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Anal abscess -please help!

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Crohn's Disease
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Posted 4/29/2008 10:44 AM (GMT 0)
Hi all,

My body's in such a mess! 

The good news is that after flaring for months on end last year, I went on the pred for a second time and it managed to get me into remission.  To sustain this my Gastro prescribed me 75mg a day of Imuran.  Everything was OK for 3 months until I noticed a painful tender lump develop on my bum near my anus.

I went to see my GP and she said I had 2 hemmies and prescribed me some ointment.  Things got so painful and I was lacking so much energy that I coyldn't get out of bed and I didn't have enough energy to stand up at the basin to brush my teeth.  I went back a week later and told my GP that there was no improvement... in fact I was worse.  I could barely stand up.  She said to carry on using the ointment.  Enough was enough of feeling terrible and the next day I took myself down casualty.  They did a digital investigation and said yes, I had 2 hemmies and a poss abscess but sent me on my way with no treatment.

I had a routine appointmest with my Gastro a couple of days later who took one look at me and said that I hadn't got piles but an abscess and taht was making me feel so bad (GP put it down to work stress -I'm not).  He prescribed me a 10 day course of antibiotics -Flagyl and an MRI scan. 

This seemed to help reduce the anal swelling somewhat but abcess didn't disappear.  In the meantime I developed a lot of very thin clear watery discharge through my vagina.  This has been going on 2 weeks now.  I went back to casualty as can't get an appointment with my gastro any sooner. 

Casualty doctors poked, swabbed and probed me and dismissed my abscess as small -it was massive the week before and said that discharde was prob down to a urinary tract infection.  A course of 7 day Augmentin antibiotics prescribed.  I'm 5 days into antibiotics and so far still got both problems.

My questions are:

1.  I've seen so many Doctors and nobody has mention drainage of the abscess -only antibiotics.  Why would this be? I was under impression most abscesses cleared by drainage?

2.  Has anybody else had this type of discharge?  It doesn't seem to fit with other symptoms of UTI as I don't have other symptoms like fever, burning sensation, passing more etc. 

3.  If it's a UTI -why drain through vagina?

4.  Why would my Gastro make me wait 4 weeks to see him when he knows I'm in so much pain and MRI scan results come back quite quickly?

I'm going back to GP on THurs for vaginal swab results so hopefully should get more snswers then but Gastro appointment not for 2 weeks and I can't get one sooner (I'm based in London, UK and see my consultant on NHS not privately).  I'm off on holiday on Fri for a week so it's not poss to have anything done sooner like a drainage.

Any answers or suggestions for me?  Thanks in advance.

Posted 4/29/2008 11:15 AM (GMT 0)
There isn't really much your gastro can do for the abscess. You need to see a good colorectal surgeon. The surgeon needs to drain it, clean out the abscess cavity, and then leave it open to heal from the inside out. This needs to be done in an operating room. While in there make sure he puts dye in it and then looks around on the inside of your anus to see if there is a fistula. Antibiotics will not take care of the abscess. Flagyl is a good rectal drug, and will help that area, but it won't take away the abscess.

What were your mri results? If they haven't given you them yet, walk into your gastro's office and ask for a copy. Then you can take that with you to your surgeon. Make sure you don't let a general surgeon touch you...it needs to be a colorectal!

In the mean time, lots of hot baths helps. It may even open the abscess up. If it does, it will just heal over again, and come back, so make sure you keep the apt. with your surgeon.

As far as the vag. discharge...don't know....def. don't think it is an uti. It could be another fistula....
Posted 4/29/2008 11:24 AM (GMT 0)
Hello Whaley,

I am sooo sorry to hear you have an abscess!! I've had 2 and from what I've been told, they must be drained and cleaned out by surgery in an operating room -- not just lanced. Unfortunately, you may now a have fistula from the abscess to your vaginal area that is responsible for the drainage. Both of my abscesses have fistula that empty out in the perinium (between the anus and vagina). I was on Flagyl and Levaquin and these helped, but I didn't get healthy until after the abscesses were surgically drained in the operating room and seton drains installed. The setons keep the fistulas from plugging and causing other abscesses. The drainage I had was milky or green-yellow and sometimes bloody.

Fistula are not something Doctors see regularly even in the emergency room. I went to the ER in January with my second abscess and they asked me to tell them what my seton was. They then said I needed to wait until the next day to see my colo-rectal surgeon. You really need to see a Doc who is experienced with CD. I strongly suggest a colo-rectal surgeon who is experienced with CD -- not just anyone surgeon!! These nasty infections, which is why you are bone tired, can get out of control quickly and go septic (which is life threatening). I strongly suggest you delay your holiday and just go to a colo-rectal sugeon expereienced with CD. Call and tell them this is an emergency and then just go see them -- heck with appointments! Sometimes you just have to take matters into your own hands. In my experience, the appointment schedulers assume that if you are willing to wait days or weeks for an appointmetn, you can be that bad. If you show up in their office and insist you have an emergency situation, the Doc will see you.

Praying that you find a great Doc and get this taken care of immediately. Then you can start healing! Please let us know how you are doing!!!
Posted 4/29/2008 2:32 PM (GMT 0)
OK, so if you have a fistula, then you have an abcess somewhere?  No one has ever mentioned abscess to hubby and I (he's the one with Crohn's), only the fistula.

What kind of test does an abscess show up on?  He's had MRIs, CT scans, ultrasounds, you name it.  Nothing has ever said "abcess".

Is it possible to have a fistula without an abscess?  He does have drainage, but it has begun to close since being on remicade (he's only had 2 infusions so far).  Is this NOT a good thing if he has drainage?

--t

 

Posted 4/29/2008 2:38 PM (GMT 0)
Also so sorry that you are going through this and seem to be getting the run around. I developed an absess a couple of years back and it was so painful and in a really awkward spot (aren't they always!) on my rear. My GI recognized it immediately and put me on antibiotics. He gave me the name of a colo-rectal surgeon. In the meantime, the absess got worse and I was put in another antibiotic. The surgeon said the absess was too infected to operate on at the time. He said that the infection would only spread and get larger if he operated on it while it was so infected. So, I was on two strong antibiotics for a couple of months. Finally he was able to operate the way it was described above, with leaving it open and all. I was lucky though and got to have it done in an out patient setting so the operation was not a huge deal.

I hope you get to a good colo-rectal surgeon soon and at least get some solid answers and better treatment. Good luck.
Posted 4/29/2008 3:00 PM (GMT 0)
Yes, the operation is outpatient...you go home that day.
Posted 4/29/2008 6:00 PM (GMT 0)
Hi Potatoqwn -- I'm surprised you were told you would have to ait until it got "less infected". Abscesses are walled-off infections. Your body seals it off so the infection can't go elsewhere in you body, which means antibiotics can't get to it. Antibiotics might calm down the surrounding tissue that is flipping out because of the infection. But the tissue will continue to flip out until the abscess is removed. Clearly I don't know all that happened. I just what you described sounds strange.

Hi NewCrohnswife -- I read post on this forum about fistulas that go from the intestine to another organ or to the skin. I don't know if an abscess accompanied it. For peri-rectal fistulas, I've only heard that they are accompanied by an abscess, but maybe others will know more than I. Drainage is good because that means the infected stuff is able to come out. When fistulas plug and there is still stuff from your rectum inside of it -- abscess! Seton drains keep the fistula open and draining. From what my Doc has told me, the large majority of peri-rectal fistulas must be corrected with surgery. I'd ask you Doc about this just to be sure you understand his particular situation.
Posted 4/29/2008 6:23 PM (GMT 0)
An abscess results from an acute infection of a small gland just inside the anus, when bacteria or foreign matter enters the tissue through the gland. Certain conditions - colitis or other inflammation of the intestine, for example - can sometimes make these infections more likely.

What Causes A Fistula?

After an abscess has been drained, a tunnel may persist connecting the anal gland from which the abscess arose to the skin. If this occurs, persistent drainage from the outside opening may indicate the persistence of this tunnel. If the outside opening of the tunnel heals, recurrent abscess may develop.

What Are The Symptons Of an Abscess Or Fistula?

Symptoms of both ailments include constant pain, sometimes accompanied by swelling that is not necessarily related to bowel movements. Other symptoms include irritation of skin around the anus, drainage of pus (which often relieves the pain), fever, and feeling poorly in general.

Does An Abscess Always Become a Fistula?

No. A fistula develops in about 50 percent of all abscess cases, and there is really no way to predict if this will occur.

How Is An Abscess Treated?

An abscess is treated by draining the pus from the infected cavity, making an opening in the skin near the anus to relieve the pressure. Often, this can be done in the doctor's office using a local anesthetic. A large or deep abscess may require hospitalization and use of a different anesthetic method. Hospitalization may also be necessary for patients prone to more serious infections, such as diabetics or people with decreased immunity. Antibiotics are not usually an alternative to draining the pus, because antibiotics are carried by the blood stream and do not penetrate the fluid within an abscess.

What about Treatment For A Fistula?

Surgery is necessary to cure an anal fistula. Although fistula surgery is usually relatively straightforward, the potential for complication exists, and is preferably performed by a specialist in colon and rectal surgery. It may be performed at the same time as the abscess surgery, although fistulae often develop four to six weeks after an abscess is drained sometimes even months or years later. Fistula surgery usually involves cutting a small portion of the anal sphincter muscle to open the tunnel, joining the external and internal opening and converting the tunnel into a groove that will then heal from within outward. Most of the time, fistula surgery can be performed on an outpatient basis - or with a short hospital stay.


:)
Posted 4/30/2008 5:09 AM (GMT 0)
FallColors, thanks for the info. All I know is what the doctors told me. I was at Loma Linda University in Southern California. They have some top notch doctors there. Lucky me, I got to have a group of about 10 medical students all stare at my rear end because Loma Linda is a teaching hospital!

In the end, it didn't seem to clear up much at all before the surgery. It started out small like a bug bite and swelled much larger. The surrounding tissue about five inches all around was really red. After the antibiotics, that reddness around did clear up. But the actual absess remained a painful oozing mess until it was removed.
Posted 5/31/2008 7:42 PM (GMT 0)
hi all.

just wanted to say thank you all for the info and good advice.

went on holiday in the end and the day after i came back i marched into casualty as my apointment with the colo-rectal surgeon wasn't for another 3 weeks and i couldn't wait that long!

to cut a long story short, i was admitted to hospital and spent a week on iv antibiotics. my surgery was booked for the following thursday wih the colorectal surgeon.

i had the op and spent another week in hospital on antibiotics. i was under the impression that abscess drainage was day surgery but i spent nearly 2 weeks in hospital! it's now been 2 weeks since the surgery and i feel a million times better. i am praying that i don't have any fistulae develop. how will i know if this happens? or will i just know?!
Posted 5/31/2008 8:27 PM (GMT 0)
Do abscesses only form on the rectum though? Can't you get them anywhere else? (In regards to Crohns)

Posted 5/31/2008 11:36 PM (GMT 0)

Hi Whaley,

I am so glad you got it taken care of!  Clearly it was very badly infected.  Abscess surgery is out-patient surgery -- your day-surgery? -- meaning no hospital stay.  I can only think you needed heavy antibiotics because it got so infected or maybe something else was wrong too.  I don't know your situation or what is going on with your life, but please, please don't let an abscess go so long next time!!  (maybe there will be no next time!!)  We on this thread recommended quick treatment for a reason!  I know it seems easy to deny them or try to ignore them but in my experience THEY MAKE YOU PAY!!  :-(   I really paid when I ignored my first abscess.  sad sad sad    I know I am coming down hard on you, but please know that it is because I am just re-living my own painful, painful experience and wish you weren't going through something similar now.  

Isn't it amazing how much better you feel once the abscess is gone!!  I just feel less "toxic".  I truly am praying for your quick recovery.  Just keep an eye on the tissue down there, especially if you have cellulitis -- that and a bad Dr. very neary killed me.  But it sounds like you have good Docs who are taking good care of you.  Healing will be slow and there may be set-backs.  But just relax, consider this time as an extended vacation, and know that it will get better and better!! yeah

As to whether abscesses can form elsewhere, I'm thinking the answer is "yes", but I have no experience to base that on.   And I don't want any, thank you very much!!

Posted 6/1/2008 12:14 AM (GMT 0)
I had a rectal abcess that turned in to a fistula several years ago. Before I was diagnosed with Crohn's. I saw a doctor who did the same thing, ointment and told me to soak it a lot. It took a week to bust and drain, that was a long painful week! After that it was just an open hole that drained and burned.

After waiting a year for this hole to heal up I finally saw a doctor in an urgent care that knew what it was, a fistula. They referred me to a general surgeon that did a fistulotomy. That took ANOTHER year to heal! Was not fun! But it did heal, and hasn't given me any trouble since.

Sorry to hear your having to go through this, hope you get some relief soon!
Posted 6/6/2008 6:37 PM (GMT 0)
whaley:

"i am praying that i don't have any fistulae develop. how will i know if this happens? or will i just know?"

From my recent experience, if passing wind has a sensation of going somewhere it shouldn't within your body (in my case- through my right buttock to the the perenium area (between the scrotum & anus))- that's a clear indication of a presence of one!
Posted 6/6/2008 8:34 PM (GMT 0)
ouch... the one draining abcess I had took closer to 4 months to heal. It was discovered at the same time as Crohn's... (well by doctors anyhow...) I was 12, they thought it was my appendix... They still took out my appendix. Wouldn't let me keep it though... *sniffle*... nor any of my resected intestine... *sniffle* I stopped asking after the second resection...

As for how you'll know... that's a toughy... My second resection was due to massive internal fistulization. I thought I had caused myself a small hernia (and hadn't gone to the Dr) then had a major flare of Crohn's landing me in the hospital... the CT showed fingerlings of fistulas spreading out from my intestine and working their way into my abdominal wall... I got lucky though... they attached to no other organs... not even back to the intestine.

As for fistulas since, I've had a few small ones near my anus. They's never been open or drainign, and Flagyl has always done the trick. I've begun taking a look on my own with a small flashlight and shaving mirror. If I suspect I have one I call my GI Dr. they inspect and so far I've been right the two times I've called saying "I think I've got a tiny fistula." I'm hoping I'm wrong about #3 here... but we'll see what they say after the appointment... (Regularly scheduled for this coming July, waiting to hear if they want it sooner...I know I do... and they have always worked to accomadate me... I just hate waiting on a call back...)
Posted 4/29/2011 4:13 AM (GMT 0)
so I have been diagnosed with one of the most painful things i have ever felt, i went to my GP yesterday and he poked and proded and said it could be an abscess or a sinus infection in my butt, prescribed me some antibiotics and no pain killers and set an appointment for june 6 with a sergeon. Well last night the pain was so bad, by the way i am a 30 yo healthy male who fears doctors, i hit the ER and a few minutes i was in. he looked at my sore and confirmed it as an abscess as well as looked at my prescription and told me it was not right for the abscess because it deals with negative and positive bacterium and i was given the negative which has no effect on abscesses. I was pissed and in pain, i had this thing for 5 days and said my body was trying to fight it hard and prescribed me tylenal T3 and ciprofloxacin and bath sitz. Went home last night and indulged in the euphoria of T3 which I have never had before. today was painful but taken these antibiotics i have reduced swelling and the doctor told me that it was caught early and small enough, the size of a flat golf ball, that in 72 hours it will clear up and no need for surgery. So i have better pain releif, reduced swellin by 50% overnight ( 1 pill twice daily so four pills as of right now) and it has only been 24 hours. So I figure after 72 hours it will be almost gone and continue with my therepy and hopefully be cleared up in a week. i heard alot of people talking about surgery is the only way to go but i typed in perianal abscess cured with antibiotics and a page came up on medscape that was not there when I typed in just perianal abscess and it states that "Controversy exists regarding the use of antibiotics in the treatment of perianal abscesses. Traditional teaching holds that drainage alone is sufficient for abscess treatment in otherwise healthy patients. A 2007 study by Christison-Lagay et al demonstrated that antibiotic use for perianal abscess decreased the likelihood of fistula formation.

All immunocompromised patients with infections should receive antibiotics as a component of their therapeutic plan. Patients with Crohn disease require antibiotic therapy in addition to the medical therapy used to treat their Crohn disease.

Perianal abscesses often grow mixed flora and can be well covered by various antibiotic choices. Common oral regimens for routine infection include cephalexin or amoxicillin-clavulanic acid. Methicillin-resistant Staphylococcus aureus (MRSA) is rarely implicated in perianal abscesses but should be considered as a pathogen in patients who are not responding to traditional antibiotic choices. Trimethoprim/sulfamethoxazole is available in liquid form and can cover MRSA." it is working for me after 24 hours but still am scheduled for my appointment with a colorectal surgeon in june for my fistula.

I hope that this information can help people out with the pain because it is excrutiating and we do not deserve to suffer. As of right now i have no prior surgery for my fistula which formed in 2005.

oh yeah a inflatable donut is awesome

take care of yourselves andhopefully all turns out well :-)
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