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Perianal Abscess Pain Management

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Crohn's Disease
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Posted 7/23/2015 11:25 PM (GMT 0)
Hi All,

For the last month I have been dealing with a problematic perianal abscess. I have had 2 surgeries to drain the abscess however I'm finding that the abscess is continuing to fill/drain almost daily. The pain from this is problematic and I haven't found anything that has helped ease the pain. To complicate matters, I have a fistula from a previous abscess which was already painful on it's own. I was getting my ducks in a row to start Humira but that has now been put on hold while I fight off this infection.

The doctor's have prescribed hydromorphone but I can't take that and function. I run a consulting company so I live and die by billable hours. This is having a huge impact on my effectiveness. I am doing 2 sitz baths a day (one in the morning and one at night) but even that isn't really helping. Any ideas or thoughts on better was to manage the pain?
Posted 7/24/2015 12:08 AM (GMT 0)
I'm sorry you are experiencing so much pain. I hope the infection goes away so you can start your treatment. I have had lots of rectal issues and one thing that helps me with the pain is a microwaveable heating pad. I like the one by Earth Thereputics. They are like $15 and you can order them from eBay, Amazon, or get at Bed Bath and Beyond. I heat it up then place in a pillowcase. It definitely is comforting and I don't know what I'd do without one!
Another thing you could ask for is Torodol (sp?) it's a non narcotic pain killer. I think you have to get the first dose via IV, then you can get an oral script. The only problem with that is, I think it's similar to Motrin so it might affect your Crohns negatively. I hope you feel better soon!
Posted 7/24/2015 5:29 PM (GMT 0)
Thanks Rose*flo. They did give me Torodol in the hospital via needle. It helped take the edge off the pain but they also warned they can't give it to me long-term because of my Crohn's. For now I will struggle on and hope that this settles down soon!
Posted 7/25/2015 1:41 AM (GMT 0)
I'm sorry you are in so much pain. Hydropmorphone is pretty strong stuff, have you tried anything a little less intense, like hydrocodone or tramadol? These may provide pain relief without making you tired or loopy. I don't think doctors will want you on Torodol for any extended amount of time because of your Crohn's. I have fistulas but have never agreed to have surgery on them. I find hot baths very relieving and precautions while wiping like using wet wipes or spray bottles. Good luck!
Posted 7/26/2015 7:48 PM (GMT 0)
Two Advil twice a day helped mine in a week!!!
Posted 7/26/2015 8:15 PM (GMT 0)
Be careful with all ibuprofen meds because they can induce bleeding and a Crohn's flare
Posted 8/7/2015 7:06 PM (GMT 0)
I have found Morphine and Diclofenic very helpful. I had a severe perianal abscess - they drained a pint in all during four surgeries and I had sepsis. On A&E admission for the third time I needed introvenous Morphine for pain. I have a fistula and seton in place, currently and am waiting for my next surgery. I have never had so much pain and suffering in my life, 3 months on healing is slow, but it does gradually get better. Get well soon!
Posted 8/7/2015 7:40 PM (GMT 0)
That is my concern Mouse! I have had 2 surgeries and still stuck in the filling/draining cycle. The pain is intense and it's not like I can just take time off work. I run a busy consulting firm and have both staff and clients that count on me to get things done. I can't function on the heavy duty drugs (i.e. hydromorphone) and even the T3's can take their toll on me.

I do find a hot bath is helpful but not always accessible so my method right now is to grit my teeth and get through. They gave me morphine in the hospital but I didn't find it at all effective. The best was the IV hydromorphone (dilaudin) but again...can't function on that.

I'd really like this cycle to end soon!
Posted 8/7/2015 10:10 PM (GMT 0)
Hi players _
Sounds like you need to treat the abscess better.
Have you discussed a seton with your doc.
That helps keep it draining and theoretically avoid the abscesses.
Also antibiotics to treat the infection and so you can start humira.
In the meantime you should also consider 6Mp, or MTX or similar.
Can be very helpful either as stand alone or in combo therapy with Humira
I have finally gotten mine to stop and it took a lot of drugs in combo to do it.
Good luck
Norcos just 2.5 mg worked for me
Posted 8/7/2015 10:44 PM (GMT 0)
I've been on antibiotics for just over a month and they have now added another months' worth to my regimen. I have another appointment with the GI to discuss options for treatment at the beginning of September including the possibility of a seton. They want the results of the MRI before they make any further decisions and it is a lengthy process here to get those types of imaging tests.

The emerg doc also suggested adding Imuran to my treatment in addition to the Humira so that will be another topic for discussion with my doc.
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