Another abscess. Does it mean another fistula?

Haven’t checked in HW for a long time as I was still struggling with Stelara. Ten years ago, I had a perianal abscess that my GI cured with antibiotics and antibiotic injections then. After almost a month on medication, an MRI showed that it had cleared. However, almost 3 years later, I developed a perianal fistula for which I was put on Remicade every 4 weeks. In 2019, an MRI showed that the fistula had healed and my infusions were spaced out to be every 2 months. Things were fine thereafter until I failed Remicade in November 2022. I failed also the Remicade dose of January 2023 die to allergic reactions. So, I was switched to Stelara every 4 weeks in addition to Entocort.

I went through very painful months and was pumped with steroid injections. Almost a week ago, I started to have severe anal pain. I thought it was my proctitis acting up and took an Budesonide enema, which caused me severe cramps and watery diarrhea. So, I thought it could be a fissure and applied a GTN cream which also exacerbated pain. I had a look in the mirror and saw a purple boil near my anal opening.

Luckily, I had a follow-up appointment with my GI and brought it to his attention. I was confused whether it was an abscess or a papillea (the residue of the previous fistula. A CR surgeon told me before that it would flare up). He immediately put me on an antibiotic for 2 weeks until I see a colorectal surgeon. He referred me to one, who turned out to be traveling and will return next week. My GI belongs to that school that won’t allow the CR surgeon to cit the abscess open to drain it and prefers prescribing antibiotic tablets and injections until the abscess heals.

When I take the antibiotic and almost 4-6 hours after it starts acting, I start crying out of pain. I have been taking sleeping pills the last couple of days as I can’t sleep out of pain. To top it all, I’m constipated as my GI put me on rifaximin because of watery diarrhea. This constipation presses on the abscess. Any suggestions to ease pressure on the abscess and have a bowel movement? Would it be the same old story and am I going to be getting another fistula? I only had 3 years of break from fistula pain and discharge. I don’t know how effective is Stelara in healing fistulas if compared to Remicade which was very effective.

Post Edited (minnietoty) : 6/30/2023 5:11:39 AM (GMT-8)

Thank you, Susie. I do take the antibiotic religiously though it’s causing a headache. The previous abscess developed into a fistula, that’s why, I’m anxious.
I will start a laxative and hope it does the trick without worsening the abscess pain.

Surprised they're not opting for a drain line. I believe the exterior of the abscess makes it difficult for antibiotics alone to be as effective. Maybe this is the case, but I would inquire. You should see some improvement in the next week or so, if not you need to see your GI. Keep us posted.

As I suggested, warm sitz baths helps abscesses. I realize you are in Canada, however, our well known medical universities recommend them. I've looked on various one. My husband (who does not have crohns) has had 2 abscesses & he was instructed to do sitz baths.

Hey Minnietoty,

I've gotten 2 abscesses right by my original one that caused my fistula. We didn't lance it, I took antibiotics, it broke open on its own, and it did not cause another fistula. Both GI and Colorectal Surgeon said not to lance.

I am still on Remicade though.... And.. knock on wood.... It's still working for me... So unsure if that was a factor in not developing a fistula or not.

I hope you feel better soon.
Clo