best med for JUST perianal Crohns???

Some of you have probably already figured this out, but I am avoiding big meds.  I am looking at some serious perianal issues with tags, fissures and general discomfort.  I am going to my GP in early January and then moving on to a new gastro hopefully.  I want to go in with an option and not just hear...so when are you going to start Remicade...again.

If the only thing you had to fix was the exterior or immediate interior issues, what med would you do?  Is there something that can treat the symptoms only???  I am going to be better at taking my maintenance meds ( a promise I made to a friend), but want to see if this can not be tamed before they kick back in more.

My peri-rectal abscesses were having a big old party at my expense, so I had to go right for the big guns. I am on 6MP right now because I am allergic to remi and humira. I haven't had an abscess for 18 months.

One strong arguement for going with big guns is to stop damage. Some damage can be permanent, and surgeries can disfigure. But these decisions are very personal, and I agree that going to a big gun can be scary at first.

Take care.

Many people have success using rectal meds for their perianal issues, worth talking to your doc about steroid foam (my favorite is cortifoam)...good luck and feel better soon!

:)

Thanks guys....
Crazyharry...if your trip to the specialist is denied, try having your regular doc write a letter explaining the other forms of care that were tried and failed. I work in health insurance and a calm, detailed letter can go a long way in getting coverage. unfortunately, a non-traditional care is not always allowed by strict policy language, but if it can be proven to be a better course of care (or more importantly a less expensive course of care) the RN case managers at your insurance company could realize it is worth covering.

pb4...thanks I thought you would have some good ideas as you have some similar issues. I am looking to care for only that part of my anatomy I am going to go back and attempt the probiotics again in January as you seem to have had great success with them. I didn't have a good reaction to them the first time, but I still wonder if it wasn't a flare up or flu that I had at the same time.

Fun Guy...thank for the other Rx names. I have never been offered non-oral or anti-TNF options and could not remember all of the names.

I am going to ask about all of this when i get my new GI and also ask my well trusted GP about them too. Thanks again

My son has mainly perianal crohn's also.  Started back in March (09) with what we now know was an abscess, he also had stomach issues and multiple trips to the bathroom daily.   He was prescribed cipro and flagyl which made the abscess less painful but after almost 4 months of being on it it did not clear up.  The abscess burst spontaneously and started draining in May.  In July he started SCD diet and in August LDN.  His abscess is now completely gone, his fistula is still draining but is hardly painful at all, and he says it is steadily getting smaller and less drainage.  This has not been a quick fix, rather a long drawn out one with 3 steps forward then 1 back, but he is steadily going in the right direction.   We too felt that we didn't want to do the big guns medicine at this time, mainly because of his age and cancer risks for young adolescent males.   We are very pleased with his progress, he's also on probiotics, vitamn c, vitamin d, turmeric, and omega 3. 

Good luck with your decision.

i also have lots of probs with fissures, tags, roids, etc.. but no fistulas. i was using corticosteroids like crazy (anusol, proctofoam, etc) and my rectum seemed to be getting more and more irritated. my doc prescribed me canasa suppositories.. I LOVE THEM! they reduce inflammation but dont thin the skin like steroids do. they are expensive, though, depending on your insurance. canasa is basically pentasa for your anus.

I've tried rowasa (enema) and found it VERY hard to use due to the pain. It was painful enough trying to get the littlest amount stool out let alone sticking an enema up there... Sometimes I could get the enema inserted and the liquid in, but right after have to sit on the toilet to let it out due to the pain. So I had to stop using that. My doctor also prescribed me nifedipine compounded and did help some with the fissue, but also recently got AnalPram and I think it does just as good. I had been taking Imuran, entocort, pentasa, but most recently LDN. I have been taking 2mg of LDN for approx. 2 months now. I have tapered off of the Imuran completely due to research showing it can prevent LDN from working and tapered to 3mg of entocort. I continue taking 1 Gram of Pentasa 4x/day.

I am glad to report after years of anal discomfort, it is starting to become better. Instead of multiple BMs a day (4-6) everyday, it is down to about 1 day a week with multiple BM. I can only hope it gets better from here or at least not any worse.

Post Edited (ChronnieMan) : 1/3/2010 7:42:20 PM (GMT-7)

the premise of your question is asking for a medication that treats the crohns exterior and is misguided in that crohns is genetic or diet related and perhaps a result of the permeability of the bowel (if inflammed, there is problems)...since you cannot change genetic you must change your diet or at least attempt to change the consistency of how the stool passes through the bowel (the theory being the consistency of the stool whether too soft or too hard requires correction). The cause of the problem is therefore not treatable from the exterior when the cause originates interior such as from the foods you consume. In other words if you have exterior problems it is likely you have interior problems as well that contribute if not cause the exterior problems. I searched a long time to solve your question and unfortunately did not find an answer, probably because of the explanation I have provided above.
Having said that the baths are the best especially salt baths and you need to get super serious about doing them. I have read about a very cold followed by very hot followed be very cold (as in ice cold) soaking approach but reluctingly offer it,, as it mite only provide some temp relief. But as can be seen the question avoids attention to the diet when attention is required.
There is another possibility in crohns possible relationship to the Mycobacterium avium subspecies paratuberculosis, MAP, in that,, to avoid the accumulation of MAP is to avoid where it mite not be killed off such as in milk thus avoid milk products. I think everyone knows the consistency of their stool and when a week of metamucil is warranted. Sometimes avoiding wheat for awhile can help, even though you may not be celiac also try avoiding gluten for awhile,, as these suggestions alter the stickiness of the stool as well ...less gluten =less sticky. The bowel needs to rid gas and when the stool is very glue-like the gas does not pass (as easily). persistent perianal problems suggests stricturing problems somewheres upstream or something like the exterior of the bowel wall stuck to another bowel wall. The perianal problems require a fiber adjustment. Adding olive oil to diet mite logically be helpful as a lubricant but unfortunately I find it mite also add to stickiness, so perhaps a mineral oil of some kind. For low fat diets fat must come from somewheres so you need to sort of find your happy medium of undigestable fiber that you consume and the amount of fat. see
http://www.wehealny.org/healthinfo/dietaryfiber/index.html
so the happy medium mite be somwhere between the diets shown,,in other words their optimal diet has extensive fiber which mite not be optimal for you and vice versa,, the typical american diet mite need some adjustment to have some fiber with at least 1 meal.
as far as your question,,seeking a med i know,,I read once about hoof balm (yea for horses) lol I havnt tried it. perhaps if there is accompanying cracking areas. For this you mite want to get a baseline of your potassium level and see if it is correlates with the perianal symptoms.

flagyl worked wonders for my perianal fistula.

Hello guys i am new to this not sure if i am on the correct sight.
I had a ileostomy in 2007 i had it reversed 8 months later
i am looking for someone that has had this and now suffers
really bad diarrhoea i have tried everything to stop it
with quite a few stops in hospital i have found that dihydrocodeine
is the only thing that gets me back to something near normal.
This all came about through a bad car crash.