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Perirectal fistula during pregnancy

I am 30 years old and 15 weeks pregnant with my fourth child.  Last spring I developed a perirectal fistula due to a previous abscess.  This does not seem to be related to the birth of my third child as she was born in June 2007 and I developed the abscess in December 2007.  

In June 2008 I had the first stage of a fistulectomy, in which the surgeon placed a seton (drain) inside the fistula.  The second stage of the surgery involves the removal of the seton and the insertion of a "plug" to heal the fistula.  I became pregnant between stages 1 and 2 of the fistulectomy.  My surgeon will not perform the second stage of surgery until after I have delivered the baby, as my current condition is not dangerous but the surgery would pose risks to the baby.  

So I am pregnant, with a fistula that has a seton, and hope to have a vaginal birth, as I had with my first three children.  After the baby is born I plan to go ahead with the second stage of the fistulectomy.

Does anyone have any experience with this situation?  Any insights or advice?  What am I at risk for?  Where can I read up on this?  I can't find anything online.  Thanks a bunch.
10 Responses
Avatar universal
Can you let us know what happened in your case? I'm also 30 years old with a perianal fistula and seton. I want to have children within the next year and would like to hear more of your story!

Thanks!
Avatar universal
So...it's been a few months, and I'm 12 weeks pregnant with my first. I wanted to write a follow up for others to know about what I've learned.

1) I have Crohn's disease and a perianal fistula and 2 setons. I've had about 10 surgeries in the past 2 years to get things to settle down. The setoffs currently manage the issue well, although I do tend to have cycles of infections. Somehow, since my pregnancy I haven't required the use of antibiotics, which is interesting. I'm assuming this may be due to pregnancy lowering one's immune system, which is a good thing for those of us with Crohn's since our immune systems are generally in overdrive.

2) I have opted for a C-section. Why, you ask? Because I do not want to take the risk of having permanent fecal incontinence. It is a REAL RISK for us fistula people. Then, at my first ultrasound I found out I'm having twins! So...for me a C-section is the way to go!

If you have your heart set on a natural delivery, perhaps if this is your 2nd+ vaginal birth your body is more prepared for the stretching needed without taring? This is something you should talk to your doctor about.

3) If you are on Remicade, it does cross the placenta barrier and in a recent UCSF study it was recommended that you not have an infusion past 32 weeks. Then, the day after delivery, while in the hospital, you should be given Remicade. Even with these precautions, your baby maybe immuno-comprimized, and you should check with your pediatrician to see if any special care is needed.

I hope this helps anyone with a fistula looking to get pregnant!
Avatar universal
I know this is a little late but I am 36 weeks pregnant and was also planning a natural delivery... in fact I have invested a lot into my hypnobirthing, perineal massage and generally stayinig really fit. I was hoping for a drug free water birth, however, after the drs re-examined the notes of my fistula surgery (I was 25 at the time and had chronic constipation) they think that if I try natural and end up tearing, the risk to me is devastating resulting in my being incontinent in terms of my bladder, bowels and wind... not a problem I want at the age of 28, esp as this is my first baby! I am having an elective C section which I am very disappointed about but the end result will be the same so I just have to get over it
I hope that helps anyone in the future
559862 tn?1311520237
I am so glad someone posted about this. I ended up having a fistula after the birth of my daughter in 2009. I didn't realize what it was till a couple months after the birth and still thought my muscles just needed time to heal and strengthen. Now I'm almost 13 weeks pregnant again and finally discussed it with my doctor who referred me to a surgeon. I saw one this week who says that since its a very small fistula and not causing infections and problems to wait till after I heal up from this baby to have surgery. However, she basically recommended a c-section. I was really bummed since I had my heart on another vaginal delivery being this is our 2nd and last baby! But I would prefer having a c-section over losing control of my bowels (I already have a hard time controlling my bladder) or tearing and doing more damage! I'm just so glad I'm not the only one out there that this has happened to. I felt crazy for many months wondering why I couldn't control it when I passed gas!
Thank you ladies for posting this!
Avatar universal
Good to see so many posts related to fistula. Even I am one amongst you. I came to know recently that there is a fistula developed at my perineal region. We are actually planning for a baby in a month or so and it is our first. I am 29 years old. Could you guys please suggest me if i need to get the fistula surgery done before we plan for a baby
Avatar universal
Hi!

My advice would be to talk to your doctor(s), ie: gastroenterologist and surgeon, before trying for a baby. The response you get may depend on how your fistula is doing. Is it under control? Do you need to be on antibiotics every week or two? What antibiotics are ok during pregnancy? What are your options if you need surgery while pregnant?

I asked all these questions before trying to get pregnant, and the basic response was that you can preform surgery for a perianal fistula safely on a pregnant woman and there are certain antibiotics that wont harm the fetus. That being said, the healthier you are when you conceive, the better! And fistulas can be tricky things...causing problems suddenly and severely (at least for me). It's great to have an action plan agreed to in advance between you and your medical team.

Good luck tweety and to all those fistula ladies out there!
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