Christine, your opinion please

Dear Sheppie,

Very sorry to hear of the fistula and chances are it probably does need to be surgically repaired. These conditions are not uncommon in OB and “pelvic floor” surgery populations. Here are a couple of good articles:

http://www.geocities.com/dinimerz/r...nal_fistula.htm

http://www.emedicine.com/med/topic2745.htm

Just another reason why prolapse surgery makes so little sense and human childbirth must be treated with utmost care.

I am hoping for the very best outcome for you! The posture and all the lifestyle factors we talk about here will be just as important for you after your recovery.

Wishing you well,

Christine

Hi Sheppie,

I always let the experts answer this type of question as I’m not remotely qualified to do so. I don’t know what your symptoms are either. The perineum and external anal sphincter can look perfectly intact while a fistula has formed just underneath the surface. Alternatively, the back vaginal opening can be in direct communication with the anal sphincter on the outside through a totally disrupted perineum. Here are a few quotes from the text Office Urogynecology by Linda Brubaker et al. just for educational purposes. Your colorectal surgeon will have answers to your particular questions.

“The term ‘rectovaginal fistula’ is often used to describe all fistulas in which the bowel communicates with the vagina. Technically, however, it should only be used to describe fistulas that exist anatomically between the rectum and vagina. Historically, these fistulas were classified as low, mid, or high, based on where the fistula exits in the vagina. Others have classified fistulas as simple or complex based on the size, level, and etiology. We favor a classification system based on the anatomic structures involved. Colovaginal or cologenital is the preferred term for this group of genital fistulas. Fistulas that originate below the dentate line [just inside the anus] and communicate with the vagina are anovaginal; those between the rectum and vagina are rectovaginal; those above the rectum are colovaginal; communication between the small bowel and the vagina is enterovaginal. Fistula-in-ano describes the communication between the anal canal and the perianal skin or perineum [these are usually inflammatory and result from diseases like Crohns, anal abscess, or anal fissure.]”

You do not even mention the vagina, Sheppie, so I'm wondering what your anal fistula is connecting to. I’m assuming it’s anovaginal, but it could be fistula-in-ano since you originally talked about anal fissure. This is important because if it is the inflammatory type, a different type of cell wall [granulation tissue] is built, which means they can heal on their own if the source of inflammation is removed. Other fistulas build epithelial cell walls like the inside of our gut, making them more permanent.

“Most anovaginal and rectovaginal fistulas of obstetric origin are located in the lower third of the vagina in the midline. On examination, the vaginal orifice of the fistula is typically located just inside the introitus. Fecal material may be present in the vagina, in which case an intense inflammatory reaction usually results, with profuse leukorrhea and marked erythema of adjacent tissue.”

Most colovaginal fistulas require surgical repair. However, small asymptomatic fistulas may not require repair, especially if the woman has not completed her childbearing. A low residue diet instituted preoperatively, will firm up the stool and diminish its volume, and therefore may minimize contamination of the fistulous tract.” [This does not tell us whether these types of fistulas ever heal on there own, for which I do not have the answer.]

“Uncomplicated fistulas from obstetric trauma are usually successfully managed if the basic tenets of surgical repair are followed. Successful management depends as much on thorough evaluation as it does on surgical technique. Timing of the surgical repair depends on the degree of acute inflammation surrounding the fistula, the integrity of the tissues involved, and the overall health and nutritional state of the patient.”

Hope this helps a little bit!

Christine

My heart goes out to you, Sheppie, as I had a lot of “bottom” troubles too in my youth. Here are a few suggestions until your next doctor visit:

• Hot baths with lots of Epsom salts (draws out impurities).

• A very green diet (raw, dark leafy greens chewed well.)

• Little if any meat or cheese. No matter what your diet preferences, it is a known fact that these foods slow transit time in the gut. Ground sesame and seaweed (esp. dulse) takes the place of cheese in a lot of grain and vege dishes. Trace minerals are essential to tissue healing.

• Sugar, white flour, coffee and alcohol imbalance digestion and sap vitamins and minerals. Same for artificial colors and flavors.

• Studies have shown green tea and ginger to be healing to the intestines. Steep 1 tbs. tea leaves and 1 tbs. grated fresh ginger in liter of hot water.

• Pulling up into the posture will take pressure off that area.

• Faith in your body to heal the abscess.