Does this sound like a fistula? TMI!

Long time no see (if anyone remembers me?)

It's been a fairly quiet time IBD wise, but since around the beginning of the year, I've had some symptoms creeping back in (previously in complete remission during pregnancy and first year after my daughter was born). Some urgency, mucous, unformed stools (not all at the same time) yet I'm going ^less^ often than is usual for me and spending easily half an hour on the toilet at a time due to the cramping.

Colonoscopy didn't reveal much, but after an A and E visit for severe abdo pain they did a faecal calprotectin test which showed inflammation, so they increased my meds (aza and pentasa).

Anyway, on and off I have been noticing that after a poo, when I wipe from the front, it looks like the odd smear of poo is coming from my vagina. I've been trying to convince myself that it's just appearing that way due to the way I wipe or something, but examining the tissue it definitely looks like poo in the middle of regular vaginal discharge. It doesn't happen every time I go, but when it does, it's after a mucousy or loose bm.

I don't have any other symptoms that are indicative of a fistula- no wind coming from down there or an unusual smell or anything like that. The only other thing worth mentioning is that I suffer from recurrent vaginal thrush, I've been to the doctor about that, so just finished an intensive treatment and it's too early to tell if that's done the trick or not.

Does this sound like anyone else's experience of a fistula? If I went to the doctors with it, what would they be likely to do?

Hi Rebecca
Could be a rectovaginal fistula. I have one that is massive & get poo pouring out of mine. Yours must be fairly tiny if you are only getting a smear. I too get recurring thrush from it. Your options are to get a seton drain, try infliximab to close it, or as I had recently advancement flap surgery (that failed). Or you can just do nothing if it is not giving you too much grief and draining by itself.
I've lived with mine for about 12 years & it hasn't always given me so much trouble.
Good luck with it all. X

The recurring thrush on top of your other concerns makes me suspicious.

It's nice to see you posting again. Sorry it is for this.
Sadly it really does sound like one. It can be hard to talk to docs about it and some just have no clue. I had mine for 7 years before it was identified as one. My OB told me that it was normal to have some of that after childbirth... sigh.

My surgeon officially found it during an eua (examination under anesthesia) and seton placement for a different fistula. He placed a seton in it but took it back out a couple months later because it was not causing amy issues the seton could help with. There was not abscessing or anything and it was draining fine. The seton is there to keep it draining so it does not abscess.

As MrsW said there are a couple surgical options but you really need to be careful. They do not have a good success rate with crohns patients and when they fail the fistula openings can get much larger. My surgeon told me that it there was absolutely no crohns activity there it might be possible to try it - but he would send me to a specialized surgical center I think it was in Washington. He said it was the only place he would trust. It really said something to me that he told me he did not have the experience to pull it off. He has been a colo-rectal surgeon for 30+ years.

I am sorry that you are dealing with this. If you ever want to talk about it offline feel free to pm me.

Well, I've emailed my IBD nurse to let her know what's going on, and ask her whether she wants me to see my GP or make an appointment with gastro. It's Sunday here now, so it will be tomorrow at the earliest before I get a reply, I'll keep you guys updated.

Hi Rebecca; sailorluna

sorry to hear this. I read a similar story on another forum - can't recall which one, sorry. The OP said she quickly got her bowel under control, then treated herself very successfully with a small syringe which she filled with a boiled water (cooled) and strained minced garlic solution, slowly administering the solution through the fistula opening twice a day until the opening was healed. She said it stung but garlic is so highly antibacterial that it worked. And saved her sex life. Could be worth a try.

I was a walking thrush factory when on high doses of prednisone and got sick of buying Cane$ten. I got a jar of cold pressed, chemical-free coconut oil. At bed time I would scoop a half tsp of the solid oil (aka butter), roll with fingers and insert it as you would a tampon. You have be quick: insert, then get legs up for 15mins or so.

All the best

Well, I had an appointment with my consultant to discuss it. He doesn't seem to think thrush could be linked to a fistula even if I did have one, and thinks it's more likely thrush is a side effect of azathioprine. He does think a fistula is a possibility based on what I told him though. He did an abdo exam, and it was pretty sore. So he's ordered a full abdo/pelvic MRI to see what is happening inside, seeing as the colonoscopy didn't show much but I might have small bowel involvement as I did on diagnosis.

Forgot to say- if the MRI shows nothing, he'll refer my to a gynaecologist to investigate the thrush.

And another thing- I saw on the notice board there's a study available at my hospital for a new treatment (plug) for fistula. So if I did have one I think I'd look into the study in more detail.

Rebecca85 said:

Well, I had an appointment with my consultant to discuss it. He doesn't seem to think thrush could be linked to a fistula even if I did have one, and thinks it's more likely thrush is a side effect of azathioprine.

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Really? A LOT of women with rectovaginal fistulas have horrible thrush because of the fecal bacteria. Still, I'm glad he is checking into it. I really hope you don't have a fistula!

EDIT: I should have said vaginosis, rather than thrush. EEK! My bad!

Well that's what I thought! I mean, we're told to wipe front to back to avoid spreading bacteria. But dr said thrush is fungal so couldn't be caused by faecal bacteria.

Rebecca85 said:

Well that's what I thought! I mean, we're told to wipe front to back to avoid spreading bacteria. But dr said thrush is fungal so couldn't be caused by faecal bacteria.

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My understanding is that anything that disrupts the natural balance of bacteria, pH,etc., in the vagina can cause thrush, so it makes sense to me!!

Good point about the pH/balance. I mean I've always been prone to thrush and am guaranteed to get it if I take anti bs, I also get it with most types of sanitary protection, but these last few months I just keep getting it for no apparent reason.

No matter what the cause, I know you are miserable! Hopefully there will be an explanation soon and maybe even a quick fix.

p.s. It's nice to see you around again!

Quick update- had pelvic/abdo MRI, showed nothing of note Crohn's wise, just some highlighting in the rectum which is probably scarring as a colonoscopy back in April was clear in that area.

However, my cervix was 'bulky' so my consultant wants me to see a gynae doc. I just need to see my GP before they'll do the referral. I'm presuming they want to do an internal examination as they made me an appointment specifically with a female doctor. So wish me luck! Especially as I think I've got thrush again This is at least the 2nd bout since posting in Sept. When I see the gynae I'll discuss the thrush with them too.