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Crohn's Disease
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Posted 10/10/2011 3:08 PM (GMT 0)
How do you know if your abscess has turned into a fistula? Do abscesses itch when they drain? How long on average to abscesses take to heal?

Also, if it's a fistula, will it heal on it's own? I've failed biologics, and don't usually respond to meds.
Posted 10/10/2011 11:33 PM (GMT 0)
Good indicators that your abscess is actually a fistula are: you pass stool through the abscess opening, or you pass gas through the opening.  If either of those happens, it's almost a sure thing.

Otherwise it's difficult to determine on your own.  If you have an abscess that continues to drain pus and is taking an exceptionally long time to heal, then you may want to schedule a visit with your doctor.  A doctor can try to determine if it is a fistula by inspection and a bit of probing.

Abscesses definitely can itch as they heal.  However the itching can be any number of things - including hemmerhoids (assuming peri-anal abscess?) or inflammation making it difficult to keep things clean.  Nothing to worry about, but I would avoid itching because it can irritate the area and if the itch is due to hemmerhoids you can damage the blood vessels.

Average healing time for an abscess varies a great deal.  My own abscesses have cleared up in about 5 months, 3 months, and 4 months respectively.  Many factors affect healing time: location, size, degree of crohn's activity, nutrition, etc.

Generally in people with Crohn's, a fistula will not heal up on its own - though it is possible.  Usually a seton is inserted to prevent the creation of an abscess and allow the fistula to continue to drain when it needs to.  Biologics have about a 60% success rate in healing fistula after a couple of years (you can look up the exact stat if you are interested).  As far as I know, only biologics have been reported to heal fistula.

A fistula that doesn't heal isn't the end of the world though.  In most cases there is no pain, and minimal to no drainage after some time so it just becomes another quirk in the aesthetics of your bum. :)

Posted 10/10/2011 11:46 PM (GMT 0)
Octobergirl, I think that, if you feel that you need to be asking these questions, then something is probably going on, and that it would be best to see your doctor. Whether it's an abscess or a fistula, it will probably need some examination and treatment, and probably sooner rather than later, if only for your own peace of mind.

All the very best to you,

Ivy.
Posted 10/12/2011 12:06 AM (GMT 0)
Hi Johnny,

Thanks for that explanation. I wasn't sure at first, but I'm pretty sure it's a fistula. Yuck! I'm so disgusted, why did my body decide that was necessary? I guess at least it doesn't hurt anymore, but I'm not very encouraged by reading they often don't heal.

For a seton, do you have to go under anesthesia to have it placed? I'm newly pregnant, and I'm not sure what they can do for me.

Hi Ivy,

I've been to my GI's NP about it, and I'm going to see my GI about it again next week. I just wanted to know people's experiences so I could get an idea what I'm dealing with. Thanks for your concern.
Posted 10/12/2011 3:01 AM (GMT 0)
Typically there would be an exploration under anesthesia to determine the tract of the fistula, then the surgeon would determine the appropriate course of action based on what he finds.  (Depending on where it goes - mostly how much sphincter muscle it passes by - different treatments are considered.  A simple fistula that avoids your sphincter can often be surgically cured).

I am not sure what they will do since you are pregnant.  They can pack the outside hole like an abscess, they can plug the fistula with glue or resin, or they can leave it and just hope it heals and doesn't come back.  Or maybe they can still do the surgery, I have no idea what's allowed when you're pregnant.  For my first fistula I was too sick to unergo the surgery required, they just left my fistula and it healed up just fine.  Maybe you will be just as lucky :).  I'll send good lucky thoughts your way.

Posted 10/12/2011 6:38 AM (GMT 0)
Hi Octobergirl

I know exactly what you're going through and it's not very nice! I had a perianal fistula and had a seton inserted which had to be under general anaesthetic. I had the Seton in for about 9 months then I was put onto Humira and had the Seton taken out after 4 months of being on Humira and it healed up over the next few months or so. You will definitely need to have an exploration under anaesthetic so they can assess the fistula, mine tracked through the sphincter muscle so wasn't able to be fixed surgically as this could make me incontinent.

I am thinking about getting pregnant soon too and because i have had perianal disease I need to have a caesarean section due to the risk of tearing and affecting the sphincter muscle, so don't be too alarmed if your doctor tells you this when you go and see him.

Good luck! :)
Posted 10/12/2011 7:08 AM (GMT 0)
You might like to click on the "abscesses and fistulae" link in my signature (below) - lots of personal experiences, and good advice, there.

Ivy.
Posted 10/13/2011 8:33 PM (GMT 0)
Hi. I have had a fistula for about a year and it has not healed on its own. I have a lot of discharge and sometimes it "flares up." I have had a few bladder infections as a result of the discharge also.

I finally got in to see a colon and rectal surgeon and he wants to do an exam under anesthesia to see how we should proceed. He said if the tissue around the fistula is healthy enough, he can do a flap procedure. However, if it's not, I may have to get a stoma for 3 to 6 months to allow the area to heal before the procedure. I do NOT want this and am very upset, but at the same time, I really don't want to deal with this fistula anymore either.

I asked my GI if I could try Remicade but he won't let me. The surgeon told me depending on what he sees, he may recommend Remicade first before trying the flap procedure.

I hope you have a good outcome. It will probably have to wait until after your pregnancy. I hope you have a healthy and happy pregnancy by the way. Good luck.
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