Abscess - rupture vs. drain?

[scoutfinch]

I've developed my first abscess ever and it's been both painful and scary. Some info: My Crohn's symptoms started 4 years ago and I have been on Remicade for a little less than a year. About 2 weeks ago I noticed a swelling and hard bump near the side of my vagina, but it wasn't painful or inflamed at that time. I went to get it checked out a few days ago (worried it was a tumor) and the doctor thinks it's an abscess and put me on Cipro and Flagyl for 10 days. Since I started the medication yesterday the bump has started swelling and become red and inflamed - it's a swelling the size of a small egg right now. For anyone who has been through this before, can you please help me out with a few questions?

1- What are the chances the abscess will drain back into my body? I've read through a few threads here and it seems like it's rare that antibiotics alone can heal an abscess.
2- If the abscess continues to stay inflamed/grow, how long should I wait before going back to my doctor to possibly have it drained? Two days? Three? I'm only on day 2 of antibiotics.
3- Is it possible that the antibiotics are making it worse? I know it sounds crazy, but the area wasn't inflamed before I started them - although of course it could be a coincidence in timing.
4- How can you tell if an abscess has ruptured inwardly? (I would think I would know if it ruptured outwardly since there would probably be a mess).
5- Related to the last question, what is the difference between draining and rupturing? Is there a difference?
6- Edited to add one last question - should I or should I not put pressure on this thing? I can't sit without putting pressure on it (unless I tilt my body to right), but is it making it worse to put pressure on it?

Thanks in advance for any insight you can provide. As I sit here typing and I shift around in my chair, I can feel the pressure and heat of this thing growing and it's worrying the hell out of me.

 

[SomethingIsMissing]

Hello, if it were me (don't panic) but go get it drained. Reason being if it burst in it might spread infection, it might damage more tissue. Abscesses have the ability to finger like out and branch out, if it is not a fistula, you do not want it to be. Better safe then sorry, be seen at the Dr. or have it drained in the ER.

If it burst it will be less swollen.
Hope you feel better.

 

[Sailorluna]

Are you taking sitz baths or just nice hot baths? It can help with pain and may bring it to a head and make it drain.

I don't think it matters if it breaks on its own or the doctor does it, when the doc does it they can clean it out so maybe thats better?

For me the doc said if you are in bad pain or get a fever you need to have it taken care of right away.

Hope you feel better.

 

[SomethingIsMissing]

for question 6: do not play with it (not that you are), sitting is one thing but do not try to make it burst touching it.
I think a sitz bath at this point is a waste of time. It will be a good thing after its drained.
I really feel once it is swollen, painful and hot it is best to be seen. It does matter. Think of it this way; a infection/abscess is best dealt with in a controlled atmosphere. Especially being close to the female area.
I would not be lax about this. Why wait, you will most likely feel way better after its drained.

 

[KWalker]

Here's my opinions on your questions.

1. I think that's highly unlikely. Like you said yourself it is pretty rare for it to go away without needing surgery. Some need more invasive surgery, some have been done and then you get sent home right after.

2. You're going to read this and fall off your chair. I waited 3 years to go to the hospital to have mine looked at! At first it wasn't giving me any problems at all and then back in November it got to the point it was one of the worst feelings I've ever had. I had two large surgeries for it and spent 10 days in the hospital. I'm still healing from it and expect to be for atleast a few more months.

3. I don't think it would be antibiotics making it worse, but the fact that it isnt draining is causing it to spread. (most likely)

4. Again, I don't personally think it would rupture inside. Usually it ruptures out because of some sort of pressure.

5. I think it needs to rupture in order to drain. You want to get all of that pus out. That's infection.

6. I would put pressure on it..but at home. If it does pop, you and everyone else around will know it. There will be a lot of pus, and probably blood as well so you don't want to be out and have it happen. Like Sailorluna said warm baths (and with epsom salt) can really help out with relieving pressure and popping it.

I know exactly what you're going through (except I'm a boy so different area) and I believe Sailorluna has too and I really feel for you. It's definitely something I never want to go through again. Mine ended with a 7.5" incision and LOTS of home care nursing.

Have a look at this thread I made. http://www.crohnsforum.com/showthread.php?t=29371&highlight=lots+blood It's my little journey with the abscess with surgery, healing, etc.

Best of luck and feel free to post or PM me if you have any questions

 

[SomethingIsMissing]

The one that went well for me was the one I had drained the one that didn't was the one I waited to have drained, similar to KWalker. So technically I guess you could wait :/
No Seton in the one I had drained and a seton in the one I waited on...
Its NOT COOL to let someone think they should wait. At least they should call and see.

 

[Sailorluna]

Of course if you are worried you should call. But it sounds like she just saw a doc a couple days ago for it and is following their instructions.

It never hurts to call in, antibiotics alone has never fixed anything for me, it just delayed the inevitable. Docs seem to like to try it first. But I really think if the pain is bad or you get a fever take care of it right away.

 

[Neko76]

I just wanted to second KWalker's (3 years??? Good god man!!!) advice. Once it get's large it is rare for it to go away on it's own or with antibiotics. However this is often due to the fact that the abscess becomes too painful and most people will go get it dealt with before the antibiotics have a chance to do their thing (keep in mind bacteria divide exponentially, it takes very little time for a small infection to become a really large one). If you can soak, soak, soak and squeeze and get the abcess to come to a head and drain at home then you may give yourself enough relief to let the antibiotics work. Your body will tell you if you need to get it drained / surgery (i.e. excruciating pain). FYI. I have had approximately 15+ peri-anal / entero-vaginal abcesses in the last year. Of those, 3 were dealt with under general anaesthetic, 3 were lanced in clinic/e.r. and the rest I deal with myself. Of course if you are worried in anyway or like abovementioned develope fever go back to the Dr. Always better safe than sorry. Good luck.

Kat

 

[KWalker]

SomethingIsMissing - I hope you didn't take what I wrote as saying it's okay to wait because I definitely regret it. I was just stubborn because it wasn't hurting me so I let it sit and as a result I ended up paying for that one. I DO NOT recommend that if you have any concerns whatsoever.

I never had any setons because mine were only abscesses. I believe it must be a fistula to have a seton.

 

[Kit]

Ok, here is some info. Just some background. I had an infection around my vagina as well and it was a bartholin's gland infection. I had it drained and felt much better. This hole stayed for a long time and I would get drainage out of it periodically. They looked for a fistula but didn't find one. I would get swelling and very minor pain down there for about a year. Just this last year I got an abscess in my abdomen. After about a month of antibiotics and no real relief, I went into the hospital to get it drained, placement of a drain and IV antibiotics. This all helped immensely, but it still didn't clear up everything and found out I had fistula and went in to get part of my colon removed. After all of this, my bartholin's gland was no longer swollen or draining. Ok I will try to answer some questions.

1: I am not sure about it draining back into the body, but antibiotics did not clear up my abdominal infection, my dr put me in the hospital to get IV antibiotics (Which he thinks works better), but it was decided to put a drain in. If you get it drained, make sure they take a culture so they can get the right antibiotics for you.

2: With my experience with antibiotics in 2 to 4 days it should start to feel better if the antibiotics are correct. I would definitely call the dr's office and let them know what you are experiencing and let them decide what should be done. I would say if you aren't feeling any better in 5-6 days to question if something else needs to be done.

4: I am not sure about rupturing inwardly. I don't have any info on that. And yes you would have a mess, if it ruptured outwardly. I think sitz baths are a good idea, I would take a lot of them with my bartholin's gland.

5: Not sure what the difference would be. I would think it would have to break open a hole in the abscess to drain, hence some kind of rupture.

6: Not sure again in pressure is good or not, you can always get a cushion that has a hole in it so you don't have to sit on it. I did sit on mine, but I think I shifted a lot to not sit on it.

Do you have a temperature? Keep track of that. Just to let you know mine never really got high enough that they called it a fever, only toward the end did it get higher. I normally stayed under 100 degrees F


I hope this helps. Good luck with it, and feel free to message me if you have more questions.

Kit

 

[KWalker]

Neko76- Yep, 3 years. I was young and hated the thoughts of having surgery so I let it get worse. However though, aside from touching it, I didn't know it was there. It was big but it did not cause me any pain at all.. This is not a reason to let it go un-touched though, and I realize that now. I will never let that happen again, that's for sure

 

[scoutfinch]

Thanks very much everyone for sharing your opinions, advice and personal experiences. I have not taken any sitz baths. I am feeling slightly feverish and I fear I will need to get this lanced soon. Of course, it doesn't help that I have a wedding to attend tomorrow - of a close friend, no less. Can abscesses be lanced at a doctor's office or does it always have to be at a hospital? Oh man, I can almost feel how painful this might be. I've had a dental abscess in my gum lanced before and it was freaking horrible. I can only imagine how much it would hurt down there.

Thanks again everyone!

 

[KWalker]

I don't think it can be done in a doctors office but I know somebody that had it done in a hospital, but they only froze the area, cut the abscess and then let him go home less than an hour later. It all depends on how bad it is. When they cut mine, they kept me for 5 days each time because they have to cut the abscess and then pull out all the crap inside.

It will also depend if it needs to be packed or not. The smaller ones don't usually need to be packed but the big ones can take a lot of work.

Best of luck!

 

[Neko76]

Not sure about Dr's office, I have a feeling no. I always ended up in ER for them. Just an idea but maybe you could go to ER tonight and have it dealt with...then you would likely be in better shape to go to the wedding tommorrow, and then be able to enjoy it without the worry. If you are already feeling potentially feverish now and the infection sits for another 12-16hrs, then the chances of getting to the wedding at all might be iffy. I don't know where you live or what your emergency rooms are like, I know that they can be hell here sometimes. I also know that missing important events sucks but your health is so very important (ok enough nagging). I really hope that you make it to your wedding and have a great time!!

K

 

[Irene3]

Hello scoutfinch. Ouch, I can only imagine how sore it would be, being on your vagina:/ Im not sure, but I developed an abscess, or fistula with an abscess at the end, above my anus. Within a few days, what was a slight irritation, became agonizing. It swelled up, and throbbed for an afternoon, but I mean constantly feeling horrible throbbing. After going to the toilet, as I sit, the area is stretched, and I had agonizing pain up there during the diarrhea, as I was pushing. During that night- (few days ago), I went several more times to the toilet, and by morning it was no longer throbbing. Went to the gp, and was told it has an opening, but no puss. Gave me antibiotics. I think during those few bouts of painful diarrhea, it drained. It's now a bit sore when I go to the toilet, (2days on antibiotics), and I think it's either filling with puss, or it's a fistula and even though the abscess drained, it's still painful.
Reason I wrote all this, is I think if it swells enough, it will rupture. They say 3-4 days on antibiotics, and you should begin to feel an improvement.
No idea about it rupturing inwards, but I should have taken baths to clean the infection out I think, so if yours ruptures, try the salt baths to drain the puss. Best wishes xo

 

[scoutfinch]

Neko76, I did not end up going to the ER last night (although that was a good suggestion, thank you) as I was worried that there would not be a good colorectal surgeon on call on a Saturday night. I live in NYC so I am lucky to have access to some of the best medical practitioners, but still, I think I might wait until Monday to get a surgical appointment.

Today the abscess is still inflamed and very tight and sore, especially when I get up and walk after getting up. I've been applying warm washcloth compresses to it but that only provides brief relief. I'm off now to go get ready for the wedding. Thanks again everyone for your advice and well wishes!

 

[Sailorluna]

Have fun at the wedding!

 

[sawdust]

I'm sorry you're in pain. Looks like I'm late to the party here :runaway: but I'll try to follow up the great advice you've gotten already with some additional forum hugs :hug: and reassurance. In my opinion, the best thing you can do is to be proactive about having your GI examine you again to see the new size, possibly order a test or two to tell what's going on, and make a judgment about where to go from here.

1. I can't say for sure, but mine certainly wanted out, not back in. It's already in your body if you think about it.
2. If it's growing and you're on cipro/flagyl, I'd call your doctor and see if you can be re-examined. This might help them determine a way forward here. I wouldn't be worried about calling and asking for their opinion. If they want to see you again, great, peace of mind. If they tell you things to watch for, great, peace of mind. That's just how my mind works, I guess. I'd rather know than worry about not knowing.
3. Unsure. As per #2, I'd be in close contact with my doc to see what they expect. My abscess looked like I had half of a baseball under my skin. The antibiotics eventually made it "go away," at least until the course was finished. (I don't remember how many days it took to start seeing results, however. Sorry!) Then it came back and they theorized a fistula they could not see was "feeding" it. They were right.
4. Unsure. Like #1 though, I theorize that it's already in your body and doing its thing, but I'm not a doctor.
5. I would guess that the technical difference between draining and rupture would be intent, but that's just a supposition, really. When I think "rupture," I think it broke open on its own and when I think "drain," I think of a doc or surgeon cause it to come out one way or another.
6. Unsure, but I sat on mine, and I mean directly sat on mine. Ever hear someone say "crooked-ass?" Well, that was me. It's not just for crooked-ass paintings or wall hangings.

I hope you get some relief real soon. :hug:

 

[scoutfinch]

So, I ended up going to the wedding without treating the abscess. Oddly, I think my sitting on it so much numbed it so that by the afternoon it wasn't AS painful as it had been in the morning. Wedding was beautiful and I had a good time (but would've had a fantastic time had I been more mobile! This freaking disease - it's almost like it knows the worst times to flare up!)

sawdust - thank you for your advice, I think our situations are similar. I am literally tilted about fifteen degrees to the right off my chair right now.

The abscess subsided a tiny little bit on Monday - I think that's when the Cipro and Flagyl started kicking in (tell-tale signs: much nausea and watery diarrhea ensued). However, the abscess is still very hard and inflamed. I went to see my GI again and he recommended I either continue the antibiotics and get a CT scan to see what's going on down there, or to get it lanced. I'm leaning toward getting it lanced tomorrow. It's just so damn painful and uncomfortable - not to mention that the antibiotic side effects are really unpleasant and I'm only on my 5th day.

If I get it lanced, I'm hoping any incision they make will be small and quick-healing. I'm worried about infecting the cut given that urine or stool might get on it given the location of the abscess. I don't exactly have a full bathroom at work where I can hop in the tub and wash up after every go!

I know I'll need to do sitz baths and dress the wound, but how long will it take to heal? Is it going to be sore for a long time? Am I going to be able to sit on it right after the operation?

 

[SomethingIsMissing]

Hi, usually it actually feels better after its drained. If it is not complicated it heals pretty fast.
Ask about a peri bottle for portable clean-up and have feminine pads on hand to be able to keep it clean and dry as possible (for work and being out).
Sitz baths at home for sure after
Nice to hear you had fun at the wedding!

 

[Sailorluna]

Glad you had fun. Just curious, after they lance it will the still do the mri or cat to see if there is a fistula?

 

[Kit]

Another thought on the side effects from antibiotics, look into probiotics that are good at counteracting intestinal symptoms with antibiotics. I was on antibiotics for quite a while, including Cipro and Flagyl. It helped, but I think the Flagyl also made me nauseous. I ate a lot of crackers and ginger ale! Here is the us government website on probiotics http://www.usprobiotics.org/. I hope this helps.

Kit

 

[raechel]

I have had a very similar experience with the location and pain/symptoms you are describing. After a week of antibiotics not working I had to have it cut open, drained, and packed. I had this done at my doctors office. It was a very very painful procedure, but I was able to leave immediately after the doctor was done. The instructions the doc gave me was to pull out a small amount of the packing each day and change the exterior dressing. After all of the packing had been pulled out (about a 5 days later) I returned for a follow up and everything healed well. I am not going to lie the pain was really bad, but day one of having it drained I was so thankful I did! The temporary pain was definitely worth the long term relief. As a crohnie I'm sure you're used to pain anyways right? Good luck.

 

[scoutfinch]

Hi all. I wanted to follow up with a conclusion to my abscess experience. So, I ended up NOT draining the thing. The antibiotics kicked in after the 6th day or so and the abscess started to diminish in size - slowly. I took 14 days of Cipro and Flagyl altogether (such awful drugs with awful side effects) and by the 14th day the abscess was down to the size of a pea and no longer painful/sensitive.

However, I still have a very small hard area where the abscess was. I suspect there is some type of scar tissue or pocket where the abscess was, and I fear it could potentially become infected again, but until then I am just monitoring it. I do want to get a pelvic CT scan done sometime soon to see if they can get a picture of what's going on down there (and in my colon/rectum).

Thanks again to everyone that responded to my questions and provided advice and support!

 

[smallfry]

I would recommend an MRI over a CT. The CT did not pick it up anything abnormal in me. It wasn't until my MRI that they were able to see 3 sinus tracts and a fluid collection in my recto vaginal septum. All the best!

 

[Sloan]

I just went through this! Same spot exactly! Doctor gave me cephalexin 4x a day 10 days and it ruptured on its own on day 4. I used warm compresses and warm baths and slept with one of my bed sheets between my legs and it burst on its own. It has to drain or be lanced to go away I was told by my doc so it might come back if it didn't. I'm using antibacterial wipes for work and keep it covered in neospron with gauze so it doesnt rub on my skin. It's important to wear cotton underwear and loose pants sweats are good as much as u can as well

 

[Tuff]

If you look at the top left corner of posts, it shows when the post was made. That thread is from 2012.