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S
So my butt has been hurting since late October. In early November I went to the ER because pain was so bad. They did a CT scan and found a perianal abscess.

Went to surgery and they drained it. They didn't put a drain in and said the wound would just close on its own.

So 2 months later I'm still having pain and there is about a centimeter of the wound that hasn't healed yet. Went back to surgeon couple weeks ago and they stabbed what felt like a giant q tip up the incision. It doesn't "communicate" with my pouch or rectum.

The surgeon said I could have crohns because it isn't healing but I don't think I have crohns because I had a full workup done less than a year ago with biopsy and blood work (was a bad case of pouchitis) Everything came back negative on Crohns and I don't have any other symptoms.

So I'm confused if I now have a fistula? From my understanding a fistula is created by the body but what it seems to me is that the incision just hasn't healed up up all the way.

How do they diagnose it as a fistula and if that's what is how is it treated?

My symptoms are very local to where the abscess and incision are and it stings like a motha when I go to the bathroom.

Is the pain from puss build up or poop getting into the open wound? I wouldn't think that area is very conducive for a wound to heal especially going to the bathroom 7 or 8 times a day.

Can anyone share their experience with me? I really don't want it to be crohns. I already have had to deal with UC and was diagnosed with Celiac a few years ago. crohns would be the last straw!

Is it normal for an abscess to take this long to heal up? Is there any topical cream I could use like neosporin or something?

Any advice would be appreciated. Bummed out right now.

Scott

Replies sorted oldest to newest

Jan DollarJan DollarModerator, RN, retired
The pain is generally from the buildup of pus and/or inflammation of the surrounding tissues from the pressure.

You actually do not want this healing too soon. The idea is to keep it open and draining while it heals from the inside out. Hot sitz baths help with the process. Topical ointments would likely just make things worse. The time this takes to heal depends on how deep it is and how good your circulation is.

Jan Smiler
Jan Dollar
S srthomas21Member
Thanks for the replies.

BarbieG- I am on Cipro and Flagyl together. Also had a course of Leviquin

Jan- can this take months to heal? What bugs me is the surgeon is saying I might have Crohns based solely on the fact that it hasn't healed yet. (been about 2 1/2 months)

I have been taking sitz baths but just hot water no minerals. Should I be adding minerals?
S
Jan DollarJan DollarModerator, RN, retired
It is the moist heat that does the job. Epsom salts are nice, but they really don't make a huge difference.

Yes, it can take months, especially if the outside heals prematurely, starting the process over again. It is possible that this is Crohn's related. I just don't think that you can make the diagnosis simply because of the time this is taking. UC is a risk factor also, and the fact you have a history of rectal surgery adds to the pile. If it is really deep, especially if the tract is twisty, it just takes longer.

Still, considering this to be IBD related, UC or Crohn's probably does not matter much, may just open more ideas for treatment, or just to anticipate a more lengthy process. I wouldn't get too wrapped up in the idea of Crohn's.

http://www.mdguidelines.com/abscess-perirectal

Jan Smiler
Jan Dollar
S srthomas21Member
Thanks Jan. I have had a j pouch for abou 13 years now. Had no issues except a few bouts of pouchitis until last February. Had same type of horrible pain in the rectum area and had a pouchectomy done with biopsies and blood work. No crohns was found and biopsy came back pouchitis. Went on antibiotics and rectal pain went away (I believe it was the start of an abcess that drugs took care of) fast forward to November 2012 and had same bad pain and drugs did nothing for it. Did cat scan and found abcess. Had it drained. My wife is a Er nurse and has pressed on it and puss has come out so it seems that the infection won't go away so it can heal.

Abscesses suck to say the least. I hope it heals soon. I'm sick of waddling around like a duck Smiler
S
Jan DollarJan DollarModerator, RN, retired
I would suspect that this is the same infection all along and the antibiotics last February did not actually take care of it, but simply suppressed it. It probably was abscessed then and the only way to really get rid of one, is external drainage. Antibiotics just keep it from spreading. Sometimes if you suppress it enough with antibiotics, it will "burn out," and the body will absorb the mess. But, once it becomes big enough, drainage is the key. You may need a long term drain to keep it open.

Jan Smiler
Jan Dollar
CO Chris (Oregon)Member
Hi Scott -

I feel your pain! I had an Abscess and Fistula in April 2011 that didn't get "fixed" until March 2012.

I had a HUGE swelling around the anal area and had a very high fever (a clear sign of an infection). My surgeon lanced and drained in the office but after 4 months the incision closed up but the fistula didn't, so the abscess just swelled up again.

The surgery that finally 'fixed' it was my surgeon opened up the entire abscess cavity and opened the fistula tract (google Fistulotomy). I was left with a giant gaping gash from the abscess site, two inches over to my rectum then another 2 inches up inside the rectum.

It took 13 weeks for that to heal up, but now I'm 100% better and right as rain. Some tips to help you deal:

1. Soak soak soak! After every BM if you can, but soak in a warm tub as Jan suggested. Helps ease pain and promotes healing

2. Don't WIPE. PAT. Get some organic, non chemical based baby wipes and pat the area clean once you have a BM. Pat dry.

3. Eat easy to digest foods. I went back on ostomy diet at the suggestion of my surgeon. Soft foods, no raw veggies or nuts, etc.

Hope you get over it soon!
CO
S srthomas21Member
thanks chris. I'm going in to have the wound / abscess opened up again tomorrow and she is going to check for fistula. If there is a fistula then she will put a seton drain in rather than do the fistulectomy.

She is concerned I may have Chrons so she said I wouldn't heal if she did the fistulectomy. I don't think I have chrons so I wish she'd just fix it while I'm in there if I have one.

Do you have crohns or did you get the fistula from the abscess ? How did they find the abscess ?

The fistulectomy sounds like it sucks.
S
D DLeathyMember

have you had your problem fixed yet?

 

I incurred an abscess in 2012 that left me in the hospital for 3 days. It started from a anal fisher. I was misdiagnosed and bacteria got into my blood stream. It took a while, but did heal up.

 

Then in December 2013, I unfortunately incurred another anal fisher. That caused 2 abscesses. Both abscesses have been lanced twice. They have both been cauterized twice. They decided that they were going to do a Fistulectomy. Once in the surgical room they could not find a fistula. They drained the wound more and stitched the areas, but left one or two stitches out so it could finish draining. This surgical procedure was in June 2014. I now in January 2014, still have 2 open wounds that will not go away. I have tried absolutely everything I can think of. (by the way this was a different doctor than before)

 

The one abscess will close and then reopen again on its own. Seems that every time I go to the restroom the other keeps bleeding. It has been a very depressing year to say the least. I can not do the normal things I used to do due to the fact that it either hurts, aggravates the area, or causes it to get worse.

 

Some of the things I have tried to get these to heal besides seeing a doctor.

 

-Organic oxy-powder supplement to increase oxygen in the gut to promote healing. - didn't work

-An Organic Apple Cider Vinegar drink to help healing the area. - didn't work

-Hot baths for weeks on end 2-3 times a day - didn't work

-Hot baths with organic apple cider vinegar in the bath. - didn't work

 

I hope you can find a reason why these things won't heal. I will try anything to get this fixed.

 

Hope this helps some and I am currently going to go get another opinion and see my third doctor on this issue. I will post again when or if I find out more.  

D
rachelravenrachelravenMember

Just posted on another thread a similar response:

 

My issues started in 2012. Got a perianal abscess of a gland that turned to a fistula. Simple intrasphincteric fistula at "7 o'clock."  Dx by MRI.  Antibiotics did nothing. might as well have taken Tic Tacs, would have had the same response. 

 

My surgeon will not perform a fistulotomy/ectomy on me, as he says it's dangerous for us in that we already have sphincters that went through a lot, and the cutting could render us incontinent. 

 

I had a seton (the rubber band drain) through the tract for 18ish months. It's out now. I'm on Humira, and finished a steroid taper, and things are holding. My fistula tract was mature after having the seton in for all that time, though (it scars the tract).  I've been ok for about a month since the last seton untied and broke and came out. I've been on Humira for almost 4 months now. I did 2 steroid tapers. The steroids make things down there amazing, but steroids are such awful meds, as a whole (well, they're great when you need them, but man they wreak havoc on a body). 

 

When things were not right, it was the skin healing, then the mucus pocketing there and the buildup of pressure that was the WORST. The seton was a God-send to stop that cyclical pressure buildup by allowing constant draining. I've never had a ton of drainage but what I had would pocket and was painful til it drained. It's been staying good on its own, no seton, right now,  I'm hopeful the Humira is helping.  I've never had a clear cut "Yes this is Crohn's" picture, but my GI who specializes in IBD only and who has a lot of J pouch patients says he's seeing "older" pouches having these types of issues, and his suspicion is that it still is some sort of IBD umbrella/issue. I had elevated C reactive proteins and sed rates, too, cuff inflammation, and outlet strictures that led him to try Humira with me. 

 

Fingers crossed. Things aren't healed/perfect, but they're holding and ok right now. He told me give things 6 months and we will reassess. 

 

UC dx age 11 1982/Total colectomy, J pouch and loop ileostomy, January 10, 1991/takedown May 15, 1991/Many healthy years!/Pouchitis then perianal abscess/fistula 2012-2013/Draining seton March 27, 2013/Outlet anastamosis dilated April 16, 2013/Seton broke April 22, 2013/new seton and outlet dilation April 29, 2013/Dilation May 21, 2013/Daughter dx with Crohn's colitis February 14, 2014 (age 11, like her mama)/Too many other EUA's, fistula, and stupid new IBD things to list/Humira started 9/25/14, to try to heal the fistula/chill things out/11/10/14 seton out /12/4/14 EUA, smaller seton placed/12/18/14 seton untied and broke, back on steroids... Things chilling. Fingers crossed.

rachelraven
Last edited by rachelraven
J JJAMember
I had a fistulectomy for an anal fisure which left me seriously incontinent, and a sphinteroplasty surgery following helped some, but still left me functionally incontinent.  I am pretty determined not to let my medical issues get in the way of living my life, so I have managed over the years, as best I can, but not without "issues" of embarrassment, accidents, leakage, raw skin, etc.

I strongly urge exploring more conservative measures before risking your continence. Although the poster above had good luck with it, I sure did not.

Also, I think some doctors just automatically think "Crohn's" when they hear "fistula" but I agree not to be afraid of the label. Finding a treatment is more unit than worrying about a label.
J
S StormwatchMember

Listen. I got diagnosed with irratractible pouchitits in 2000. Tried every antibiotic. Every single clinic I went to. Remicade, entyvio, everything I tried. I had a fistula so huge between my Anus and Scrotum that when I got it lanced, the surgeon was legitimately concerned. I was getting abscesses lanced twice a month. 

As of today I have been 90 percent better for 1 yr. Firstly and most importantly, my intestines were not absorbing the antibiotics. I randomly started chewing them into paste, Augmentin and Cipro, and my abscesses and pouchitits cleared up in 3 days. Dr Peter Rubin in nyc said "your intestines are comprised and haven't been absorbing the antibiotics for the last 17 years". My scope showed no pouchitits. Some tissue is still damaged where the abscesses were, but nothing is active. 

Simithicone... I take about 10 gel caps right before meals. It wipes out gas. You know that horrible cramping we get? That's from gas in the inflamed area sometimes. My pouch has trouble passing gas.

This wipes that out. 

I also use some other unorthodox methods. But science says whatever I'm doing is working. Please make sure you're digesting all your antibiotics. Take the liquid forms if you don't want to chew them up. If it doesn't help you within days, than I guess we all really have different causes for our chronic pouchitits. 

S

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