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Perianal Abscess / Fistula

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Posted 7/4/2013 2:42 AM (GMT 0)
First of all: I posted this question under this heading because all the abscess/fistula questions I found were all listed under this heading.

June 2012 I was hospitalized with a perianal abscess. The perianal region was so swollen I couldn't sleep for days. After like 6/7 days of unbearable pain the doctors finally understood what I had and I underwent my first surgery of the sort. It came back again and I did surgery again, also another 2 times but these times it drained itself. After 7 months it comes back again and I had to undergo surgery again, and now I am recovering. It's now 5 days after surgery, 2 days left antibiotics, and when I feel the surrounding area I still find that it is a bit hard. When I press on this area; the pain I feel I believe is more related to the wound rather than anything else. Do you think it could be the abscess returning so early, or a scar tissue / inflammation still healing? The wound is not very deep.

Another question is this: I know that anal abscesses tend to recur and that many of those who in their lifetime are unlucky enough to encounter one, has the probability of it coming back again, but I think you all agree with me that 5 times are kinda too much and that is why I had a colonoscopy to determine whether there was something wrong in that area. The results were clear apart from a slight scar which the doctors said was nothing to worry about. (This was 2 months ago). Then they booked me an MRI, which is to be held in August. (This means that the last surgery I had was in between the colonoscopy and the MRI that im still going to have). Such delays between procedures are due to my familly not being able to pay for it, and having to use the government's health service.

Now I know that the MRI is going to be done to determine whether there is a perianal fistula. I know it exists, but do not have enough information about. I'm tired of all this so if there'd be a fistula surgery that needs to be done in order for the abscesses to stop recurring, then I'd have to do it and it'd be for my own good, but can you give some info as what the surgery would be like and how the pain compares to the pain you feel after the perianal abscess surgery? is it more painful? does it condition your life more? would it take more time?

Extra info: Im on an augmentin 625mg course, and pain killers when they're needed
first surgery took me 5 weeks daily dressing, second surgery took me 3 weeks daily dressing, im recovering from my 3rd one. They pack the wound with alginate dressing.
I am turning 19 in 7 days (though I cannot be bothered about my birthday really: I just wanna get better :( !)

any help would be greatly appreciated, I know there might be some people here who went through similar experiences and could share their experiences with me and possibly help me out on my query
Posted 7/4/2013 5:08 AM (GMT 0)
Hello,

Sorry you are having problems with this abscess. I cant give you too much advice about how something should feel after surgery as it varies person to person, so long as you follow up with your dr and surgeon to keep and eye out for proper healing and no infection.

You may be right in regards to recurrent abscesses due to fistulas, depending on how they drain them, sometimes they can tell if there is a fistula tract or not which is causing the abscess to reform later on. An MRI is a decent way to check for such things, if you were put under for the abscess surgery they should have been able to take alittle peek to see where the problem may be coming from, but with no clear direction and if the tract is quite small it may be difficult.

In my case I had an MRI that confirmed a fistula tract that ended up giving my a perianal abscess. I had a fistulectomy(sp) and the abscess drained with a draining seton put in. Pain was quite sore for the first couple days and tender to sit certain ways for a week or so. After 8 weeks I was working out and working full time again. The draining seton does not bother me and I run and do everything with it, but I avoid pools. I have had it in since oct 2012 and check in with the surgeon every three months. It is a big relief to not have the pain of the abscess. In time they told me the seton will be removed and everything should hopefully heal up.

I hope this answers some questions...

:) Take care

 

Posted 7/4/2013 1:30 PM (GMT 0)
So kinda if there's a fistula and it's causing the abscess to reform the seton is the only way to heal it over time, isn't it?
Posted 7/5/2013 2:42 AM (GMT 0)
Well yeah from what I know the abscess can continue to form because the outside of the skin heals faster than the inside, so the infection builds up and recreates the abscess. The seton is laid in the fistula tract and hangs outside the body so any discharge has a way to exit. Over time your body heals around the seton and at a certain the doctor may take it out or take the ties off and let it fall out on its own. I have heard some people have them for a few months and other years, I think it all depends on the fistula, crohns activity, healing etc... I am not really sure how it manages to heal over without forming again after the seton is out, I think its cause it is healed as much as it can so its a small area left and the disease should be more under control. I hope to find out more about the final healing stage in a few more months when I see the surgeon.
Posted 7/5/2013 3:05 AM (GMT 0)
Depends on the surgery you'd have for the fistula. I've had two setons put into the same fistula (the first one we took out to try Remicade, but it didn't heal it, so we did another seton). The first one was a piece of cake, but the second one was pretty rough to recover from. But that was because I was in a ton of pain before I went in from the prep and enema, and so even under anesthesia I was so tense the nurses had to pry my legs apart and hold them down, so I was black and blue between my legs and my thighs. It was a bit rough, to say the least. But like I said, the first one was really easy and I was just mildly sore for a few days.
Posted 7/5/2013 7:18 AM (GMT 0)
I heard of some fistula treatments that didn't involve the seton, what would that be about? what other days could their be of healing fistulas?
Posted 7/5/2013 1:04 PM (GMT 0)
I'm not super familiar with all of the different surgeries for fistulas; I know there is one that involves cutting open the fistula. There are also different seton surgeries that you can do. I think you can search on here for different ones that have been done.

Here is a link for the Mayo Clinic to help get you started with some of the terms:

www.mayoclinic.org/anal-fistula/treatment.html

As for other treatments, many people with Crohn's have found the biologics like Remicade and Humira will close up fistulas very well. Some others have had success with the SCD diet (Simple Carbohydrate Diet).
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