Butt wound again

So since my proctocolectomy back in 2010 I have had a non-healing butt wound. For some of you that don't know they sewed it up when I had my surgery but it got infected and opened back up. I used creams, gels and even a wound vac.
about 7 months ago I had some bloodwork done by my GI doctor and they said I didn't have any Iron in my system. I started having Iron infusions regularly and my wound started healing. I have been struggling for the last 1.5cm to heal and close so I didn't have to pack it anymore.
I had a friend doing it for me every single day up until about a 2 months ago because of how deep it was and the angle of it. I have been doing it myself for a few months. So about a week ago I started having pain and it got really bad. To the point where it hurt to sit again like when it was deep. It was almost unbearable. I had my friend take a look at it and she said it was really red and inflamed. Well she pushed on it and a ton of infection came out. Now she's been changing the dressing 3 times per day and infection has been coming out and the wound opened up more.
I just got on Medicare because I have not been working.
Now my questions is this.. Can it heal with just changing the dressing and using the antimicrobial gel or do I need an oral antibiotic?
I would just hate to have to go to the doctor and owe $800+ for them to just tell me to keep doing what I am doing or just tell me to take an antibiotic. I don't want it to get any worse... I get better insurance in January but I dont know if it can hold out that long. Any advice?

Oh, Brian, I am so sorry. You have had such a bad run with this wound.

I think the answer to your question is that it could heal with topical treatments, but then it also could not. Not sure how any of us could tell. It seems to me that the worst case scenario (systemic infection, hospitalization etc) is bad enough that it's worth going to the doctor, although I'm sure it'll feel like a waste if it's not that scenario (although that would be better). Maybe you could postpone any expensive tests until after January, but just have someone look and prescribe something if you need it?

You could also try going to the hospital patient advocate to see if they would lower the cost for you.

Hang in.

     Sorry you are still dealing with this Brian.  As you know, my surgeon left my anus open.   When I developed an abscess inside the anus post-op he was able to get in there with a suction tube and suction it out and I was then placed on antibiotics.  It's best to check with the surgeon to see if you need oral antibiotics.  Better to be safe than sorry.

     From time to time I have some mucus but it is able to escape and, touch wood, no abscess problems.

Equestrian Mom- Unfortunately every time I call the doctors they always want me to come in. I don't know if it's because of the money or because of the liability or whatever.

I think it opened up a little wider and a little deeper. It's hard to know since I haven't been taking exact measurements.

Blueglass- I was always under the impression that the packing and the topical or antimicrobial creams or gels helped prevent infection... Read below for what the doctor told me today.

Allbluezoo- I am going on 2.5 years now and it's still not all the way closed. I've tried not to ride a bike or do anything strenuous to that area since I thought that it would open up if I do. I always had blood or discharge from the area requiring a lot of packing and ABD pads up until about 7 months ago it started being pretty dry, which was nice.

Chrstine- I read about some of the issues you had, glad you are doing better right now.

ddd45- Is that also known as a debriedment surgery? I had that done after it wasn't healing for a year and it didn't do anything for me. I tried everything and after a year of requesting blood work to see if nutrition might have been preventing my wound from healing but they said no. My GI doctor (not surgeon) did a test and found out I had no Iron. After Iron infusions it started closing.
I am also going to try the sitz baths.

Ok so I did end up going to the doctor today. Him and his assistant jabbed a long q-tip in there very hard and it hurt really bad and it was full of blood and my butt was bleeding. They just put a 4x4 gauze in there to catch the blood.
He said not to pack it anymore and just to take the antibiotics. He said the only reason you pack it is so that it doesn't heal from the outside in. I could have sworn they said that adding the gels or creams to the dressing was to prevent infection. I also thought I wasn't packing it right and that's why I have an infection.

Yes I flush it with water every day and then spray the microcyn in there.

The doctor jabbed it really hard with the q tip yesterday and it hasn't stopped bleeding. He told me not to pack it so now I have gauze in there catching the blood. It's very annoying.
I've been seeing a few different doctors for this but the reconstructive surgeon that they sent me to had been monitoring it. I had questions about my stoma and this came up so I ended up seeing my original surgeon. I don't think they tested it this time. I know the last surgeon did a while back. I am just afraid that they made the hole bigger and it's going to get worse from not packing it and I am going to be set back another year or two.