new w/ possible fistula

Hi..

1st time poster here, but have a great educational experience lurking on Crohn's and UC boards.  I know many with CD have had the unfortunate experience to of dealing with fistulas. 

I was DX w/ UC three years ago via a biopsy taken during a colonscopy which found active, mod-severe colitis. GI saw little to no inflamation as I had been on meds for about 7 weeks before the scope and they were working great.

I have been flaring on and off for about 5 months now.  I developed a rectal abcsess about 8 weeks ago.  It was surgically removed/drained and I spent three days into the hospital because the infection was "systemic?".  Afterward the wound was kept open with gauze packing for another fifteen days.

What I have left now is a small hole next to my anus that drains stringy green glop and a pink or brown colored clear fluid.  GI looked at it about 2 weeks ago but couldn't be certain if it was an unhealed wound or a fistula..A fistula, to me, seems like a crazy unreal thing and brings to mind tiny aliens with tiny rayguns blasting their way through my flesh (most likely to escape the vile, malordorous events transpiring in that region lately) :) 

Finally my question(s), Is it possible to develop a fistula such a short time after having an abcsess.  I thought that generally, a fistula comes before an egg, I mean, an abcsess?  Does what i have sound like an abcsess to those who know about them?  Also next to the hole is a small red flap of skin that looks likes a tiny part of my insides trapped on the outside (probably the work of the fistulizing aliens).

Thanks in advance!

Question that might help the others to help you . . . . what doctor did your surgery for the abscess??? Depending on his specialty, he 'may' or 'may not' have had a lot of experience what he was 'actually' dealing with. Blessings!

I have had abscesses drained, and depending on how deep they are, they do take time to heal, and I don't think that 8 weeks is too long to worry about it being a fistula yet. I have had open and draining still for around 4 months. There is a 30-50% chance that you will be left with a fistula after you have an abscess drained, so don't be too surprised. I would definitely give it a couple more months before I would worry about it being a fistula.

You had it properly taken care of which is great! So, it is healing from the inside out the way it is supposed to, so hang in there. Do you soak in the tub at all? When mine are healing, I soak in the tub as often as I can and in the hottest water that I can stand. The hot water brings the blood there and promotes healing.

Ask your dr. to look around on the inside while he is in there scoping to see he can find an internal opening. Your surgeon should have done that also when he drained it. They insert dye in the abscess cavity and then look around on the inside to see if it comes out anywhere....if it does, that would mean you have a fistula. Keep us posted on your progress.

Hi Madabs,

Sorry to hear you had an abscess. I've had 2 abscesses and a have branched fistula. The fistula starts out from one hole in my rectum and empties out in my periniem. The fistula tube that formed from the hole actually split/branched so I have two exits. My colo-rectal syrgeon is very experineced with CD and put in seton drains in both fistula. These plastic rings keep the fistula open so the stuff can drain out and not plug up and abscess.

There are many threads about fistula and setons. I suggest you use "Search Site" if you want to check them out.

It is critical that your surgeon and GI Doc have experience with fistula. Not many know of them unless they specialize. I've even had the head ER doc at a premier hospital in D.C. ask ME what a seton was. Don't let anyone touch you/cut into you unless they have experinece with CD. Even though you have UC, a Doc who knows CD will know how to handle fistulas. We CD people don't heal the way others so or as fast, so your Doc needs to know how to handle us. I suggest you go see your colo-rectal surgeon -- or one that knows CD.

I hope it works out for you!! Let us know what happens.

This site has been an excellent resource for me too. My Docs are very experienced with CD, and are very good about answering questions and educating me. But once home, I always think of more quesitons. The folks here have such a wealth of experience (unfortunately) and are so willing to share. They are wonderful!!

I agree -- learn as much as you can and then don't leave your Doc's office until you get the answers and explanations you need. However, something I know too well is that everyone's CD is different and dealing with damage is often more art then science.

Over the last week I have had more drainage out of one fistula. Yesterday, I felt a very small swelling but it is hard to feel because it is under the scar tissue from the last abscess surgery. I was trying to feel what was going on when I felt a small popping feeling and a small amount of bloody stuff came out of the fistula -- small amount, a couple spots of the toilet paper. This is probably another abscess off of the fistula. I will get into my colo-rectal sugeon ASAP but I'm wondering if this won't be a wait-and-see situation. The whole area is probably like swiss cheese!! And maybe I will get these problems now and again. What I will ask my Doc, after we decide what to do about the current problem, is in the future, should I call him at the first sign of something?? Should I take an antibiotic (I have a small stash) and call him only if it doesn't resolve itself after a few days??? Having a plan of action will really help me know what is important and what we can watch. All part of disease management. I'm blessed that my colo-rectal guy is sooo willing to take the time to discuss everything!!!

Anyway, hope your situation resolves itself very soon!!

Thanks to everyone who helped me out with my question.

My doc took a look at my little hole during my scope and said it is fistula to nowhere and may heal in time.  I guess since I have uc I am not likely to have such severe complications from the abscess as someone with crohn's.  I think I was just being overly sensitive because I felt like perhaps my hygiene was coming into question since people with UC don't get abscess' or fistula.

Thanks again!

Are you sure that you don't have crohns???

As far as the hygeine comment, my surgeon told me to stop being so anal about keeping it so clean down there. :)