If you or someone close to you has been diagnosed with Crohn’s disease, you may have heard the word “fistula” from your doctor. It can sound alarming. But understanding what it means — and why it happens — can make a big difference in how you manage it.
At Kaizen Fistula Care, Pune’s dedicated fistula treatment centre, we see many patients with fistulas in Crohn’s disease. Our team, led by Dr. Samrat Jankar, has performed over 5,000 successful fistula surgeries. In this blog, we explain everything you need to know — in simple language.
What Is a Fistula in Crohn's Disease?
A fistula is an abnormal tunnel or passage. It forms between the intestine and another organ — or between the intestine and the skin.
Fistula in Crohn’s disease is very common. Studies show that around 30 to 35 percent of Crohn’s patients will develop a fistula at some point in their lifetime. In some cases, a fistula from Crohn’s disease can even appear before the disease itself is formally diagnosed.
Fistulas are not just a physical problem. They cause pain, drainage, and significant emotional stress. The good news is — they are treatable.
A Quick Note on Crohn's Disease
Crohn’s disease is a type of inflammatory bowel disease (IBD). It can affect any part of the gut — from the mouth all the way to the anus. What makes Crohn’s different is that the inflammation goes through the full thickness of the bowel wall. This is called transmural inflammation. This deep, full-thickness inflammation is the main reason fistulas in Crohn’s disease develop.
Crohn’s disease has three main behaviour patterns:
- Inflammatory
- Stricturing (narrowing of the bowel)
- Penetrating — this is where fistulas develop
How Does Crohn's Disease Cause a Fistula?
This is the most important question. Let us explain it step by step.
- Step 1 — Deep ulcers form. Crohn’s inflammation creates deep sores (ulcers) on the inner wall of the intestine. Unlike normal ulcers, these go very deep.
- Step 2 — The ulcer tunnels through. As inflammation continues, the ulcer pushes through all the layers of the bowel wall. It creates a small tunnel called a sinus tract.
- Step 3 — An abscess forms. The tunnel gets infected and fills with pus. This is called an abscess.
- Step 4 — The abscess ruptures. When the abscess bursts — either on its own or during a procedure — it creates a pathway. That pathway becomes a fistula.
- Step 5 — The gut microbiota sustains it. Bacteria in the gut enter the fistula tract and keep the inflammation going. This is one reason fistulas do not heal easily on their own.
There is also a biological process called epithelial-to-mesenchymal transition (EMT). In simple terms, the cells that should form a barrier in the gut instead start behaving like invasive cells. This breaks down the gut lining and allows the fistula to persist.
This is why fistula with Crohn’s disease is harder to treat than a simple fistula not related to IBD.
Types of Fistulas in Crohn's Disease
Fistulas in Crohn’s disease can form in different locations. Here are the main types:
- Perianal Fistula — The most common type. It connects the rectum to the skin near the anus. Symptoms include pain, swelling, and discharge of pus or stool.
- Bowel-to-Bladder Fistula — Connects the bowel to the bladder. Causes recurrent urinary infections and cloudy urine.
- Bowel-to-Skin Fistula — Opens on the abdominal skin. Intestinal content drains from the surface.
- Bowel-to-Vagina Fistula — Connects the bowel to the vagina. Causes gas or stool to pass through the vagina.
- Bowel-to-Bowel Fistula — Two intestinal loops become connected abnormally, causing malabsorption.
At Kaizen Fistula Care, Dr. Samrat Jankar evaluates every patient individually to determine the exact fistula type before recommending treatment.
Who Is at Risk?
Not every Crohn’s patient will develop a fistula. But certain factors increase the chance:
- Location of disease — Rectal involvement raises perianal fistula risk to 92%. In isolated small bowel disease, the risk is only 12%.
- Untreated abscesses — An abscess not treated in time often turns into a fistula.
- Long-standing disease — Poorly controlled Crohn’s significantly raises the risk of fistulas and Crohn’s complications.
Symptoms and Diagnosis
Signs of fistula with Crohn’s disease vary by type. Common symptoms include:
- Painful lump or swelling near the anus
- Continuous discharge of pus, blood, or stool
- Recurrent urinary infections
- Gas or stool passing through the vagina
How is it diagnosed?
- MRI Pelvis — gold standard for perianal fistulas
- Endoscopic Ultrasound (EUS) — detailed imaging of the tract
- CT Enterography (CTE) — maps the extent of Crohn’s alongside the fistula
- Examination Under Anaesthesia (EUA) — essential for complex perianal cases
At Kaizen Fistula Care, advanced diagnostics are used before any treatment decision is taken.
Treatment Options for Fistula in Crohn's Disease
Treatment of fistula Crohn’s disease usually combines medicines with surgery. Not every fistula needs an operation — but all need attention.
Medical Treatment
- Antibiotics (metronidazole, ciprofloxacin) reduce infection and drainage
- Immunomodulators like azathioprine and 6-MP are used alongside biologics
- Biologic therapies — infliximab, adalimumab, vedolizumab, ustekinumab — around 75% of patients show benefit
Surgical Treatment
- Seton placement — a thread is passed through the fistula to drain infection. Often the first step.
- Fistulotomy — the tract is cut open so it heals from inside out
- LIFT procedure — the tract is tied between the sphincter muscles, preserving function
- FiLaC (Fistula-tract Laser Closure) — minimally invasive laser treatment to seal the fistula
- VAAFT and Fistula Plug — additional sphincter-preserving options for complex tracts
Kaizen Fistula Care in Pune offers all of these procedures under one roof. Dr. Samrat Jankar is a highly experienced Fistula Specialist in Pune, India, treating both simple and complex fistulas in Crohn’s disease with modern, minimally invasive techniques.
Living with Fistulas and Crohn's Disease
Managing fistulas in Crohn’s disease goes beyond surgery. Daily life needs adjustment too.
Keep the area clean and dry. Follow all wound care instructions. Eat a nutritious diet to support gut healing. Attend every follow-up appointment without skipping. The emotional impact of fistulas and Crohn’s is real. Many patients feel embarrassed or isolated. Do not suffer in silence. At Kaizen Fistula Care Clinic in Pune, the team ensures patients receive not just physical treatment but full emotional support through every step of their journey.
Can Fistulas Be Prevented?
Fistulas cannot always be prevented. But the risk can be reduced:
- Start Crohn’s treatment early and remain consistent
- Do not ignore perianal pain — treat abscesses before they become fistulas
- Stay regular with biologic or immunomodulator therapy as prescribed
- Attend all gastroenterology reviews to monitor your disease activity
Conclusion
Fistulas in Crohn’s disease are a serious but manageable complication. Understanding how they form — from deep inflammation to abscess to tract — helps you take the right steps early. Whether you are newly diagnosed or have been dealing with fistula with Crohn’s disease for years, the right specialist can make all the difference.
Kaizen Fistula Care, led by Dr. Samrat Jankar, is one of India’s most trusted centres for fistula treatment. With over 5,000 surgeries performed and a full range of minimally invasive options, the team is equipped to handle every type of fistula from Crohn’s disease — from simple perianal tracts to complex internal fistulas. If you are looking for a Fistula Specialist in Pune, India, do not wait. Early treatment leads to better outcomes.
- Kaizen Fistula Care Clinic Contact No – 9763635252 | 7558423708
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