Reoccurance?

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Hi everyone. I've just experienced my first perianal abscess, dealt with the excruciating pain for a week before I went to the hospital to get it drained on August 27th. Post-op I had the repack done about 3 times and the nurses said it healed really fast and I no longer needed any more packing.

Now, my question is what are some symptoms of a reoccurance happening? I'm really worried because no one wants to go through that all over again like some of you who have unfortunately repeatedly dealt with it. I still feel on occasion a very subtle pain sometimes right on the inside of the butt cheek where the abscess was drained. And it's still a little tender to the touch. Are these symptoms or am I just being paranoid and still in healing since it's only been around 12 days. I have no fever. No constipation. No other symptoms. Thanks everyone for reading and any advice or help.

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  • Posted

    Hi RollR6,

    I had a perianal abscess back in October of 2014. First and foremost, you need to determine if you have any underlying medical conditions that caused the abscess. While 90% of them are caused by simple clogging of the anal glands (from excessive straining or diarrhea or injury, etc.) about 10% are caused by an underlying disease (most commonly Crohn's, but also diabetes, AIDS, and other immune-compromising conditions). You should make sure to get a colonoscopy with biopsies ASAP in order to rule out Crohn's. If you are an otherwise healthy individual, the best way to prevent a reccurrence is to change your bowel habits- make sure to get plenty of fiber and to NEVER strain. In addition, you should use a psyllium husk supplement like Konsyl or Metamucil. I've found these to make my BM's much cleaner and less sticky. Also, if you are a smoker...even occasional smoker, STOP IMMEDIATELY. Smoking destroy's your immune system and can make abscess much more likely to occur and recurr. 

    So, if you are an otherwise healthy individual, you shouldn't get another abscess at a different spot (that's the good news). Here's the bad news- in many cases (not all, but in AT LEAST 50% of perianal abscesses) a fistula will develop within the months post-drainage. This will either result in a tiny "dot" with a small amount of occasional drainage or mild pain, or it will result in a reccurring abscess (if the wound is 100% healed). The good news is that, provided you do not have Crohn's, this is usually fairly easy to fix (albiet, a bit time consuming). Your CRS will perform a surgery known as a fistulotomy (about 95% effective at eradicating the fistula and, thus, the abscess as well). It leaves a large open wound that must heal from the inside out through secondary intention (this may take months...in my case it took 3 months). During this 3 month period you will need to gently wash the area with a shower head or bidet after every bowel movement, but otherwise there is little pain at all, despite the wound size (at least, I didn't have much pain). If you have Crohn's they usually will not perform this surgery because the risk of incontinence and poor wound-healing is high (I've heard of some Crohn's patients needing a full year for their fistulotomy wounds to heal...if they heal at all), so they instead insert a permanent or semi-permanent drainage seton. 

    It's been almost two years since my horrific experience with this and I haven't (*knock on wood*) had any further issues....but I DID have the fistula occur about two months after my abscess was drained. 

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    • Posted

      Thank you soooo much for taking the time to write all that info!! I've been searching all over for some of the information you've just given me. You're amazing. I'll definitely take your advice! Yes from what the lab tests and doctor told me I'm a normal healthy young adult. I'm 28, 5'10" 166lbs and am a very frequent gym goer. I quit smoking some months back so hopefully that will help the situation some. And I also don't have a very bad diet, I'd eat veggies, fruits, and nuts on the regular even before the abscess. It seems like the best thing I can do right now is use all of your advice and just wait it out and hope for the best.

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    • Posted

      Not a problem RollR6, happy to help. Just a word of caution, don't be surprised or worried if a fistula develops...this is very common and is actually more common in younger people with abscesses than in older people and diabetics (for some reason), so on the 50/50 chance it occurs, just go to your CRS promptly and have the fistulotomy surgery, as it is the definitive treatment. If you notice the abscess comes back, it would strongly suggest a fistula is present. 

      I'm also a frequent gym goer and I often wonder if lifting heavy weights may have something to do with it. I was a powerlifter and I would often get hemorrhoids and fissures from straining to deadlift and squat....and an infected fissure can easily cause an abscess. If I were you I would still get a colonoscopy with biopsies just to definitively rule out anything serious. 

      Do you have any other rectal issues other than the abscess? Sometimes perianal crohn's diseases arrives prior to the intestinal disease, but it is usually diagnosable by the presence of other anorectal symptoms like blood unrelated to hemmorhoids, frequent fissures, granlomous tissue, and multiple abscesses/fistulas (not just one). So just keep any eye out for this sort of stuff. 

      Oh, and a final and VITAL word of advice- try to refrain from message boards about Crohn's abscesses. The people on them might freak you out into thinking you absolutely have Crohn's (they did that to me) simply because you have an abscess. This is not the case! Always listen to the experts and your doctors and peer-reviewed journals, rather than people on message boards (I can see the irony in my saying this haha)..because all studies suggest at least 90% of perianal abscesses are unrelated to that disease, its just that they are extremely common in that disease (something like 30-40% of people with Crohn's get them...and typically get many over the years). Just trying to save you some of the paranoia and fear I went through smile 

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    • Posted

      I have just read your post on here, I am 36 female and I do a lot of running and walking and keep fit.I don't smoke or drink and eat healthy. I do lots of ab crunches' squats etc... i don't have crohns or anything. I sit ALL day at work though... worried i have perianal abscess/fistula because of exercise 

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    • Posted

      Hi tulip78,

      The sitting is more likely to contribute to it than the exercise. In my case exercise "could" have (its possible, but there are more likely causes) contributed to it simply because I was lifting very heavy weights (over 500lbs) and this caused both hemorrhoids and fissures...and an infected fissure can cause an abscess. I don't think I had a fissure at the time of the abscess, but I can't know for sure. More likely than not my abscess was caused by excessive straining on the toilet resulting in clogged anal glands, or holding my poops for too long (sometimes days) and then trying to push them out. My uncle also had an abscess/fistula that resulted from chronic straining (his was 10 years ago, and he has not had a recurrence). Light exercise like crunches and light squats wouldn't cause a fissure (unless you're doing heavy squats). Working out while in an immune compromised state (e.g. while you're sick or have an infection) can increase the chance of abscess...simply due to the fact that your body cannot fight off the infection. But, from all ofthe peer-reviewed journals I have read, it seems by far the most common cause of perianal abscess is the clogging of the anal glands at the denate line, and this is caused by excessive straining or excessive diarrhea. It can also happen spontaneously without any real cause (luck of the draw, so to speak). These account for around 90% of perianal abscess/fistula. Around 10% of perianal abscess/fistula are caused by underlying diseases, the most common of which is Crohn's (at least half of that 10%) and the other 5% or less are caused by things like diabetes, HIV, radiation therapy, etc. etc. But anything that results in chronic constipation or diarrhea can put you at increased risk (this includes irritable bowel syndrome). 

      In short, the most vital thing you can do to prevent getting another one is making sure your bowel habits are healthy- eat plenty of fiber, take a fiber supplement (psyllium husk) and try to refrain from holding your BMs for longer than you need to. Also, eat healthy and stay active. Obviously lifting to the point where you are giving yourself fissures is counterproductive haha but all other exercise will lower your chance of getting infections. 

      When I said sitting for long periods may be a factor, I simply mean that if you are holding in feces or have incomplete evacuation. Sitting itself will not contribute to a perianal abscess (although it can contribute to hemorrhoids), but if you ignore the urge to "go" when you need to on a chronic basis for long periods, this can increase your risk. I did this for decades before I got an abscess, but I've had hemorrhoids my entire life (since I was at least 12 years old), as has the entire side of my mother's family. I'm currently 33 years old- I'm 5'11" and 200lbs....a bodybuilder (can't do the powerlifting anymore). 

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    • Posted

      Thanks for your advice! I didn't have any whatsoever from the doctors or hospital. The only advice I received was from the district nurse dressing clinic, (which I had to visit everyday for 6 weks for paking of my abscess.) where they told me to have a salt bath every morning before visiting the clinic..

      It's a shame that you can't do your weight lifting / body building anymore...I feel for you. It's a horrible condition with such little advice....

      I was worried mine could have been caused by my exercising / walking running etc.. I asked the surgeon after my op and he suggested it may be '' one of those things - you're just unlucky to get one''. I am 5ft 6ins and a slim build 114lbs but we're sat all day at work for long hours and as our ladies lavatories do not have windows, I ignore the urge to goto the loo, sometimes holding on for hours, just before my abscess occured, I needed to go at 7.30am and held on until 5.30pm - my own silly fault. I was off work a long time with my abscess, having to have it packed with aquacel everyday... I felt manky and horrible and with being off work I was so fed up..

      Now i've been reading that the abscess incision which I had done ( it was an x shape ) shouldn't have been that shape for that area,( but there again, it could be because I don't have much ''padding / fat'' in that area, ) and that packing delays healing but I just went along with the doctors / nurses advice. 

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    • Posted

      Thanks very much too, Crohn's has passed through my mind and I was fretting but think the ''holding on'' too long is my problem.. lol typical British and lady thing - so embarrassing having to go at work or a friend's / relatives house, I make myself hold on.. 

      Worried about fistulotomy incase of incontinence neutral

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    • Posted

      It shouldn't cause incontinence...particularly if you go to a good colo-rectal surgeon. I do not have any incontinence from mine. I DO have a weird groove shaped scar, but it isn't very large and it doesn't interfere with anything. If you have a low fistula (which you most likely will) it is an easy fix, but it might take 3-4 months to fully heal. It surprisingly shouldn't hurt much, at least mine didn't....I often forgot the open wound was even there. But I highly suggest you get the fistulotomy ASAP, because the longer you wait the greater the chance that the fistula can branch out and form alternate tracks, which is much harder to get rid of (sometimes virtually impossible). It should go without saying that you want to avoid this! 

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    • Posted

      Hey cporosus1! Sorry on the no reply for a long time. I've unknowingly been taking your advice and just avoiding looking at forums and touching the abscess or even thinking about it, kind of an out of sight out of mind thing while still taking necessary precautions to not make it any worse. I haven't done any excessive movements such as heavy lifting like I used to as to prevent making anything worse. And no crohns and no history of any sort of rectal issue, first time for me and it sucks. I feel like I can't live my normal active life. Anyways thanks again for all the words of wisdom I definitely listen and use your advice and get myself a colonoscopy with a biopsies once my health care from the new job kicks in.

      Just an update on my situation. So it got much better since we last chatted. Since last week I noticed a hard lump, and I noticed the scar tissue from the incision became really soft and had a protruded very slightly. Fast forward a week (yesterday), I was having a bm and before flushing noticed some blood. I panicked, shortly relieved to see that the blood has come from the scar tissue that I mentioned got soft. Apparently it burst or opened and was dripping blood only, I cleaned it, and put a fresh gauze and bandage over it. All the pain was relieved right after though, and the hard lump was no longer there. It felt amazing and I was so relieved to not feel any pain. How ever today I see that the incision has turned into a big looking pimple, very soft and can be pushed in. And there is a minor hard lump near it again. From your experience is it just blood needing to be purged? Or something worse. What are signs of a fistula? Thanks again for any help. I'd love to go to my nearest kaiser but like I mentioned it will be just a few weeks before I have health care again and I'd like to avoid any huge payments if I can.

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    • Posted

      Hi, it sounds exactly like a fistula. There's no need to panic though- if you are healthy (no Crohns or any other disease) it is easy to eradicate. You need to go to a colo-rectal surgeon (NOT a GP or a general surgeon) and have them check you for a fistula (which is almost certainly there) and they will perform something called a fistulotomy which is about 90-95% effective at permanently removing the fistula (and, thus, permanently removing the abscess) if you are healthy. The symptoms of a fistula are leakage of blood and/or small amounts of pus from the rectum and/or from a spot in the perineum (often where the abscess was drained). In addition, there might be pain or itching, but not always. If the skin heals over the spot of leakage then an abscess will recur.

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    • Posted

      Super lame. Yeah it turned from blood to mostly pus. And there's pretty much no way around it except to have a fistulotomy huh? Have you had experience in this procedure cporosus1? If so what's it like and what's the pain level I should be expecting? I like to think I have a very high pain tolerance. I was laughing during my abscess drainage and all my bandage repack didn't hurt aside from the first one which was barely.

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    • Posted

      Disregard that final question sir. I stayed up last night reading all the different procedures they do and it doesn't sound that bad. Plus they medicate you and put you to sleep so that sounds great. Plus it's better to just get it over with and begin healing so I can get back to my life, it's so weird not being able to ride my motorcycle or hitting the gym every day, I'm sure you understand that feeling. Haha. I'd still be interested in your story and experience with a fistulotomy.

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  • Posted

    Hi RollR6, I had a perianal abscess years ago and my first surgery turned it into a fistula. Sounds like you are doing everything right, I upped my veg intake 100% and have never had a reoccurrence.
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