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Surgery or not? Nervous/confused!

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Posted 9/3/2013 8:12 PM (GMT 0)
Hey everyone! I'm still new here, but have done loads of browsing on the topic of perianal abscesses and perianal fistulas.

In early July I developed a Perianal Abscess. Not knowing what it was at the time I believed it to just be an ingrown hair. After it enlarged in size, I went to the ER believing they'd lance it since it already started to partially drain. They just told me to take sitz baths and follow up with the Dr. I followed up a week or so later, and he said everything was fine. No need for surgical intervention, antibiotics, etc.

Fast forward two weeks (to the day) and my perianal abscess has returned. Albeit this time smaller than the first. This time around I started the sitz baths immediately and the abscess drained within a couple days. Still not knowing much about perianal abscesses and fistula I believed this would be the end of it.

Fast forward another two weeks (to the day again!) and the abscess has returned for a third time! This time around I did a bit more research and discovered I may have a fistula. So I went to get checked out by a CR doc. He confirmed to me that I indeed have a fistula. We've scheduled surgery for a fistulotomy this Friday, Sept 6th.

Since I've seen the doctor now almost a month ago I've yet to have the abscess return, and I've been experiencing absolutely no discomfort, no drainage, nothing. Now that the surgery is looming over me I've been debating with myself whether to go through with it or not. Is it possible the fistula has healed itself? Is it just in a state of inactivity? Would it be foolish to not move forward with the surgery? Likely that it'll return, and or worsen if not treated?

Truth be told I'm petrified of having surgery since I suffer from anxiety. I've never had surgery before. What complicates things is I've just sold my house and am to move by Oct 16th. We're moving almost 1,000 miles away. I'm nervous that the surgery will delay my move because of potential long recovery time. I'm also nervous that if I don't get the surgery that an abscess will reappear, and I'll regret not getting it taken care of beforehand in a city I'm familiar with.

Sorry for the long post, but thank you very much for any and all insight!
Posted 9/4/2013 1:45 AM (GMT 0)
Hi Buttwhy (like the name), Welcome. Do you have Crohn's Disease? The reason I ask is because there are medications you can go on that are pretty good at healing fistulas without the need for surgery. Personally, I am a conservative when it come to my CD treatments and would try medications before surgery, especially if the fistula is not currently causing you pain or discomfort. I had a perianal fistula for a few years that drained puss when I was flaring, but generally responded to antibiotics and was never annoying enough for me to consider surgery. It eventually healed on its own and I have not had another since.

I don't think it would cause any damage to push off surgery for a while if that's what you feel most comfortable with, but make sure you consult with you surgeon or GI prior and get them on board. Good luck with whatever you choose!
Posted 9/4/2013 3:41 AM (GMT 0)
I agree with Myrne; under your circumstances it should be okay to reschedule. I would want to do the same if I were in your shoes.

I hope your health and your move goes well. -Joy
Posted 9/4/2013 6:29 AM (GMT 0)

Myrne said...
Hi Buttwhy (like the name), Welcome. Do you have Crohn's Disease? The reason I ask is because there are medications you can go on that are pretty good at healing fistulas without the need for surgery. Personally, I am a conservative when it come to my CD treatments and would try medications before surgery, especially if the fistula is not currently causing you pain or discomfort. I had a perianal fistula for a few years that drained puss when I was flaring, but generally responded to antibiotics and was never annoying enough for me to consider surgery. It eventually healed on its own and I have not had another since.

I don't think it would cause any damage to push off surgery for a while if that's what you feel most comfortable with, but make sure you consult with you surgeon or GI prior and get them on board. Good luck with whatever you choose!

Hi Myrne! Thanks for the compliment on the username and also the welcome smilewinkgrin ! I have not been diagnosed with Crohn's Disease. I've never had any of the symptoms associated with it, and it's not something that was mentioned to me by my doctor. Would the medications you mentioned still be helpful for someone with a fistula, but does not have Crohn's Disease? Would it be correct for me to assume the medications are either Remicade or Humira? Those seem to be the common ones I've been reading about. I'm glad to hear that your fistula didn't give you much trouble, and it has now healed! That must be a relief!

I think I'll speak with my surgeon further tomorrow to get his take on things. At this point I'd rather be more conservative with my approach as well. Even when the abscess would flare up it'd only put me out of commission for a day or so while it drained. The biggest deterrent to me is the recovery time and the delay of the move. My wife has job lined up in our new city, and while she certainly is understanding I don't want to put our life on hold. I'm just nervous if the fistula were to return or worsen that I'd have to take this on in an unfamiliar city with an unfamiliar doctor.

Again, thanks so much for the insight!
Posted 9/4/2013 6:31 AM (GMT 0)

JaSanne said...
I agree with Myrne; under your circumstances it should be okay to reschedule. I would want to do the same if I were in your shoes.

I hope your health and your move goes well. -Joy

Hi Joy! Thank you for the kind words. That's the direction I'm leaning right now. I hope to myself I'm not making a foolish decision though. I'll keep this thread updated.

Hope you're also doing well! :-)
Posted 9/4/2013 5:26 PM (GMT 0)
A temporary solution would be to get a draining seton placed in it to keep abscesses from forming.
Posted 9/4/2013 7:07 PM (GMT 0)
Hi Buttwhy....scifi beat me to it....ask your colorectal guy about a draining seton. It depends on muscle involvement and fistula location, but for me it was a great non-surgical option when I could not take flagyl and the Cipro did not do enough & I did not want to go to Remicade at that time.
Posted 9/5/2013 5:02 AM (GMT 0)
Thank you Scifigal and HabsHockeyFan. I'll ask about the draining seton as well. I'm to call tomorrow morning and put off surgery for the time being.

As of now I'm not on any antibiotics, and the fistula/abscess is not in a state that it's draining. If there's no current activity would it still be a good idea to get a draining seton anyhow? How do they put it in if there's currently no opening?

Thanks again for all the help!
Posted 9/7/2013 2:16 AM (GMT 0)
I agree,

You should look to Cipro or Flagyl as first steps,

I would thing surgery would be the last option when there are so many other effective solutions

Also, I noticed you joined a crohns forum, so do you think there is any possibility of Crohns or Colitis that is causing the fistula? 

Posted 9/7/2013 8:50 AM (GMT 0)

zoso73 said...
I agree,
You should look to Cipro or Flagyl as first steps,

I would thing surgery would be the last option when there are so many other effective solutions



Also, I noticed you joined a crohns forum, so do you think there is any possibility of Crohns or Colitis that is causing the fistula?

Are cipro or flagyl usually effective in closing/healing a fistula? Surgery is most definitely my last option, albeit I'm sure I'll need it eventually if the fistula doesn't close.

I did join a crohn's forum because this is where majority of the information is regarding abscesses and fistulas it seems. As far as I know I do not have crohn's or colitis. I don't believe I show any symptoms other than a fistula. It's not something that's been suggested to me by my doctor at this point either. However, I'm not sure how much relevance it has, but I've recently been diagnosed as lactose intolerant.

Thank you kindly for the suggestions and help.
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