I'm a male who's had a j-pouch due to uc for around 4 years now, everythings been good until a month or so ago when I thought I had a pile.

After some careful manouvering and adjustments of a mirror and light today I was able to have a closer inspection at my back passage and what I see appears to be a small red blemish (half the size of a pea and very slightly raised) just off to the side of my sphincter. The skin around the lump appears to be indented too. It feels very tender and sore and the pain levels fluctuate with it.

After doing some further reading it seems that all the symptoms of a fistula fit the bill. The only thing I don't have is discharge of any kind or anything that appears to be an opening.

I just wondered if there was always discharge with a fistula? I'm thinking perhaps the fistula has just not developed fully yet and its only a matter of time before it breaks through my skin?

I'm off to the docs asap next week, but was just hoping for an answer to my question, as the prospect of this being a serious complication for me and my pouch is weighing heavy on my mind right now!


Thanks for your time.

hey, well a little red painful bump could be other things too, but maybe it is a fistula that is not broken through...dont freak out tho!...i have a small fistula and it doesnt really bother me much. it's so small that nothing really drains through it and it doesnt really hurt now that it is formed- it's just there. i wear a little bandage over it that always falls off (annoying!) but it really doesnt drain enough that i have to worry about it. some people have fistulas that drain a lot and cause problems but not everyone. i guess mine is not only small but it also starts at the bottom of the rectum and goes upwards- so i guess it is hard for stool to travel up it and gravity is on my side. the only crappy thing is that i have to take remicade to prevent any more from forming. remicade can also help to heal fistulas so you might be able to get on some medicine that will get rid of yours (if it is in fact a fistula). im hoping mine will still heal up cuz i have not been on remicade too long. an mri should show what is going on in there...
good luck!

It sounds like a perianal abscess to me. These rarely develope into a fistula. Hot soaks in the bath really help. In the meantime I would make an appointment to see your doctor for a proper assesment.

Good luck.

Shell

Thanks for the replies niki and shell.

I just got back from my visit to the gp, explained my symptoms and specifically told him of the small hard tube/chord like structure/mass I could feel coming from the lump towards my anus.

He examined the area quite thoroughly as well as inserted his finger. He came to the conclusion that it was not a fistula, but instead was what appeared to be some scarring that had become tender. We both agreed that there was not and had not been any discharge from the lump to date.

I know I'm no dr but I just have a "gut" feeling that it's not as simple as scar tissue making itself known. It just doesnt seem right that scar tissue would rear its ugly head 4 years after step 3 of 3 (takedown) took place? I was not happy with his diagnosis and insisted he inspect it further, so he called the GP up who deals with surgeries within the clinic and I went off to see him.

He also examined me quite thoroughly as I discussed the things I had felt from examining myself, and he agreed there was some hard mass around and below the lump, but it was not a tract typical from fistulas. He said it was some fibrous matter like scar tissue.

So after all this they had both concluded it was scar tissue and would not do anything further for now. I still felt that there was more to it than just scar tissue so I tried hard with them to push forward my consultation with my pouch drs at st marks hospital, but they insisted that at this moment it was not urgent enough and that if it did start to present itself as a fistula then I could ring up and get an appointment the same day.

I do still feel that it would be best/safest for me to just get an appointment with them asap. After all, peace of mind is the best medicine and prevention is better than cure.

So for now I just have to put up with the discomfort, soreness, itching and strange feeling when sitting, breaking wind or passing stool.

My consultation at st marks is in the first week of august, which was originally to discuss the pouchoscopy I had that showed ulcerations in my pouch (DISCUSSED HERE) So it looks like I’m just going to have to hold on till then for what I consider to be proper and more thorough answers.

I was hoping some of you may be able to cast your opinions on this as it would be great to hear others thoughts on the whole matter.


Thanks for reading!

I've had plenty of experience with perianal abscesses and your symptoms still sound like mine did. If I'm right it will get worse before it gets better and may even erupt on it's own, but it would be better to get it lanced and drained by a doctor if it is indeed an abscess.

My advice about the hot soaks in the bath still stands as not only does this feel soothing it will also help to bring the abscess to a head if that's what it is (a bit like the old wives remedy of putting a hot poultice on a boil).

Even if it is an abscess it won't be deemed an emergency unless it starts to give you a lot of pain or gets considerably bigger which is probably why your GP isn't overly concerned. You could always ring your surgeon's secretary at St Marks to ask to speak to him if you are still worried. Or if it gets really bad then present yourself at A&E.

Hope you get some relief and peace of mind soon.

Take care.

Shell