Perianal abscess

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Hi Am Jamoss i in Rwanda   I had a perianal abscess and  i had 1 operation in july after operation  in two weeks i start felling better because i saw only remain of  a  scar  but only one week the scar start swelling i go back to the doctor and he told me the there is another absecess starting developing so its need another operation before fistula being created so i take another appointment of saturday means tommorrow for another operation plz help me or advise me what should i do, if i have to go there again or if there is another option. Thank u am waiting for ur quick response

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  • Posted

    If the abscess came back then there is probably already a fistula. You should have your doctor just do a fistulotomy.
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    • Posted

      Hi Jamoss,

      I have a few questions that could help me to suggest some things.-

      1.) Did your wound have gauze packing after the surgery? If it did, for how long? If the wound heals over too quickly it will recur because all of the pus takes some time to slowly empty (weeks, even months).

      2.) Was your surgery done by a colo-rectal surgeon or a general surgeon? This is very important, since colo-rectal surgeons know how to cut it at the right location for optimum drainage.

      3.) Are you healthy? Do you smoke cigarettes? Do you have Crohn's disease? Diabetes? Do you have chronic diarrhea or constipation? All of these things are of vital importance since they will affect what the best possible solution will be.

      Final note- abscesses that are drained often become fistulas (more than 50% of the time) regardless of health status, so a fistulotomy is something that you should consider (if you are healthy, they do not recommend fistulotomies for people with Crohns).

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    • Posted

      Thank u Cporosus

      1. Only doctor wrapped the wound after operation but when I reach home I remove it as he told me to use 5 liters of mixed with 2 spoon of salt to clean wound

      2 in my life no smoke cigarettes I don't have crohns disease no diabetes

      no chronic diarrhea or constipation

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    • Posted

      I had trouble with a perianal abscess. It's really important that your abscess wound is packed daily until it's fully healed as the wound heals from the inside out. If the ouside skin heals over before the inside has healed, the abscess will reoccur and it is highly likely a fistula will develop

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  • Posted

    It sounds like you are otherwise healthy, so perhaps a fistulotomy would be the best option. Are you able to get to a qualified colo-rectal surgeon in Rwanda? There should be some good colo-rectal surgeons in Kigali. It is a fairly straight-forward procedure- the surgeon will identify the fistula (which is likely present) and obliterate the tract and leave the wound open (it's a fairly large and frightening looking wound, but it surprisingly isn't painful and will heal within 2-4 months in heathy people) to heal from the inside out. The most important thing is to keep the wound clean until it heals, so gently washing the area with water (a bidet is ideal) after each bowel movement is vital. Infections of the wound are surprisingly rare (I think only 1-2% of patients) since the area is fairly infection resistant. As for what causes these abscesses- most (90% roughly) have no underlying disease as the cause, and are believed to have been caused by the clogging or blocking of an anal gland (which lie just inside the anus). This can happen through straining to push stool out, hard stools, foreign objects (e.g. Fish bones), and occasionally anal sex.

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    • Posted

      Thank u so much but am gonna ask if here we have colo-rectal surgeon

      I would like to ask some questions depending with my problem.

      1its now 2 month after 1 operation for the first time doctor told me my fistula is simple cuz its has one output

      after operation just I continue to go to work as usual but twice daily I clean wound using mixed water hot and cold with salt just in 2 weeks wound was healed depending how I was feeling cuz I was able to sit no pain I start doing sport as asual but after another 2 weeks the scar start swelling just when I press on the scar I saw the liquid goes out on a very small hole

      on a side where operation made but not on the scar of the first operation,I would to know what I will change after the second operation

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    • Posted

      If the wound healed in only two weeks then it probably wasn't large enough. The surgeon should cut a fairly large and deep area that "lays open" the fistula tract and then it slowly heals from the inside out. This usually takes a minimum of two months, sometimes as long as 6 months, but usually not. Mine took 3 months to fully heal. A colo-rectal surgeon will know how to properly open the wound to prevent recurrence

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    • Posted

      so I would like to know if I take antibiotics to reduce pus there is any problem ?cuz the operation will be made this coming Saturday so the scar is full of pus
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    • Posted

      Hi Manzi, I hope you are recovering. Anti-biotics don't necessarily help, it depends on where the abscess/fistula is, your colorectal surgeon will advise on this. After my fistual operation I could not do anything for 2 weeks, just rest and wash the wound as you are doing. After 6 weeks, I would be more back to normal but really it took three months for me to heal and the surgeon then checked the area for me to confirm I was properly healed. I still felt it slightly for a longtime afterwards but I guess this is to be expected.

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    • Posted

      Hi am not yet but always ask this question cuz my doctor told me my fistula

      not yet become an abscess so i want to know difference between fistula perianal and abscess perianal

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    • Posted

      Perianal abscess usuall comes first. - An anal abscess is an infected cavity filled with pus found near the anus or rectum.

      A fistual is commonly formed when a surgeon drains a perianal abscess. Sometimes called fistula-in-ano is a small tunnel connecting the anal gland to the skin of the buttocks outside the anus.  They almost always occur following a previous perianal abscess.

      An abscess can be quite minor and heal quickly but if it is more complicated then it can become a fistula, which can take more time to heal and may ead to further operations until it does.

      The bowel and keyhole website or the webmd website have a very good page with a diagram expaining this. Once you get to the sites search for anal abscess or fistula.

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    • Posted

      ooh thanks for the information but i want to ask u about my issue now if feel comfortable now there only a scar but the problem is only on onr week the wil start

      to swell with pus and one day later the scar burst and again heals so i want to know is it the operation which is made unproperly way?

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    • Posted

      Hello again Manzi

      It sounds like you need to go back to your surgeon to understand better what is happening and how best to treat it. As Tulip said above an abscess and a fistula need to heal from the inside to the outside. If is just heals on the outside it will likely fill up with pus again and then burst again. If your surgeon has told you that you have a fistula then this will take longer to heal. I had a rubber band inserted into my seton, 1. It stops the wound closing fully which means it can continue to drain, draining can take many weeks before it stops. 2 depending on where the fistula is the rubber band is supposed to move through your body until it falls out naturally closing the wound behind it, leaving no space inside for infection to re-occurr. This last part is more complex to understand and you may not need this but your surgeon should do an xray - I had an MRI scan - to show more clearly what is happening inside of you then the surgeon knows how best to operate to clean out the abscess/fistula to allow it to heal. Packing the wound each day after is supposed to stop the wound healing too quickly on the outside. Talk to your surgeon, tell them your concerns. They should listen and explain properly what the problem is and how they think it should be dealt with short and long term. best wishes for a speedy recovery.

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    • Posted

      It sounds like you almost certainly have a fistula. If the abscess hole keeps healing but then reforming, this is a common sign of a fistula being present. A fistulotomy will get rid of it (so long as you don't have Crohn's disease).

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    • Posted

      thank u for ur advice i will go back to the doctor i will let u know,but am suprised now when am trying to touch behind its like for sure healed i do my work as usual no pain no anything i do gym no problem but i wonder how it reforming again mine is on the left bum not inside
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