Crohn’s Disease Fistula: Causes, Types, Symptoms, & Treatment

When I first got diagnosed with Crohn’s, I thought the worst parts would be cramping and frequent bathroom trips. But then I kept seeing the word “fistula” pop up in forums and medical websites and I realized there was a whole other side to this disease I hadn’t even begun to unpack.

To be totally honest, I’ve never had a fistula myself. But I’ve read a lot about them, and I’ve talked to other folks in the IBD community who’ve had to deal with them head-on. It’s one of those things you hope never happens, but knowing what it is can really take the fear factor down.

Let’s walk through what a Crohn’s fistula actually is, how it forms, what symptoms you might notice, and how people treat and manage them (from meds to surgery to lifestyle shifts). Along the way, I’ll share how the holistic gut-healing tools I built into GutMellow still support overall healing, even when fistulas are part of the picture.

A Crohn’s fistula is basically a tunnel your body creates where it’s not supposed to. It forms when inflammation and ulceration in the intestines erode through the intestinal wall and create an abnormal connection, often between the intestine and another part of the body.

This connection could be between two sections of bowel, between bowel and bladder, bowel and skin, or even bowel and the vagina. It’s your body’s very dysfunctional way of trying to deal with chronic inflammation.

It’s one of the more intense complications of Crohn’s, and though I’ve been fortunate not to experience it myself, I’ve come across many stories in support groups that show just how disruptive and painful it can be.

Here’s a quick rundown of the types people most commonly talk about:

Perianal fistulas – These form near the anus and can cause pain, drainage, and swelling. They’re common and particularly frustrating to manage.

Enteroenteric fistulas – These connect two different parts of the intestine. Sometimes they cause no symptoms at all, but they can mess with digestion and absorption.

Enterocutaneous fistulas – These connect the intestine to the skin. You might see stool or pus draining through the abdominal wall. It’s rare, but when it happens, it’s a big deal.

Enterovesical fistulas – These go from the intestine to the bladder, leading to recurring UTIs, air in the urine, or even stool in the urine.

Enterovaginal fistulas – These can cause discharge or infections due to a connection between the bowel and the vagina.

The symptoms depend a lot on where the fistula is. Perianal fistulas can cause pain, itching, or drainage. Bladder-related ones can make urination painful. And skin fistulas can have visible discharge that’s hard to miss.

Diagnosis often involves a mix of:

• Physical exam

• Imaging (MRI is a big one for perianal fistulas)

• Endoscopy

• Sometimes, dye tests or ultrasounds

For anyone with Crohn’s, keeping an eye on strange new symptoms, especially drainage, recurring infections, or pain in unusual places, is key.

I’ve never personally dealt with a fistula, but I’ve seen how frustrating treatment can be. Sometimes medications are enough. Other times, surgery is needed. A lot of the time, it’s both.

Medication

Biologics like infliximab (Remicade) and adalimumab (Humira) have shown promise in helping heal fistulas. Antibiotics and immune system suppressants are also used.

Surgical Approaches

For more complex cases, procedures like seton placement, fistulotomy, or flap surgeries may be necessary. Surgery helps drain the area, reduce infection risk, and sometimes close the fistula completely.

Emerging Options

Stem cell therapy is making headlines. It’s still new in a lot of places, but it’s being used more in Europe and starting to gain traction in the US. For people who haven’t found success with meds or surgery, it’s something to keep an eye on.

Even though I haven’t had a fistula myself, I know what it’s like to feel betrayed by your body. That sense of unpredictability and embarrassment that comes with Crohn’s can be heavy. Fistulas just amplify all of that.

Some folks I know have found relief by adjusting their lifestyle. Less about curing the fistula itself and more about making daily life feel less like a minefield. Things like:

• Sitting on cushions to reduce pressure

• Keeping the area clean and dry

• Wearing loose, breathable clothes

What’s helped me most overall has been the gut-healing diet and lifestyle I lay out in the GutMellow Remission Roadmap. It doesn’t target fistulas directly, but by focusing on lowering inflammation and healing the gut lining, I believe it gives the body a better shot at overall recovery, fistulas included.

There’s no guaranteed way to prevent fistulas, but staying in remission helps. That means managing inflammation, sticking to a gut-friendly diet, and keeping stress low. (Easier said than done, I know.)

I’ve built my whole approach to Crohn’s around calming the gut and giving it the best environment to heal, through food, rest, low-tox living, and key supplements. I share it all inside GutMellow, because it’s what finally gave me results after years of trial and error.

If you’re dealing with a fistula right now or worried about developing one, it’s okay to be scared. It’s okay to be tired. It’s okay to be mad at your body. Crohn’s doesn’t fight fair. But you’re not broken, and you’re definitely not alone.

While I haven’t had a fistula myself, I’ve fought my own version of the Crohn’s battle. And I’ve learned that when it comes to healing, knowledge is power. The more we understand about what’s happening in our bodies, the more clarity and confidence we can find, even in the hard parts.

If you're looking for a grounded, natural way to support your gut through all of this, check out what I put together at GutMellow. Whether you’re deep in flare-up mode or managing chronic complications, it's built to help you simplify, calm inflammation, and find your footing again.

After a decade of trial and error, I finally found a combination of strategies that actually worked. I went from constant flare-ups to long-term remission, without biologics or surgery. I created GutMellow to share my experience and help others navigate their own healing journey.

The GutMellow Remission Roadmap includes everything I wish I had when I was first diagnosed. It’s a comprehensive resource that outlines the exact steps I took to regain control of my gut health, including:

This blog is for informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. While I am sharing my personal experience, every individual’s health journey is unique. Always consult with a qualified healthcare professional before making any changes to your diet, supplements, medications, or lifestyle. Healing is a personal journey, and what worked for me may not work for everyone.