel rest, medications, and surgical procedures. Treatment depends on the type of fistula you have and your existing UC treatment plan.

You’ll likely continue your UC treatment, as a UC flare-up can worsen a fistula. However, if your UC treatment includes steroid medications, your doctor may ask you to stop. Steroids can increase your chance of developing an infection or abscess, which is a risk factor for sepsis.

Treatment for anorectal fistulas includes:

• medications, such as:
  • antibiotics, like metronidazole (Acea, Anabact, Flagyl, others) and ciprofloxacin (Ciproxin, Ciloxan, Cetraxal), to treat infection
  • biologics, like infliximab (Remicade, others), adalimumab (Humira, others), ustekinumab (Stelara), or vedolizumab (Entyvio), to reduce inflammation and help close fistulas
  • others, like ciclosporin tacrolimus, azathioprine (Imuran), methotrexate (Jylamvo, more), or thalidomide (Contergan, others)
• surgery to drain an abscess, if needed, and close the fistula, such as:
  • fistulotomy, where a surgeon cuts the fistula lengthwise and flattens it
  • advancement flap surgery, in cases of complex fistulas, to cover the internal opening of the fistula
  • ligation of the intersphinteric fistula tract, in instances where the sphincter muscle is in the way
  • video-assisted anal fistula treatment, a telescopic procedure where a surgeon seals the fistula using an electric current, stitches, or a special glue

As with any surgery, fistula surgeries have certain risks, including:

• infection
• recurrence of fistulas
• loss of bowel control

Speak with your doctor about the best treatment for you.

Takeaway

Although uncommon, UC can cause a fistula. This most commonly occurs in or near your rectum or anus.

If you have symptoms of a fistula, contact your doctor for prompt diagnosis and treatment.