Perianal abscess? Or am I just paranoid?

Hi all, I have a question I'm hoping some of the more experienced crohns sufferers (survivors? Heroes?) will be able to help with! I'm sorry this post is a little graphic but you guys are really the only resource I have outside of my doctor and knowing we've all been through the same embarrassment/nasty experiences really helps.

I have Crohn's colitis and have been flaring the past 2 months. I've been getting it under control with prednisolone and upping my dose of azathioprine, and whilst there have been ups and downs I've been getting slowly better.

Last week I became quite constipated & didn't go for 4 days, which is an AGE for me as I'm usually 3-4 times a day even during remission. Yesterday I finally managed to go, ended up going 8 times with stools getting more and more watery.

Okay so I can cope with that, but god it HURTS. The perianal skin is really inflamed - I've had a totally painless skin tag there for a few years but it's become very very swollen, tender to the point of being painful to walk & I'm having to be very careful sitting down. Having a BM is...eurgh, so painful. There's also bright red blood & mucus whenever I go.

So question of the hour - is this a haemorrhoid? I've never had one before and am guessing it might be given the constipation. But I'm really worried it could be an abscess, given I have colitis and have been flaring.

I'm not sure what the 'warning signs' are that should make me go see my specialist about this...I know a haemorrhoid can just go down by itself but an abscess is a lot more serious, I'm just not clear on what the difference between the two is. Please help!!!

You know what else? Unless you're feeling some kind of bump, you may very well have a fissure, rather than an abscess or a fistula. A fissure (i.e., a tear) can hurt like hell. My husband, who doesn't have Crohn's, was so sure that his desperate pain had to be from his hemorrhoids that he didn't go see a doctor--and, after 18 months of rolling around on the floor and stealing my hydrocodone, finally found out that what he had was a fissure. Which would have been relatively easy to heal if he'd gone to see the doctor right away. Instead, he had to have surgery.

I have a permanent anal fissure that acts up from time to time, but that can't be repaired without making me incontinent. So I'm just living with it.

You can also get absolutely crippling perianal pain just from being inflamed and irritated down there from lots and lots of diarrhea (particularly if it's full of bile and acidic), straining, and not being totally clean (hard to do when you're running to the bathroom and spewing bile eight times a day). See if you feel better after a warm bath--and spreading some Calmoseptine around the area.

Good luck with this. I know from personal experience that it hurts like crazy, whether it's an abscess, a fissure, or a severe irritation.

I had a perianal abscess 18 months ago which I originally thought was a hemorrhoid. But the pain just got worse and worse until I finally had to go to the doctor. So according to my definition if it remains more or less inert and stable then it is a hemorrhoid, but if it gradually get worse then it is an abscess. (As you can see I really don't know.) I think your best bet is to let a doctor check it out. If it is an abscess then you want to treat it before it morphs into a fistula.

As far as fiber goes, if oatmeal suits you then you probably will do well with daily supplementation with psyllium. I prefer psyllium seed but many use psyllium husks such as metamucil because it tastes better and can be purchased everywhere. I mix psyllium with probiotics for an effective way to help maintain remission.