It’s hard to predict whether an abscess will “point” (make an opening to the surface), but without that they can be real trouble. The best home remedy I’m aware of is hot soaks: as hot as you can do without burning yourself, as long as you can put up with. If a few days of this don’t seem to be changing anything then perhaps you’re stuck with medical intervention, perhaps after stalling a while, if it seems stable. But hot soaks are tried and true, and sometimes help surprisingly deep infections drain.

Thanks for your reply Scott! How long and how often would you recommend I do a sitz bath? And is epson salt good or irritating and how much?

Since the alternative may be invasive, I’d spend plenty of time on this - perhaps as much as you can stand. Heck, read a book. I usually run out of patience when soaking a boil way before the value stops. The hardest part is keeping the water hot. I wouldn’t bother with Epsom salts for this purpose.

Ok. Thanks!

As I never had serious complications for 28 years, I do not have a colorectal surgeon...I know now that I should find one but in the short term I may not be an option to seek treatment from one...

If it comes to needing a surgery to have the abscess drained - and it likely will - can it be done in ER? 

I would reserve ERs for actual emergencies. You certainly won’t get to pick your ER doc as having the best skills for the problem at hand. Do you have any doctor you can discuss this with, and perhaps get a referral from?

Just got back from urgent care and was diagnosed with anorectal fistula. The Dr. could actually feel the fistula track and said it seemed stable. He ordered a colon and rectal surgery referral - and imagery. I started feeling the fistula track 3 weeks ago but had such mild pain that - like I said before - I dismissed it for something that would go away soon...Although not making it sound like its an emergency, Doctor said he wish I had come sooner, so I'm a bit worried over that...Now that I know what the problem is, I got tons of Q's. Can I continue working and are there things I should be avoiding doing while waiting for the surgery? What down time/recovery period should I expect post-surgery? Meantime, Doc prescribed antibiotics, would that really do anything? 

Fistulas can be a serious issue, but surgery often isn’t the best course. Hopefully the surgeon you see will consider a variety of options, including perhaps a draining seton. Unless you are disabled you can work. The antibiotics may not help much, but they might help a little. Good luck!

Thanks Scott!

So along with the fistula there's the abscess - I've been describing - that's been causing the pain as of late. It now seems that its closer to the skin, so hopefully it will point. I don't expect I will get to see a colorectal surgeon for at least a week or two at best then it could take at least another 2 or 3 weeks for the surgery to happen if warranted - (can't make an appointment until offices opens tomorrow)...I do plan on taking antibiotics and do Sitz baths in the meantime, but given the presence of a fistula, how long can the infection be left untreated? I fear greater complications and possible worst case scenarios of infections if nothing is done soon. I'm I too worried? What else can I do?

The abscess and the fistula are likely part of the same process. Fistulae often go through cycles of draining and getting clogged up. When they are clogged they will swell, hurt, and pretty much act like an abscess. Then the “abscess” drains, and may keep draining a bit until the opening clogs up again. A draining seton keeps it open all the time.

This may not be your situation, but it’s worth Knowing about.

Scott, the pain related to that fistula is completely gone along with - most of - the bump - abscess. But it never pointed - bursted - on the skin/bun side...Could it have just dried out on the inside? Is that typical? I can still feel a small bump but it used to be at least 1" if not 2" wide before it shrank. I can also still feel the fistula track which shouldn't go away on its own. Correct? Can I live with a fistulae without a surgery?

I have an appointment with a colorectal surgeon in a couple of days. So I'll know more but wanted to see if anyone has had the same experience and if anybody is living with a fistulae without having had a surgery performed.

Each fistula is different. If it isn’t giving you trouble then it’s very unlikely that surgery is a good idea. Even if it is giving you trouble, surgery often doesn’t help and sometimes makes things worse. 

So what are the non-surgical options to help living with a fistula?

URGENT CARE diagnosed you with a fistula by feel? seems odd. usually they need to scope you or do an MRI to diagnose I thought. Sure you don't have an internal hemrhoid , especially if it comes and goes

Omg. I had experience with peri-anal abscesses/fistulas. They made my life hell but I believe I always had some rectal issues going on since day number one with my J pouch. I hope it is something else because your body doesn’t recognize fistula tracts as foreign so they don’t heal per se. This makes them hard to get rid of. Or maybe yours is superficial so it won’t lead to horrible problems. My tracts kept abscessing which led to both painful abscesses and painful procedures to cut the abscesses open. Setons were put in to keep the fistula tracts (I had two) open. I despised the setons but I know some people live with them for years with no problem. I will keep my fingers crossed that this is just a bump in the road (or butt) for you!! If you are really curious, you can google the different ways they try to tackle fistulas. It might be better to just wait and see what your diagnosis is before you cause yourself unneeded stress. The abscesses from my fistulas were super painful/unlivable so I hope something else is going on. I remember bringing a beach lounge chair into work b/c I couldn’t sit in a regular chair until I got the abscess drained. Luckily I work night shift. Crazy times!!

Thanks everyone for you feedback! Pouchomarx, it does seems odd I feed that the physician could diagnose a tract by feel but I can tell myself that something hard like a track is happening down there...But I’d sure prefer it to just be a hémorroïdes...

LORI726, I’m sorry you had- and perhaps still have- to deal with fistulaes and abscesses. I heard of Fibrin Glue injection - or other plug treatment - that’s not invasive and proven to work somehow. I sure hope that a seton isn’t my only option but will find out soon...

@TONY LAVICTOIRE posted:

Thanks everyone for you feedback! Pouchomarx, it does seems odd I feed that the physician could diagnose a tract by feel but I can tell myself that something hard like a track is happening down there...But I’d sure prefer it to just be a hémorroïdes...

LORI726, I’m sorry you had- and perhaps still have- to deal with fistulaes and abscesses. I heard of Fibrin Glue injection - or other plug treatment - that’s not invasive and proven to work somehow. I sure hope that a seton isn’t my only option but will find out soon...

With my first pouch I had a leak at the tip of the jpouch. My GI, Dr Bo Shen at Cleveland Clinic tried an experimental procedure with fibrin glue to close the leak but it failed. I eventually had to have a pouch redo as I had other issues as well.

for whatever it's worth, sitz baths are fine but if you have a true fistula it can be life threatening.  i have three setons to drain active fistulae, and after the second seton i was so tired of being cut up that i decided to see if i could muscle through the pain.  took 2 days to go to ER.  the morning of the 2d day, my perenium had swollen to the size of ping pong balls.  i had sepsis and had to be hospitalized for 4 days on all kinds of nofun iv drugs.  i don't mess around with them anymore.