Abscess and fistula questions

Hi all,

Looking for some advice. I had a perianal abscess back in July following my first UC flare by about 5 months. Had it incised by a colorectal surgeon (very painful if you've never been through it). I was told by my surgeon that there is a chance that I have Crohn's, not UC, but that this is not necessarily the case. Apparently, perianal abscesses are very common in Crohn's and less so in UC. He also stated that I have a 50 percent chance of recurrence and that if it recurs that it will be because of a fistula and fistulotomy will be needed under general anesthesia.

I followed up with my GI, who went back to her records and was still convinced of her diagnosis of UC.

Fast forward almost 5 months later to this past Sunday, and the abscess pain is back. I don't know how many of you have dealt with this but it is very demoralizing. I hobbled around work yesterday due to the discomfort and told people I pulled a muscle. I've been feeling great and this is a huge blow to my morale. Anyway, I try to stay positive, but I also like to be mindful of some of the negative consequences of surgery. I can't get into my GI or colorectal surgeon till the end of the week so I guess I'm just looking for some advice on how to deal with this and what to expect from fistulotomy and the recovery.

What is the surgery like?
How painful is it?
How long/painful is the recovery?
What are the risks?
Should I be on biologics? No flare up, just the abscess/fistula problems.
Anything I can do to deal with the abscess over the next couple days?

Any advice is greatly appreciated. Especially from those who've been through it.

Hey Uniform,

Well you know I've been through it. I really have to commend you for going to work. You're tough. The pain is agonizing and it's difficult to think of anything else when you feel like there's a finger up your butt.

Did you try the Wild oregano oil/olive oil remedy? It's helped me twice. Only issue now is that I'm dealing with a hemmie. Never ends:(

As far as surgery....it's weird. my MRI showed a horse shaped fistula but when she went in, I only had a very large abscess. A massive one. I was doing a lot of research regarding the types of surgery for a fistula and was terrified of being cut especially when incontenience is a huge issue for me. I was extremely firm in that I didn't consent to the seton technique. Although it is the most recommended way to rid yourself I simply didn't have confidence in my ability to heal well. You may have better luck with your situation than I though. The other options are the glue/plug or injecting an antibiotic into it (if your surgeon has forward thinking). Maybe research under the Crohn's forum, but yes the reason why my GI thinks I now have Crohn's is because of these issues:(

I'd give the WOO a try though and of course sit in a hot bath. You may also try lidocaine works for the pain.

Sorry you're going through this.

Hi
Sorry you are having to deal with this. It is horrible and so painful!

In the short term, try Sitz baths with the water as hot as you can stand it. It should help some with the pain and for some people their abscess will burst from the heat. I also took advil and leftover narcotics to get through the night, but I know most people with UC cannot tolerate advil.

Do the doctors office know you have abscess? How can they expect you to wait for an appointment with such agony! If you get to the point where you can't stand it, you should consider going to the emergency room.

Also please monitor yourself. If you start to feel ill and run a fever go to the emergency room. I became very ill when I had an abscess and spent three days in the hospital. Not to be dramatic, but for fact's sake, I'll tell you that the emergency room doctor told me rather bluntly that an abscess can kill a person.

As for a fistulotomy, I guess you know that there are alternatives to the surgery and that it is only one of many options. However since I had the surgery I will share my experience the best I can remember.

The surgery was less than hour. It was done at an outpatient surgery area of a hospital and I was on my way home after about four hours from arrival.

The initial recovery was surprisingly quick and beyond the first day, the pain barely registered when compared to the pain of an abscess. It healed up fast and there was no wound packing involved because the fistula channel is laid open. Probably a couple days off of work and if you could work the surgery into the end of the week so you would have the weekend added on, more the better. You have to take a lot of sitz baths though!

The long term effect is that I have a small amount of leakage which I think is the main risk of the surgery if I recall correctly. Even though the sphincter was cut I don't feel that the leakage is from that though. I think the leakage is primarily a result of the open channel left by the fistulotomy that acts like a viaduct from deep in my anus to outside my sphincter. A small amount of liquid escapes from that nearly everyday. It stays mostly in the crease that was left from the fistulotomy and there is not enough to stain underwear. I don't think it will ever go away, but I've gotten used to it and keep wipes soaked witch hazel nearby.

Explore your options. I'm don't think I would do it again as a first choice. In the meantime....Bug those doctors and see if you can get an earlier appt!

Charlie...yes the surgeon and GI mentioned this was a risk., for me....it may not be for you.

Stay in bed for sure. I'd sit on a heating pad constantly. If you do end up trying WOO--- use far more drops of OO than WOO to begin with, it lessens the burning. I inserted and hopped into a hot bath. At times I took a gravol so I could sleep after the insertion. The abscess should burst within a few days.

I got the protocol from Canada Mark. I'm sure he wouldn't mind if you contacted him for help/advice.

Hello!

At 17 I had a perianal abscess, which was misdiagnosed initially as piles, and it wasn't until it was impossible to walk that it was diagnosed, I was admitted immediately to hospital where I had it excised under GA and stayed in for 6 days.

Over the next 11 years, I 'ignored' the weeping, reinfecting fistula that developed. The pain was at times unbearable, I used to have to call a taxi half way home because I could no longer walk. I recently wrote in another thread that I found using a dressing called Duoderm over the external openings (I had 9 in a circle externally, all linked internally-looked like a weird dot to dot!), this seemed to reduce the inflammation and weeping, and was wonderful for stopping the pain and chafing.

At 28 (three years ago now) it all got too much for me and I visited my GP and asked for surgery. I had a fistulectomy three weeks later under GA as a day case, but was kept in overnight to await biopsy results (which were all clear). I'd not had my UC diagnosis at this point.

The first couple of days I was spaced out on pain killers, after that, I found the pain so insignificant in comparison to the pain of the ever reinfecting fistula. I had the wound cleaned and dressed daily, it took around 2.5 months to 'grow', and then I started over granulating, that was solved with silver sticks. The tissue remained delicate for around 6 months, but I was just careful not to over exert myself, and I wore loose fitting trousers!

Had I known the difference it would make to my life I'd have opted for surgery much sooner! I've been pain free since, had no incontinence and no reinfection/recurring abscess. I know everyone's experiences are different, but they're not all bad. I'd do it again in a heartbeat.