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Is perianal abscess only present in Crohn's but not in UC?

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Posted 12/18/2018 7:24 PM (GMT 0)
Hello everyone,

I'm a 20 years old with a long history of sporadic LRQ pain and joint pain since I was 14 years old, along with being chronically underweight and fatigued. I have mouth ulcers since I was 5 years old. But I never had much diarrhea and no other symptoms were present. Until I turned 18 years old and decided to quit smoking. Then I suddenly had 4 weeks of diarrhea followed by what turned out to be a perianal abscess but which was assumed to be a sinus pilonidalis/ingrown hair. I also started to get skin ulcerations.

I did not know what was going on and assumed all those symptoms would go away. Even though my symptoms seemed worse, I seemed to gain weight initially and had plenty of energy, and that was actually the only reason why I went to a GP for my LRQ pain. It sounds stupid but it did not assumed a possible bowel disease, neither did I went to a GP for my skin ulcers (even though I was almost on OTC painkillers). Neither did my GP initially suspected possibe IBD, she thought I had a ovarian cyst or inguinal hernia due to swelling.

Based on a suspected fistula I was send to a GE in April 2018 but luckely it turned out it was just an aftermath of my abscess and it took to long. I started to smoke again and no abscess ever returned. My skin ulcers are gone as well. I know UC can be aggrivated with quitting smoking but Crohn's? I heard that abscess are exclusive to Crohn's. Does anyone know whetether LRQ is indicative of Crohn's, because that happens even when I smoke and is not immediately related to quitting. I'm not officially diagnosed with anything either because I no longer found a colonoscopy to be neccessary as all my symptoms had already disappeared when I arrived at the GE office.
Posted 12/18/2018 11:37 PM (GMT 0)
Honestly, it's a bit immaterial on if you have UC or Crohn's. But just so you know, UC is ONLY in the inner layer of the large intestine - nowhere else. So the fact that you are having skin ulcerations and abscesses leads me to think it's Crohn's.

Either way, you definitely need a colonoscopy. Yes, quitting smoking can cause things to act up, but starting up again will not get you into remission. The fact that you still have pain is a problem.
Posted 12/19/2018 12:50 AM (GMT 0)
Other than your GP mentioning possible ovarian cyst or possible hernia, was any testing done to rule this out? If not, I would ask to be referred to a gyno for a consult. The skin issues, what was the diagnosis & treatment?

It is hard to even guess if it may be crohns, especially not having the other things ruled out. The only way to find out is have a colonoscopy & be sure the dr does biopsys.

I hope you can get some answers.
Posted 12/19/2018 8:37 AM (GMT 0)
Thanks to both of you for the answer. They did an ultrasound and thought I indeed suffered from a swollen ovary so they refered me to a gyno who said there was nothing wrong with me as an MRI came back normal. I have not been to my GP with the skin ulcerations as I hoped it would go away and I felt ashamed and scared (was 18 years old and had no experience with such symptoms, that played a role in me avoding medical help).

My GE considered a colonoscopy even though my blood results and CRP came back normal (I also felt normal, but it's still great that he does not immediately says IBS, he took the abscess serious apparently) so that could be done if my symptoms return, as my GP now knows it's perianal abscess related to quitting smoking. My LRQ is sometimes worrisome, but it's intermittent and not always accompanied by diarrhea but always a lot of white mucus even when the stools are still formed.


But just so you know, UC is ONLY in the inner layer of the large intestine - nowhere else.
So that means there can be no deeper rectal abscesses, and no smaller abscesses that break through the skin and resembles a fistula?
Posted 12/19/2018 1:13 PM (GMT 0)
Hi EbruNink,
A perianal abscess and a subsequent fistula can occur for no apparent reason, just bad luck.
In approximately 70-80% of cases the cause is idiopathic, meaning just accidental.It's obvious then that you could have a fistula and no Crohn's.
In the rest of the cases underlying factors may exist such as Crohn's or Colitis.
Approximately 30-40% of patients with Crohn''s will have a fistula at some point in their life. In Colitis this is less than 1%.
Taking all this into consideration I would not overly worry and overdo it with exams, unless I had an abscess reappearing. Obviously that's what I would do, not medical advice. Above all trust and love your Medical Advisors!!
I really hope you have a smooth sail with no more abscesses my friend! Enjoy your 20s; I wish I could become 20 again come this New Year!
Posted 12/19/2018 2:20 PM (GMT 0)
People can develop fistulas & peri-anal abscesses without having crohns disease. We have a couple of members here that do not have crohns & are dealing with both. My husband started down the peri-anal path 4 years ago. Each time he required wound care to get them to heal up, it was a long process before they healed. These are not limited to any IBD.

Your skin cleared up on it's own, the mouth ulcers can hit anyone at any given time. I don't think this is crohns given the events you have given here, however, I am not a dr., only a dr with proper testing can do this.

You are young, enjoy life. See your drs as needed & listen to what they tell you.
Posted 12/28/2018 8:27 PM (GMT 0)
Skin ulcerations can happen with UC or Crohn's. They are generally due to PG (Pyoderma gangrenosum) and happen roughly in equal numbers with Crohn's and UC.

There are many on the UC forum who have dealt with abscesses. Much more common with Crohn's. That being said, I know several people who have had them with no IBD. You are wise to note a connection with your other symptoms and mention them to your doctor. Trust whatever they tell you and don't assume the worst.
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