Advise for Anal Abscess Newbie

[2much]

Hello Friends....while I am not new to Crohn's Disease and the horrors of how this disease affects our daily living; Today I noticed my first anal abscess. I had a bit of discomfort and checked and there it was. The abscess feels small overall...not overly painful but I do wonder what is really going on underneath....is it really a fistula?
Sometimes I feel like a durr brain when it comes to my own health. Not only have I had this disease for a while....I am also an RN....when it comes to my own health it seems that all logic goes out the window.
So back to my new abscess. I know that I need to do sitz baths and hope for natural drainage and healing. What I do not know is do I contact my GI for other forms of treatment? It would be a good idea just to let them know but I am not overly excited about antibiotics...I do not tolerate Flagyl well at all. Cipro I do a bit better on but not for more than a week. My overall condition is that I feel that my disease is active and that I have good days and bad days...I have not felt that I was in a "flare: per se but I am not sure how this all plays into it. I have a fantastic surgeon who has always been available to me and is kind and not so eager to cut me open which I love. Is this something that inevitably will have to surgically treated....how will this affect my day to day life....my job, which is in a fast and chaotic environment...I need to work so i am hoping for some tips on maintaining as normal life as possible as this is treated. I have been lucky regarding this as I am 50 and have not had an anal abscess until now. Back in my 20's I had a fissure that needed surgical intervention...I was not diagnosed then....should have been with all of the symptoms I was having but was told I had IBS. I have had a resection back in 2008....on humira biweekly now and have done pretty well on it overall. Did not tolerate Remicade or 6MP or Pentesa.
Any suggestions would be much appreciated...I love being a part of this forum.....you all are so kind and understanding.....I have learned so much from you all.
Thanks

 

[nogutsnoglory]

I think your GI definitely needs to know and you may want to consider a pelvic MRI. Most likely you will need antibiotics but know that most cases require incision & drainage + antibiotics.

"Antibiotics alone are a poor alternative to drainage of the infection. For uncomplicated abscesses, the addition of antibiotics to surgical drainage does not improve healing time or reduce the potential for recurrences. There are some conditions in which antibiotics are indicated, such as for patients with compromised or altered immunity, some cardiac valvular conditions or extensive cellulitis." http://www.fascrs.org/patients/conditions/anal_abscess_fistula/

Take it from someone with very aggressive abscesses and fistulas, they can grow and get out of hand very quickly. Please be on top of it.

 

[2much]

Thank you for your quick response...I will contact my GI doc tomorrow....my added inconvenience is that I live 5 hours away from him...I can get to my surgeon much quicker....he is only 2.5 hours away....
In any event, I kind of knew that was the route but there is this denial factor and wish that if I don't pay attention maybe it will go away....another durr moment.

 

[Sailorluna]

I am with ngng you have to get with a doc and keep it under control. To me the colorectal surgeon is my primary resource for my fistula. In fact my initial GI refused to see me for it at all. They sent me directly to the surgeon.

The denial factor for fistula/abscesses are HUGE. I don't think anyone wants to think about problems in that area. Good luck. I hope you heal quickly.

 

[nogutsnoglory]

You probably will need to contact the surgeon but of course you always want to exhaust the medication option. If your abscess is more superficial it has a better chance responding to antibiotics. But overall the rates of antibiotics alone as shown above are not great.

 

[lgpcarter]

Antibiotics may be able to knock it back, so definitely worth the trip the to GI. I also find my perianal disease to be waaaay worse when in a flare, so you might want to discuss that too.

I'm on Cipro and Flagyl right now and I think they are part of the reason I feel so miserable, so understand not wanting to take them. They are helping with my abscess and fistula though.

 

[Essieluv]

For all of my perianal abscesses and fistulas, the first step is always to see my colorectal. She then gives a Cipro/Flagyl combo (which I HATE), and schedules me for drainage/other procedures under anesthesia. I never get my abscesses drained under local anesthesia anymore, it was too painful for me. Unfortunately, there isn't much you can do for abscesses once they have appeared besides antibiotics, sitz baths, and drainage.

 

[annawato]

I've had 3 anal abscesses. The first two were lanced by my doctor and then all was fine. This last one drained on its own - I think it was a bit deeper, and has been continually draining pus or blood for a few weeks so I'm on cipro at the moment but my GI said I should see the surgeon as he suspects there may be a fistula.
If you don't normally have crohn's in your bottom you may find that lancing and cipro will do the trick. If you have anal/perianal disease then more vigorous investigation as NGNG suggests should be done as it is more likely to lead to complications.
Antibiotics without drainage are often unsuccessful as they cannot get to the infection in the abscess but they may help with whatever caused the abscess in the beginning.
Since you feel your disease is active a visit to your GI is probably a good idea then s/he can advise you from there.
I tend to the wait and see before visiting the doctor approach as its amazing how often the body rights itself but many people here have had awful ongoing problems which started with an abscess. I guess only you can determine whether its worth seeing if it drains and heals naturally.
Reading over this it seems I am firmly sitting on the fence so sorry for not being of more help. I guess I just wanted to let you know that they can resolve without major problems it just depends on the person.
good luck,
:heart: anna

 

[2much]

Thank you all for your support and advise. I am scheduled for a colonoscopy next week. This is what is going on......it seems that the abscess has drained fully or almost. I have no pain...when I touch the area the skin feels different and a bit tender but again...no pain at all. Is it possible for an anal abscess to be superficial and heal on its own? I have been really good about sitz baths and keeping clean....I have not noticed any draining since Monday.....you all have hadbsuch varied experiences.....I would love to know what you think......thanks a bunch

 

[nogutsnoglory]

Please keep us posted with the results. I hope it heals fully in the easiest fashion possible.

 

[Essieluv]

I'm glad you're feeling better, however I do think that it is still best to mention your abscess to your doc if you haven't already. Even if it is healing, some antibiotics might be needed to heal what is deep inside the tissue, things that are not easy to see or feel. The problem is, sometimes the abscess can appear to heal on the top layer (what we can see), all while forming a fistula tract deep inside. An abscess can be quite a deceptive little pesk. I understand your hesitation to take Flagyl and Cipro. They are very hard on my tummy, and give me diarrhea and extreme nausea. But, I would much rather deal with two weeks of feeling worse if it means avoiding a fistula. Good luck, and please keep us posted.

 

[annawato]

Hi 2much, How did you go with the colonoscopy and what were your doctors thoughts on the abscess?

 

[2much]

thanks for checking in....the abscess drained on its own and is no longer there, I was very good about my sitz baths; I will never second guess the power of sitz baths again; lol....and my colonoscopy had to be moved up so I have not had it yet....I think my disease is quite active....not sure if I would call it flare purse but it is clearly interfering with my life. My general consensus is that the abscess was related to crown;s disease just by virtue of location....not a boil or skin abscess. This was my first and hopefully the last.....
thanks again for checking in....means a lot to me to know there are caring people out there in the world who totally get what it means to live with a chronic disease.
Hugs

 

[2much]

well...how things change in a day or two....as i posted above...my abscess appeared to be superficial....drained and went away...then 2 nights ago it appeared again....same exact place...same shape....next day while at work I noticed that I felt...well....sort of moist where I shouldn't and went to the bathroom and the abscess opened and blood was draining out...not a huge amount but enough....then the abscess was then smaller. It is still there in that I can feel it...doesn't really hurt but more annoying.....raw feeling maybe.
So I called my GI nurse who recommended calling surgeon...long story short...colonoscopy on Monday...surgeon the following week.
Needless to say, I am quite concerned...I have had a sense that my disease process was changing...not sure if I am going to need to be cut and drained but then again, I am on unchartered territory for me and feel clueless. I don't know what to expect.
To top it off my supervisor was an absolute jerk to me when I told him i needed a couple of days....I was floored...I am a nurse...work in a primary care office and my supervisor is a nurse...it is not like he doesn't understand what could happen...he barked at me and asked me if I considered the staffing at the clinic before I scheduled my appointment...I just said no I didn't....my health and the idea that this could ultimately be a life changer for me was first on my mind. Then he played martyr and told me he had the week off but I guess I will have to work then. I responded by saying..well...then what would work best for you and the clinic and he just looked at me and said there is no good time.
What ever happened to compassion, being a human being.....then he threw the I am the supervisor card at me...jerk....meanwhile he has a few health conditions that are chronic in nature and he just goes and does what he wants and when he wants to. But then again...he is the supervisor. I struggle with that...we are all equal...that hierarchal stuff has no space in my mind...it is nonsense ego bologna.
Well..that just spewed out.
Anyway...what do you all think....could this be a fistula...my GI nurse thought is could and then it could be as simple as a small abscess. The swollen area is really small....size of a pea maybe...I don't know...I am a good nurse for others but when it comes to my own health...I seem to have such a durr brain...I just seem to lose all logic and end up creating all these horrible scenarios in my head.
Am I the only silent drama queen? I don't necessarily act on my brain chatter but boy it is loud sometimes...
Thanks for listening

 

[Essieluv]

Are you having any fevers? If you are, just keep an eye on it. If you spike a really high fever just go to the ER. It could be a fistula, but it could also be a little abscess. Try not to worry about it too much, hun. Just try to relax and focus on you right now. Hang in there <3

 

[2much]

Thank you....I will try to mellow my mind. I have not had any fevers....my other symptoms have increased....urgent wake up runs to the bathroom.... Joint pain....belly pain....blah blah.....
But you are right.....active brain chatter certainly does not help the situation .....:>)

 

[CrohnsOHNO!]

Consider seeing your surgeon who may be able to probe the abscess to see if its connected to a fistula. This process combined with Cipro on 1 week and Flagyl on other 3 weeks/month, along with 6MP successfully eliminated my fistula after a lengthy time, several years. Good luck!

 

[annawato]

Your supervisor sounds like an absolute jerk! and I'm glad you've got this forum to have a good old rant about him.
How did you go with the colonoscopy?

 

[2much]

Thank you....well I am totally confused....my colonoscopy looked great.....not complaining but just don't understand. The doc felt that the abscess is not Crohn's related.....don't get that either .... Never had anything like that but okay.....
Will se surgeon next week.
My only real complaint is feeling rushed.....trying to absorb the info and wrap my head around this all. I know I am not imagining this all....my right lower quandant pain.....diarrhea....and abscess .... So if in remission......what is causing all of this.....my partner feels this stress related.....she is saying this with heart and not blowing me off.....she is quite aware of my boss etc. I guess I was looking for validation of my physical symptoms.....at the same time am very happy that my disease remains in remission....
Any thoughts?

 

[annawato]

I dont think its unusual for the doctors to say everything is normal when you are feeling like , well awful. It will be interesting to see what the surgeon says. It sound like you are on the right medication already (humira) so maybe its just having the abscess that is causing everything else. so no real new thoughts from me other than to see how things go once the surgeon performs their hopefully magic on the abscess.