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Are surgeries always the solution for abscesses/fistulas?

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Crohn's Disease
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Posted 5/10/2024 5:02 PM (GMT 0)
Since 2013, I have started my perianal abscesses. I developed my first perianal fistula in 2016 and for which I was put on Remicade every 4 weeks. After 3 years, the MRI showed that it has healed. So, I was given Remicade every 8 weeks and had no fistulas until I failed it in November 2022. Ever since, I have developed many abscesses and the fistula got reactivated. For almost a month, I have been suffering from a resistant perianal abscess. I failed 3 rounds of antibiotics. Saw my GI last Wednesday and he prescribed the 4th round of antibiotics, mentioned that it is a resistant abscess and ordered any MRI to rule out the reactivation of the fistula. Pain is unbearable and I cannot tolerate it any more and Solpadeine doesn’t alleviate it and doesn’t allow me to sleep. I feel I’m like a zombie. My GI talked to me before about placing a seton but I refused for fear of having fecal incontinence. Is surgery a must to treat abscess/fistula? In another group, other fellows mentioned that they had colostomies and different types of surgeries to treat the abscess/fistula. How could you heal your abscess/fistula?
Posted 5/11/2024 2:14 AM (GMT 0)
Minnietoty,

There are ladies in my support group that had setons and they have been ok... Or at least they say they are ok. Another lady had one and she was having difficulty but after every thing had healed the colorectal surgeon went in and tightened everything up and she's doing much better. So I dunno.

Personally, my RVF would not heal, I was frequently incontinent or severely constipated and by the time I had surgery...a colostomy... I was ready for it. I could not believe that I had fought as long or as hard to avoid it. It improved my quality of life so much. Do I wish that I still functioned like other healthy people? Of course occasionally I think that. But usually I am just so darn grateful for where I am that regrets are few and far between.

I met a lady that was having the same issues I had experienced. She asked the CRS to speak to someone and he gave her my number. I went to her house. She could not leave hers--accidents. She decided she could not have the surgery. Shed rather be at home the majority of the time, or she would not eat for 3 days prior to going out and limit her liquid intake plus wear disposable underwear..and then she'd go out and only stay a very short time.

I did read about a doctor that was in the US that repaired fistulas and he had a higher success rate than others....I can't remember his name. I remember that he went to Africa every year and repaired a bunch of them yearly so he had more experience than other doctors. I'll try to find it again.

My concern is the abscesses. When I experience an abscess it causes another fistula tract. They can go in and surgically remove them and allow you to heal from the inside out....on both the fistulas and the abscesses. We've done that in some of my abscesses so they would not go on to develop a fistula tract....and so far they haven't developed the tract, nor have they returned...but we started using IV antibiotics whenever the abscess first develops. If larger...they drain it if possible, pull the "sack" out and then IV antibiotics...if it isn't large we just go straight to the IV antibiotics. Since we started using the IV method, along with the Remicade and methotrexate...I haven't had many larger abscesses that require a drain and remove procedure.

I'm sorry the antibiotics are not working. Hopefully someone else has more information.

Clo
Posted 5/11/2024 6:48 AM (GMT 0)
Clo, thank you so much. That was very insightful. I understand now why people opt for colostomies. Definitely, the idea is terrifying but having this constant pain without seeing any light at the end of the tunnel is so devastating.
So glad that your abscesses/ fistulas are under control. Fingers crossed.
I think I’m starting to reconsider the idea of a surgical procedure. I can’t imagine myself tolerating this constant pain more and more. I’ve had 4 abscesses since the beginning of the year. My GI informed me that they are all Crohn’s related and we ruled out HS. I can’t act like the lady you had mentioned who chose to stay home rather than go out. I have work to do.
I’ll have the MRI and then see my GI to discuss all treatment options.
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