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Hi all.

It's been a while since I last posted. Back in the fall I had an MRI which discovered several small abscesses in the pelvic area. Because of this, my diagnosis was changed from ulcerative colitis to Crohn's disease. My GI sent me to my surgeon to access whether it was necessary to drain the abscess. At the time, my surgeon felt it was better to wait and see if medication would close them up. I was put on Pentasa, Cipro, and 6mp. It's been a little over 6 months and the abscesses still flare about once a month, and I cannot seem to get off of the cirpo. I was sent for another MRI on Monday. Got a call today from my GI. Most of the abscesses have stayed the same or have shrunk a little. There is one that has gotten quite a bit bigger (I don't know if it's an internal one or external, or where exactly in the pelvic region). He wants to put me on Remicade because he feels it will close them all up (I am no opposed to Remicade). But before I start, he wants my surgeon to drain the bigger abscess.

When I went to the surgeon in the fall he talked about setons. I don't totally understand them other than they can be temporary or permanent and it's basically a string that dangles down under. Is this the only way to drain an abscess? Is it painful? For ladies, how unattractive is it? I'm 23, in a fairly new relationship (he is understanding, but doesn't know the full extent and we haven't done the deed). How does the area stay clean?

I know some of these questions are for my surgeon, but I figure many of you are more experienced than him (from a different view).

Any input would be wonderful.
Thank you.

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I only have had a simple abscess turned fistula. It's not enough, based on other assessments, to turn my dx to Crohn's.

That being said, I've had a seton now for just over a year. 85-90% of the time, I'm not bothered by my fistula. The seton itself is nothing; the fistula stinks, though. I have no real plan for this at this time, because traditional fistulectomies etc. are things my surgeon feels are a liability with me (our big pelvic surgery makes our sphincters less "great," so chopping them up with a fistulectomy etc. can cause higher rates of incontinence... Something I am not willing to mess with.).

So it's a seton indefinitely, at this time. I do not have any internal abscesses/fistulas. Just this one stupid intrasphincteric fistula that is a nuisance.
rachelraven
Rachelraven,

I'm not sure where the need is. I have three abscess that are external that swell on and off. But my GI said I had many small ones (and the one big one) in the pelvic area. I don't know if the one he wants drained is external, or internal, or where it is. I have one that I think is on the bartholin? gland and two on either side between my butt cheeks near my anus.
B
Then you must have at least 2 perianal abscesses/fistulas if 2 are by your anus. Those would be similar to my 1, and a seton would work there.

I've heard that it is a bad bad idea to do surgery on Crohn's fistulas. That sometimes, setons are left in for years... However, meds like Humira and Remicade can actually close some Crohn's fistulas, so that's worth asking about, if you're not already on a biologic.

I try to think of my seton as my "exotic piercing," lol. It sucks, but I do try also to keep some perspective, because I'm an ICU nurse, and I know I could have it worse.
rachelraven
I'm also dealing with couple of fistulas (or at least one that leads to 2 separate tracts). I have a seton going through both, the problem is that in one case, its not helping much. That area hardly drains and still swells up. The only thing that seems to relieve the swelling is antibiotics (ie. Flagyl). I wish there was something topical I could apply there that would help.
S

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