Pain -and lump?- at anus. Should I be concerned?

It's still early days, and it sounds like things are still changing quite a bit. The lump might disappear slowly, depending on what it is. I do recommend you find a way to accept a proper physical exam next time, even though it's difficult.

Thank you for responding, Scott. Yeah, I need to get it checked. I'm downplaying how much it hurts. does anyone know what it could be so I can ask my surgeon specifically?  I have found my appointments are much more fruitful when I have specific questions. He is good about answering, but if I don't ask, he is usually to rushed to offer up much info. 

are there specific issues, maybe with the staples or something that I should consider?  Strictures?  I hear these terms pm but dint know how they might relate to my experience. 

From what you describe, this could be an anal abscess or anal fissure. Since it is not goinf away, you will need to be examined. You can ask the doctor to use a topical anesthetic since you already know you are tender there. Otherwise, schedule a scope with sedation.

 

It is the only way to figure out what is going on. It could be a hemorrhoid, but even that would need examination. 

 

Jan

That's how my perianal abscess started: a larger than pea size lump, right near future the anus. It continued to be more and more painful, til finally it burst.

Then I developed a fistula.

Definitely get it checked. Mine was diagnosed by MRI, which is gold standard for diagnosing them.

Thank you guys so much!  Appointment made for wednesday.  I am going to ask for an MRI. I've been downplaying how much it hurts. :-/

Theyed probably opt for a sedated exam before an MRI, but makes sense to discuss it.

 

Jan

Sorry, me again... now that you folks have enlightened me that it could be an abscess, I did a search here on the topic. oh my. Thank you for replying!

With the pain I feel, and the definite lump, I am quite worried and am wondering if Wednesday (5 days away) is too long to wait?  I would go to the ER, but I'm afraid they don't be familiar with our issues. I have a PPO insurance plan, can I just schedule my own MRI or CT?  Finally, by coincidence, I have a gynecological exam scheduled for Monday, would that provide any answers or should I reschedule that till after this is resolved?  

Just wondering what you might do in my situation. I used to be far too passive in my medical care and now want to be more proactive. 

It's hard to tell how urgent this is. Does it hurt even when not touched/disturbed? How big is it? You'll likely get better care at your Wednesday appointment than at an ER, or perhaps they could squeeze you in sooner (e.g. Monday). Very warm water soaks might give you some relief. Good luck!

I would avoid the ER unless you are in extreme pain and/or have a high fever. They'd probably send you on your way to follow up with your regular doctor. They probably would not do imaging unless there was something scary going on. Even lancing has to wait for the abscess to "ripen." Lancing too soon can just spread the infection.

 

Your GYN exam could definitely shed some light on the diagnosis. Still, a CT or MRI is not the first thing they do, unless you have other unusual symptoms. A simple anal abscess is fairly evident on visual and manual exam. 

 

So, no, I don't think that 5 days is too long to wait. But be sure to call for an earlier appointment if you get escalating pain or high fever.

 

Jan

The gold standard for dx of fistulas is MRI over exploratories, but both can yield conclusive results if the EUA is completed by a good surgeon.

It sounds like what happened to me after take down. Mine continued to get worse and it was a fistula. I would call your dr and see if you can get in just to be safe because a fistula is not fun. 2 years later I'm still dealing with mine. If you have any questions you can message me!

Guess I'm talking more fistula vs beginning abscess when I talk about MRI.

Believe me, if it's what I had/have:  perianal fistulas HURT. I told my GI, I'm an ICU nurse, and I see serious, serious problems people have, and if prior to getting this any of them complained like I do about my "tiny" problem, I'd think them nuts. But wow. They really hurt. It's RIGHT THERE, in a very sensitive place.

Pretty hot sitz baths got mine to finally drain, but I ended up in the percentage that developed a fistula after. I'm trucking pretty ok now, with my meds and my seton. Since my last seton placement at the end of February, I've had zero pain, which is marvelous.

Hi all,

my surgeon was good enough to squeeze me into his schedule today. It's an infection. he gave me both cipro and flagyl and I will go back on Wednesday to see if that's helping. I hurt so much right now and am having a tougher time maintaining continence. 

All of your input has really made a difference for me - in knowing a little bit about what I'm talking about and in getting the attention I need. I was concerned about this weeks ago and should have been more vocal then. Thank you for helping me be vocal now. I hope the antibiotics help!

Abx did absolutely nothing for my abscess, because these kinds if infections are walled off and difficult to treat/for the med to get there. I hope you have better luck, though... keep us posted!  And contact if you ever need to talk.

Yeah, antibiotics won't heal an abscess, but can help keep it localized and heal any local cellulitis.

 

Watch for fever and increasing pain. Hot sitz baths should help get this to improve.

 

Jan

Thank you all again. I have been reading all the other posts about abscesses people have experienced. It seems that, yes, no one has posted that antibiotics alone took care of things, nor is there ever just a simple resolution . :-/. a little good news?  Antibiotics seems to have helped my frequency!  I am 8 weeks out and have been going 15 times a day, but surgeon was not suspecting pouchitis, just thinking my body was slow to adapt. So I am really glad that this got me some antibiotics to address that; though I'm bummed that maybe if we had addressed it initially, I wouldn't have formed an abscess?

 

Anyway... Can you give just a little more feedback On what I am understanding?

it seems that all abscesses should be surgically drained because they won't clear on their own, and ones that drain in their own might not empty fully or have a large enough opening to heal from the inside out?  

What is the procedure like?  Very painful afterward?  Necessary drain tubes?  Does this leave a big scar?  

 

When do they determine if it's a fistula, should there be an MRI before any other procedure Or is it determined at the time (I plan to be under so wonder if I could wake to surprises). 

thats enough questions for now. Thank you!

It is a matter of timing in regard to what happen when. Hot soaks help hasten the "ripening" process, where the abscess is walled off and the infection is in a pocket that can be drained. If it comes to the surface, breaks open, and drsins on its own, you need to keep up the soaks in order to keep it open and draining. surgical incision is mot always necessary. It just depends on how large and/or deep it is. You also do not want it to sit without drainage too long, or it can lead to a fistula. Generally, it is after some time (weeks or months) without progress that a fistula is suspected. 

 

I am not sure if antibiotics at an earlier time would have prevented this. Maybe, but impossible to know. People who never had rectal surgery get these.

 

Jan