How to stop a fistula from leaking? Understanding treatment and management

October 1, 2025 •

5 min read

According to studies, spontaneous closure is less likely for many fistulas, especially complex ones. Managing the leakage is a critical part of treatment, but the key to addressing the issue of how to stop a fistula from leaking involves targeted medical interventions.

Quick Summary

Management options for fistula leakage range from surgical procedures like fistulotomy and seton placement to conservative care involving proper wound dressings, advanced skin protection, and dietary adjustments.

Key Points

Consult a Specialist: Leakage requires evaluation by a colorectal surgeon or gastroenterologist to determine the type and severity of the fistula.
Surgical Repair: Definitive treatment for most fistulas involves surgery, with options ranging from simple fistulotomy to complex procedures like LIFT or seton placement.
Advanced Wound Care: Use specialized systems like ostomy bags or absorbent dressings to contain drainage and protect the surrounding skin from irritation.
Protect the Skin: Apply barrier creams, powders, or wafers to shield delicate perifistular skin from digestive enzymes and moisture.
Manage Bowel Movements: Maintain a high-fiber diet and stay hydrated to prevent constipation and straining, which can worsen anal fistulas.
Practice Good Hygiene: Use sitz baths, gentle cleaning, and absorbent pads to keep the affected area clean, dry, and comfortable throughout the day.
Follow a Medical Plan: Medical management, including antibiotics or specific drugs like octreotide, may be used to control infection and reduce drainage, as directed by a healthcare provider.

A fistula is an abnormal, hollow tract or passage that connects two epithelial-lined organs or vessels that do not normally connect. The leakage is drainage from this tract, which can consist of pus, stool, or other bodily fluids depending on the fistula's location. While leakage is a common symptom, it poses significant hygiene challenges, risk of infection, and skin breakdown. The approach to managing and stopping the leakage is determined by the fistula's location, complexity, and underlying cause, necessitating a comprehensive medical strategy.

Understanding the Cause of Fistula Leakage

Why Fistulas Leak

Fistula leakage occurs because the abnormal tract provides a pathway for fluids to escape from their normal containment. In the case of an anal fistula, drainage is typically a mix of pus, blood, and stool. For an enterocutaneous fistula, which connects the gut to the skin, the leakage is intestinal effluent. The characteristics and volume of the drainage are crucial for guiding treatment.

Low-output fistulas: These produce less than 200 ml of drainage per day and may be managed more conservatively.
High-output fistulas: These produce a greater volume and often require more intensive management, such as nutritional support and specific medications to reduce gastrointestinal secretions.

Surgical and Medical Interventions

Surgical Options for Closing a Fistula

For many types of fistulas, especially anal fistulas, surgical intervention is necessary for a permanent solution as they rarely heal on their own. The type of surgery depends on the fistula's location and whether it involves important structures like the anal sphincter muscles.

Fistulotomy: The most common and effective procedure for simple anal fistulas. The surgeon cuts along the entire length of the tract, scrapes out infected tissue, and allows it to heal as a flat scar.
Seton Placement: For complex fistulas involving a significant portion of the sphincter muscle, a surgeon may place a seton, a thin surgical thread or cord, into the tract. This keeps it open to drain infection and heal gradually, often in multiple stages.
LIFT Procedure (Ligation of the Intersphincteric Fistula Tract): Designed for deep fistulas, this technique involves accessing the tract between the sphincter muscles to tie it off and seal it, avoiding muscle damage.
Fibrin Glue or Bioprosthetic Plug: This non-cutting, non-surgical approach involves injecting a biological glue or inserting a plug made of animal tissue to seal the fistula tract. While less effective than fistulotomy for simple cases, it is a useful option for complex fistulas.
Endorectal Advancement Flap: Used for complex fistulas, this involves removing the internal opening and covering the area with a flap of healthy tissue from the rectum.

Medical Management to Control Leakage

Medications are often used in conjunction with other therapies to control symptoms and address underlying issues.

Antibiotics: Prescribed to manage infections associated with the fistula and prevent sepsis.
Anti-diarrheals: For high-output fistulas, medications like loperamide can help reduce the volume of drainage by slowing bowel movements.
Octreotide: A somatostatin analog that can inhibit gastrointestinal hormones and decrease fistula output, especially for high-output enteric fistulas.
Anti-inflammatory drugs: For fistulas related to conditions like Crohn's disease, medications such as Infliximab may help heal the fistula by reducing inflammation.

Advanced Wound and Skin Care

How to Protect Skin from Drainage

Protecting the skin around the fistula opening (perifistular skin) is paramount. Constant exposure to enzymes and fluid in the drainage can cause significant irritation, maceration, and breakdown.

Wound Management Systems:

Pouching: For high-output fistulas, a custom ostomy bag or wound manager system can be applied to collect the effluent and protect the surrounding skin. These systems can be connected to a drainage bag for easier management.
Barriers: Skin barrier powders, wafers, and protective films are essential for creating a secure seal and protecting skin, especially when it is wet or irritated.

Protective Creams and Dressings:

Zinc Oxide Creams: These waterproof and protect the skin from corrosive drainage, but need frequent reapplication.
Absorbent Dressings: Simple, non-woven gauze pads or maxi pads can absorb low-level drainage and should be changed regularly to keep the area clean and dry.

Home and Lifestyle Strategies

Daily Care and Hygiene

Proper hygiene is critical for preventing infection and managing comfort, especially for anal fistulas.

Sitz Baths: Soaking in warm water for 15-20 minutes, especially after a bowel movement, can cleanse the area, reduce swelling, and soothe pain.
Gentle Cleaning: Use mild, unscented soap and water to wash the area. Avoid harsh scrubbing and pat the area dry gently with a soft cloth or gauze. A handheld fan can also be used to keep the area dry.
Absorbent Pads: Use gauze or leak-proof underwear to absorb minor drainage and prevent it from soiling clothes and irritating the skin.

Dietary Adjustments for Bowel Management

For fistulas related to the gastrointestinal tract, diet plays a major role in managing leakage.

Increase Fiber and Fluids: A high-fiber diet with plenty of water helps prevent constipation and straining during bowel movements, which can put pressure on the fistula.
Foods to include: Fruits, vegetables, whole grains, and lean proteins are beneficial..
Avoid Irritants: Spicy foods, excessive caffeine, and alcohol can exacerbate symptoms and should be avoided.

Comparison Table: Surgical vs. Non-Surgical Treatment


Feature	Surgical Treatments	Non-Surgical Treatments
Efficacy	Often curative for many fistulas; high success rates depend on the procedure.	Primarily for symptom control and preparing for surgery; may be curative for some simple cases.
Invasiveness	Varies from minimally invasive (LIFT, Laser) to more extensive depending on complexity.	Non-invasive externally (dressings, baths) but may involve minimally invasive internal procedures like glue injection.
Recovery Time	Varies significantly (e.g., 1-2 weeks for fistulotomy, longer for complex cases).	Ongoing, as treatment focuses on managing symptoms and protecting the skin until definitive closure is possible.
Associated Risks	Fecal incontinence (especially if sphincter muscles are involved), infection, recurrence.	Skin breakdown, persistent infection, discomfort.

The Role of a Multidisciplinary Care Team

Managing fistula leakage effectively often requires a team approach, including a surgeon, a wound care specialist, a dietitian, and other medical professionals. This ensures that the patient receives coordinated care, from optimal surgical planning to personalized wound care and nutritional support.

Conclusion

Stopping a fistula from leaking is not a one-size-fits-all problem; it requires a tailored treatment plan based on the fistula's specific characteristics and location. While surgical procedures offer the best chance for a definitive cure, non-surgical methods and diligent wound care are vital for managing symptoms and preventing complications. A collaborative approach involving a specialist healthcare team is crucial for achieving the best possible outcome and restoring the patient's quality of life. For further authoritative information on fistula management, consider consulting resources such as the National Institutes of Health (NIH) website.

Frequently Asked Questions

Most fistulas, especially anal ones, do not heal on their own and require medical intervention to close. While some simple fistulas might spontaneously close, this is generally followed by recurrence. A persistent or recurring leak is a sign that medical treatment is necessary.

The best dressing depends on the amount of leakage. For high-output fistulas, an ostomy bag or a wound management pouching system is often necessary to contain the effluent and protect the skin. For low-output fistulas, non-woven gauze with a skin barrier cream can be used to absorb drainage and protect the surrounding area.

A high-fiber diet rich in fruits, vegetables, and whole grains, along with plenty of fluids, can help soften stools and prevent constipation, which reduces strain on the fistula. Avoiding spicy foods, excessive caffeine, and alcohol is also recommended.

Use skin barrier products, such as zinc oxide cream or pectin-based powders and wafers, to create a protective layer over the skin around the fistula opening. This helps prevent skin breakdown and maceration caused by the drainage.

For most fistulas, especially complex ones, surgery is the most effective and often the only way to achieve a permanent cure. While non-surgical methods like fibrin glue or conservative management can help control leakage, they may have lower long-term success rates.

A seton is a piece of surgical thread placed in the fistula tract to keep it open and facilitate drainage. It allows the tract to heal from the inside out, managing infection and controlled leakage over a period of weeks or months while preserving the sphincter muscle.

You should contact a doctor if you notice an increase in the volume or pus in the leakage, or if you experience pain, redness, swelling, or fever. Changes in the quality of the 'thrill' or pulse in a dialysis fistula also require immediate medical attention.