Perianal abscess - Help!

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Hello, I'm back on here as last year I had an operation at hospital to drain a large perianal abscess, it was cut open in an x shape and left open to heal. I had it packed everyday for a week, then every other day but  unfortunately it healed on the outside before the inside, so I had to have it done again, the surgeon made a larger incision and this time I had it packed everyday until it healed. There was no fistula at my check up. Now a year later it although the wound has healed, there is a tiny hole in the centre of the x shaped wound. The other day there was a tiny bit of drainage from the tiny hole...... Do i need to see a doctor or will it be ok?

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  • Posted

    Hi tullip78,

    Yes it sounds like a fistula has developed. This is very common and not surprising at all. Most studies suggest at least 50% of perianal abscesses become fistulas, but I think it might even be higher. If it is a simple low fistula (which most non-Crohn's fistulas are) then getting rid of it is fairly simple- your surgeon will give you a fistulotomy. It will leave a large, open wound that will need to heal by secondary intention. This should take 2-4 months depending on your health and the size of the wound. You'll need to use a shower head or bidet to GENTLY wash the area after each bowel movement. If you have Crohn's disease then the situation is different and a permanent drainage seton will probably be inserted...but you didn't mention Crohn's so it just sounds like you had the normal perianal abscess. But make sure you go to a colo-rectal surgeon and NOT a general surgeon. And please get it taken care of sooner than later. While your surgeon will tell you it isn't "technically" an emergency, if you let it go there is a chance (not a high chance, but a chance none-the-less) that the fistula will branch out and create more tunnels, making it much harder to eradicate. There is also a much higher chance that it will become another abscess if the tiny hole heals over. I'm not a doctor, but it certainly sounds like you have a fistula. 

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    • Posted

      Thanks for your rapid reply. I don't have Crohn's - just suddenly developed an abscess which came up within days! I had went to my GP, she prescribed antibiotics but the didn't workgot sent to the hospital. It was a general surgeon both times - NHS. The wound keeps healing over then about every 7 days it opens and a tiny bit of white drainage appears, i'll make an appointment with GP if i can ....

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    • Posted

      I do a lot of running/power walking to keep fit  as i sit ALL day at work, might be aggravating it?
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    • Posted

      Definitely don't go to the GP as they don't know what to look for. You need to go to a colo-rectal specialist (CRS). If you can't find any, then ask you GP to refer you to one. A GP will not be able to sufficiently help you. Your symptoms sound like textbook fistula drainage.

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    • Posted

      I am in  the uk so think I will have to go private. My two previous perianal abscess operations were done by general surgeons, the first was an emergency referal by my GP so I didn't have a clue what was going on didn't even get told what was wrong until i was in anaesthetic room. It was a cross shaped incision both times  and since i've been reading about them online, i don't think it should have been a cross shape incision as they supposedly  don't heal well in this area, the tiny hole i have is at the centre of the x. it heals over then opens and bleeds a bit so think i will have to look into private care. 

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    • Posted

      If I goto GP she will refer me to nhs, will take ages to be reffered and it's hard to get appointment with a gp nowadays anway.

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    • Posted

      Hi tulip78,

      The reason the hole heals and then opens continuously is because there is a fistula present. That is exactly what happens when a fistula is present. A colo-rectal surgeon can easily fix this with a fistulotomy. 

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    • Posted

      This sounds very similar to me. I went to my GP in Scotland when I found I had a lump in a not very nice place. He diagnosed an peri-anal abscess straight away within in 2 minutes of me being in the surgery and I was given anti-biotics. To be honest I was just relived it wasn't cancer and thought great it's just an abscess anti-biotics will heal it. Big mistake The anti-biotics did not help at all. Three months later I was in alot of pain and it was getting worse so I was referred to the colorectal surgeon, who sent me for an MRI. The surgeon then went on holiday for a month so I heard nothing back from the hospital. By then I was in agony and went back to my GP to demand to know why I had not received a reply from the hospital. He told me to go home and pack a bag and get myself to the hospital and I had emergency surgery that night. The surgery was a disaster and I was left with a fistula but I had not been operated on by the same surgeon. I complained and after that the initial surgeon who had ordered my MRI managed any further surgery I had. It is very difficult, we don't know the right questions to ask, I had never been in hospital before. I didn't go private but the surgeon I had did NHS work and private work as many surgeons do. So my advice would be don't rule out NHS unless you are really sure about it.

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  • Posted

    Hi Tulip,

    I hope you have found your way to a colon/rectal surgeon by now. If not, please talk to your GP and insist on a referral. I had an abcess back in June and was in an emergency situation and was sent to a general surgeon and although he drained it and temporarrily eased the pain, the abcess returned very quickly. I then found myself a CRS and was very glad I did. I had a second procedure to drain the abcess again and then under the care of the CRS we determined I had a fistula. So 6 weeks later (last Tuesday) I had a fistulatomy. These things are tricky, as long as it was open, there was no pain and just a small bit of drainage, but the pain would resume as soon as it healed over. The cycle will continue until the fistula is addressed - since the bacteria is coming from inside and the wound tract is not sterile. I'm home now trying to heal and hoping this ordeal is nearly over!! Good luck!!

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    • Posted

      Thanks for your reply!!! I too had an abscess drained in an emergency situation and it healed too quickly on the outside before the inside, so i had to have it drained again!! There is a tiny hole again where my abscess scar has healed, it keeps healing then opening... what kind of cut did they make when you had your abscess drained as mine was a cruciate (cross shaped incision) now i have heard that a cruciate incision shouldn't be made on a abscess... so so so worried about incontinence..... 

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  • Posted

    Good luck and best wishes,,, i hope you're better sooon! thanks again

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    • Posted

      My first abcess was drained under local anesthesia (which was horrible!!) and they did the cross cut but then cut the tips off so I was left with a round wound. The second time was under general anesthesia because my doc was looking for a fistula. She couldn't find one, so she aggressively drained it and left a huge round wound, about 2cm across. After 3 weeks my doc was convinced I still had a fistula, she took a tool and put it into the wound (ouch!) and because of how far it went in she was convinced it would never heal and would either heal over and develop a third abcess or stay open and continue to drain. I am not in the U.K., I'm in the US so I just scheduled my surgery, had to wait about 1 week. I was very nervous about the risk of incontinence too, but I just put my trust in my surgeon and hoped for the best. Living with it and doing nothing just wasn't an option for me. And luckily my muscles are still well intact!! Try not to worry, just get it taken care of as soon as you can!! I am looking forward to the holidays with no pain and no problems - fingers crossed! Best of luck!!

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    • Posted

      Thank you for your reply. Hopefully I'll be able to get an appointment with a GP, so they can refer me to a surgeon, I'll ask for a colorectal surgeon, not a general surgeon. I',m from UK so need to see a GP to get a refferal to a surgeon. Hopefully don't have to wait too long. Last time I had myabscess drainrd the surgeon said they'd put a seton in if a fistula was found. A work friend said to me they had an abscess but their surgeon left a 'scoop' style scar and said to me 'they should never make a cross shape incision' so i kind of felt 'butchered' but suppose all surgeons are different, I had to have my wound packed everyday but she didn't

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    • Posted

      My CRS said she would only do the seton if I was either too scared to do the fistulatomy or if my fistula looked like it might cause issues with incontinence ( based on location, muscle available etc). So going into surgery I didn't know exactly what she would do, it was up to her discretion. She did not do the packing for my abcess drainage which I was thankful for. The general surgeon I saw initially did the packing immediately after but I removed it the next day and they didn't do it again. I would definitely make sure they send you to a specialist, I really think you need a surgeon that is very familiar with this stuff because they just aren't that common.

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    • Posted

      If I were you I would opt for the fistulotomy if you are healthy. If you have Crohns or even think you could have Crohns (get tested) then you should only do the seton since the fistulotomy might not heal well. But if you are healthy then there is no reason you should just get a seton. If you have an experienced CRS then the chance of any incontinence is small. I had a fistulotomy 2 years ago and I'm glad I had it done- and I don't have incontinence.

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    • Posted

      Hi Cporodus1, can you tell me what the recovery was like from your fistulatomy? I am exactly one week post op, still very uncomfortable, although I think my healing is going pretty well. Do you remember how long you had to take pain meds? I'm only taking Ibuprofen, but looking forward to being in a lot less pain 😊 Have you had any issues since then?

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    • Posted

      Hi Birdie786,

      I had very little pain at all...I stopped using my pain meds about 4 days after the surgery and drainage completely ceased almost immediately (I may have had a tiny amount in my dressings immediately following surgery, but nothing significant). By the 2nd or 3rd weeks I barely knew the wound was even there (unless I actually touched the inside of the wound, which I never would!) It took abut 3 months exactly (12 weeks) to reach 100% healing and I've had no significant problems with it since. You might get some pinching pains as it reaches close to full healing (this is new skin/scar tissue stretching) and when it actually IS healed you still might get occasional pinching pains, I find rubbing coconut oil on the scar alleiviates much of the discomfort. It's vital that, while you still have the open wound, you gently wash the wound with a shower head or bidet after each bowel movement (or after working out at the gym, etc.) It's been 2 years since my abscess and almost 2 years since my fistulotomy and the doctors have checked dozens of times and say it healed perfectly. I DO have a slight "groove" like scar in my rectum, but this is normal. I have no problems with continence at all...and since I now use psyllium husk I actually have to wipe a lot less than I used to (the trade-off being that psyllium increases flatulence 10-fold....at least for me it does). If you don't have Crohn's then chances are you are going to be fine- the recurrence rate for someone WITHOUT Crohn's is about 5% (with Crohn's I think it is around 60% or higher). 

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    • Posted

      Wow, that sounds like a pretty easy recovery. I'm a little jealous!! I am now 8 days post surgery, pain is present, but I can still mange normal activities with IBuprofen. I am still lightly draining and or bleeding pretty much all the time. I hope this doesn't mean that anything is wrong. I do feel improved over the last day or two so I guess that is positive. I am tired of the baths, pretty much at least 3x per day (who has time for that!!) and more depending on timing and frequency of bowel movements. I am dying to start exercising again, but I feel like I am still a week or two away from that. I see my doc at 4 weeks post op and I guess by then I should know if things are looking good. I don't think I have crohn's, since I have none of the symptoms (other than this!). Thanks for sharing your story with me, I have hope that this will heal up and go away for good!!

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    • Posted

      Hi Birdie786,

      I think I may have just been lucky...most people I have read about online experience similar to what you are experiencing. I was able to start lifting heavy weights again about 2 weeks after the operation (although I did wait a while longer to start lower body exercises like squats). While it is true that in some cases perianal Crohn's (which includes abscesses/fistulas) will begin months (or, sometimes, even years) before the intestinal symptoms begin, there is usually a sign of perianal Crohn's disease (e.g. multiple abscess/fistulas...not just one, or perianal lesions, fissures, abnormal skin-tags, etc.) If you only had the single abscess/fistula and have nothing else going on down there, then you should be fine. Plus, all doctors and CRS SHOULD check this before operating, since people with Crohn's are NOT supposed to get fistulotomies. I have a history of mild internal hemmorhoids and I have had a non-Crohn's skin tag since I was 12 years old (I'm 33 now) but I've never had a fissure or any other rectual issues. My doctor and CRS saw no sign of perianal Crohn's so they chose to operate and everything healed great. I did get a colonoscopy with biopsies eventually, as well as dozens of blood tests and fecal tests just to rule out Crohn's and everything came back normal. I'm about 2 years post-abscess now. Do you know what might have caused your abscess? I have a strong suspicion of what caused mine (holding my poops for hours or even days on a regular basis and trying to forcibly push them out....did this for years.....in conjunction with poor rectal hygeine). 

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    • Posted

      I guess my surgeon was comfortable that I do not have crohn's. Perhaps something I should ask her about before we hopefully part ways down the road. In case it comes later? I have a suspicion my abcess may have been caused by either the birth of my son (8 lb baby and a bit difficult to deliver) or by a lot of time on my bike. Hard to say, since my baby is now 1.5 year old? So I don't know for sure, maybe even a combination of those two things? My surgeon said I may have just had bad luck - boo. Anyway, now I just keeping my fingers crossed for the next few weeks, until I see my CRS for a follow up!!

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    • Posted

      It's interesting that you mention spending a lot of time on a bike. There hasn't been any link proposed between bicycle riding and abscess formation, but in my experience I personally know multiple people who are active cyclists and have developed perianal abscesses/fistulas. It could just be a coincidence, but it might be something interesting that doctors should perhaps study and look into in the future. I'm not sure what mechanism could cause it (since perianal abscesses "usually" begin inside the anus and not outside) but it would be interesting to investigate nonetheless. According to peer-reviewed studies, around 90% of perianal abscesses/fistulas have an unidentifiable cause, but it is believed to be the clogging or obstruction of the anal glands by something (fecal matter, foreign objects, or even ingested animal bones). I've also heard that an infected fissure can also cause a perianal abscess. The remaining 10% are caused by Crohn's (a full 5% of that 10), diabetes, HIV, chemotherapy, and other conditions that supress the immune system. One thing I will warn you against- try to stay off Crohn's websites, as some Crohn's patients may convince you that you must have Crohn's because you had a perianal abscess. They are in unfortunate circumstances and I understand their pain, but they are not doctors and are not in possession of the facts. The facts being that MOST perianal abscesses are not related to an underlying disease. I am 2 years post-abscess and almost 2 years post fistulotomy, but for an even better reference- my uncle had a perianal abscess/fistula 6.5 years ago and he has had no further problems since his fistulotomy, and he does not have Crohn's. There is a history of non-Crohn's rectal problems in my family- hemmorhoids and we all have a single, benign skin-tag (literally the entire side of my mom's family) but only my uncle and I have had an abscess. So clearly there is something genetic involved, but it isn't IBD. If I were you I would still get checked somewhere down the line...getting a colonoscopy WITH biopsies will pretty much rule Crohn's out definitively. 

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    • Posted

      Hi

      I also had a perianal abscess in 2009. I had emergency surgery which left me with a fistula. I then needed a seton to keep the fistula open to drain the wound until it healed correctly. However the seton did not move through my body as it should so the colorectal surgeon would operate on me every three months to cut me to help move the seton through me. After 5 operations the surgeon told me I had years of more operations ahead of me. I could not go on this way but no-one was helping me to understand why I had this condition in the first place and what to do about it. So once I could actually sit down again I thought about what was going wrong. I had an infection that my body couldn't fight off. Why was my immune system not working as it should? I had been having problems with many foods due to alot of stress, maybe I wasn't getting enough nutrients. So I went back to basics, how much vitamin A did I need, how much vitamin b etc. Not using vitamin tablets I bought foods that would provide me the recommended daily nutrients. For three months I was eating practically all day every day, lots of veg and fruit, 80/20 split. Guess what? My seton fell out on it's own as it was supposed to and my fistula healed. My surgeon was stunned. Since then I have changed to drinking vegetable juice as this is a quicker way to get the right amount of nutrients that I need and I have had no abscess recurrence. I had also been plagued with verrucas on the soles of my feet for years. That cleared up and has never reoccurred either. everyoe is different so it miht not work for everyone but I think it must be worth a try to avoid this painful condition and the risks that surgery brings. Wish you good luck.

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