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Posted 5/3/2012 12:33 AM (GMT 0)
After suffering with anal pain and drainage for the last year I went in for a colonoscopy. My ulcerative colitis is in remission but i developed a superficial anal fistula at the site of an old anal fissure. When I went to colorectal surgeon consult he was concerned with my diagnosis of UC and said fistulas are not typical, but could I have Crohn's instead? What would the chance be? I am waiting for Prometheus labs. I was initially diagnosed with "colitis" on colonoscopy in 2002 and disease has been limited to rectum/sigmoid.
Posted 5/3/2012 1:52 AM (GMT 0)
Fistulas are very rare with UC and definitely more common with CD...it's not the only thing to base a DX on though, the important things the GI should know via scoping is what your pattern of inflammation is....if it's patchy then that's CD (UC will have the entire area inflammed with no patches or skipped patterns of inflammation) the other key difference is how deep the inflammation goes, surfaceable is UC, but CD can affect the many layers of the lining in the GI tract. Lastly is location, CD can affect the entire GI tract from mouth to anus, UC is limited to the colon/rectum.
Posted 5/3/2012 2:03 AM (GMT 0)
If your disease has been limited to the rectum and sigmoid colon, then the treatment modalities are the same anyway. Although now that you have a fistula, you might be having a discussion about Humira as a treatment plan. I'm sorry you're suffering with this and hope you feel better soon!
Posted 5/3/2012 2:07 AM (GMT 0)
What is drainage from an anal fistula like?
Posted 5/3/2012 11:28 AM (GMT 0)
I have UC and developed a perianal abscess three years ago which eventually developed into a fistula. Initially, my surgeon was fairly confident that I had Crohn's because of its development but changed his opinion. He has been treating me as if I have Crohn's in that he has not been as aggressive in my treatment as he would be to a patient in the general population but fortunately my fistula is now nearly completely healed. Ultimately, people with UC are also part of the general population and therefore will also end up with fistulas at a similar rate.

As to 'Do you have Crohn's?' I agree with pb4's comments. I would recommend reviewing the differences in symptoms of the two diseases to see if you have any that are unique to Crohn's.

Best of luck in your treatment.

I eventually got a bidet lid for my toilet to help me deal with having both problems at the same time which allowed me to keep the abscess/fistula clean when I was using the toilet for hours a day during flares.
Posted 5/3/2012 12:35 PM (GMT 0)
I sort of wonder if he's thinking CD because you didn't have an abscess that turned into a fistula - I know that is relatively common in the general population, but I'm not sure how common it is in the general population for a fissure to turn into a fistula. It might be worth discussing that with him.

I developed a perianal abscess in early August last year, which turned into a fistula. Neither my GI nor my CR surgeon think I have CD instead, and my CR surgeon also said that he doesn't think it had anything at all to due with my UC, that it was just a bad luck sort of thing, like it is with the general population (my GI hasn't commented about this). Part of the reason they still both think I have UC is because I was diagnosed with pancolits, and it's very rare that CD will produce a continuous pancolitis like I had. My biospies also pointed to UC instead of CD. My CR surgeon did say that if I develop more abscesses/fistulas, that he would lean toward changing my diagnosis.
Posted 5/3/2012 1:54 PM (GMT 0)
I too, have a long-standing fistula that developed from an abscess. My GI & the 2 colo-rectal surgeons I've met with all think it's just good old UC- it's not THAT rare for a UC patient to develop fistulas, especially if you've had active disease for quite some time. Any long-term active inflammtion leads to tissue degradation, & things like a fissure, etc. just won't heal like "normal" tissue.

Posted 5/3/2012 1:58 PM (GMT 0)
Eva's post brought up another point: my abscess/fistula is not at all related to long-term active inflammation. I've been in symptomatic remission (and I mean ZERO symptoms) for almost exactly 3 years now (so over 2 years when I developed the abscess) and a scope in October last year showed a normal, healthy-looking colon. So that's why mine was thought to be totally unrelated to UC.
Posted 5/3/2012 3:30 PM (GMT 0)
Ha, fruitgirl you're just one of those lucky people who develop an anal abscess anyway! rolleyes
Posted 5/3/2012 3:35 PM (GMT 0)
Haha, Eva! Yeah, I'm soooo lucky!
Posted 5/3/2012 4:26 PM (GMT 0)
It's rare for UC in comparison to CD was my point.... even healthy people without bowel disease can develop a fistula but that is even more rare compared to a patient with an IBD.
Posted 5/3/2012 11:23 PM (GMT 0)
Don,t mean to be graphic, but can anyone describe the drainage, I have some, but not sure where it is coming from.
Posted 5/3/2012 11:27 PM (GMT 0)
Can someone describe what the symptoms of a fistula are?

Thanks
Posted 5/4/2012 12:05 AM (GMT 0)
chrissy,

Usually they start with a painful/annoying bump/sore, they may resemble a pimple with a white head on it and usually red everywhere else on the bumb, here's a link that explains more info...

http://www.nhs.uk/conditions/Anal-fistula/Pages/Introduction.aspx

Posted 5/4/2012 1:12 AM (GMT 0)

allswell said...
Don,t mean to be graphic, but can anyone describe the drainage, I have some, but not sure where it is coming from.

I had blood, puss, and a yellow colored liquid flow from my fistula. My fistula, which is basically a channel, went from about a half an inch from my anus (on my right side) to the mid-poiint in my anal canal.

I initially thought that I had a hemorrhoid but the pain grew extreme. The morning before I saw a doctor, I used the toilet then got up and walked ten feet to the living room and abruptly passed out from the pain. Next thing I knew my wife and daughter were standing over the top of me.
Posted 5/4/2012 8:20 AM (GMT 0)
Thanks.
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