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Beginners guide to Fistulas and Abscesses

Jennifer

Adminstrator
Location
SLO
Please note this was not written by Jennifer but a member who decided to leave the community. Due to the important nature of this post, we needed to save it so he took it over in his name.

Crohnsforum/fistula/abscess veterans, if you have any tips to go into this (there's a tips section later), please post it in a reply. Also, any extra information is welcome. The section on treatment for abdominal fistulas needs aid, and any experience sharing would be great.

Introduction


Abscess: a collection of pus/fluid in a cavity formed of the surrounding tissue. Can appear in the perineum/anal area (perianal abscess), intestines (intestinal abscess), or on organ/skin surfaces/under teeth. Sometimes, abscessing is a defensive reaction to foreign matter existing in tissue. IBD patients sometimes develop perianal or intestinal abscesses as a result of the disease (not as a result of any foreign matter). Unlike a cyst (which is filled with a variety of liquids), an abscess is filled with body mucous intended to destroy foreign material/organisms and is an infection, however in patients with IBD, there is often no underlying foreign material/organism: the abscess is mostly a result of hyperactive immune responses. Abscesses MUST be attended to by a doctor: the infections fluid contained therein can be deadly.

tl;dr: Abscesses are like chronic pimples in uncomfortable areas, almost always requiring medical intervention.

Fistula: Abnormal communication (tunnel) between two tissue walls. Fistulas can exist between intestines (enteroenteral fistula), between intestines/skin surfaces/organs (ex: biliary fistula), between the anal walls and the exterior perianal area (perianal fistula/anorectal fistula), between the anal walls and the vaginal walls (recto-vaginal fistulas) or between anal walls and the bladder (vesicointestinal fistula). Fistulas sometimes seep fluids or gasses, sometimes because of where the fistula originates (ex: stool seeping into bladder), and sometimes because the fistula will bleed or create pus like an abscess. Fistulae (plural) are usually caused by microperforations or ulcers that have tunneled through one surface to another, without abscessing.

tl;dr: Fistulae are connective tubes/holes between two surfaces (imagine a tunnel or an ear piercing)


How to tell if you have an abscess/fistula



Abdominal Abscesses and Lower Abdominal Abscesses: Acute (local) symptoms include abdominal pain and swelling (distention), lack of appetite, nausea, diarrhea, feeling of "fullness", vomiting. Lower abdominal (colon) abscesses can push on the bladder, causing urgency. Fever, chills, weakness or delirium are signs that the infection is beginning to spread. Get to a doctor, or go to the hospital.

Anal Abscesses: Acute symptoms include rectal/anal pain, foul discharge, swelling, redness, warm to touch, problems sitting, constipation, feeling of fullness, induration (hardening of skin). An anal abscess will usually feel better after a BM. Fever, chills, weakness and delirium are signs that the infection is beginning to spread. Get to a doctor, or go to the hospital.

Is it a cyst? : Many people have trouble differentiating between an abscess and a cyst: An abscess is an infection, and will display appropriate symptoms which would not indicate a cyst. These symptoms include systematic infection, fever, fatigue or delirium, warmth/heat at the area affected. While a pilonidal cyst (a cyst near the tailbone) or an anal cyst will be painful and swollen, they should not be inflamed or hot to the touch unless they are infected. A cyst which has become infected is an abscess.

Abdominal Fistulas : Abdominal fistulas (small and large intestine) can connect from the bowels to the skin (enterocutaneous fistulas), from one section of bowel to another (enteroenteral fistulas), or from the bowels to the stomach (gastrocolic or gastrojenjunocolic fistulas). Enterocutaneous fistulae symptoms include an obvious sore that discharges potential foul fluids. The sore may resemble an ingrown hair. Enteroenteral fistulas can sometimes be completely symptom free, but often are accompanied with pain, malabsorption, dehydration and diarrhea. Fistulas leading to the stomach can also cause pain, diarrhea and other diarrhea associated problems.

Fistula in ano (anal fistulas) : connections from the anus or rectum to outside anus. Can be painful, and usually discharge some form of fluid. Usually caused by a previous abscess, but sometimes the body will fistulize faster than it can abscess. External openings can look like ingrown hairs or needle wounds. The internal opening may feel like a fissure in the lining of the rectum. Some people may confuse their fistula with an ingrown hair or pimple, but unlike a pimple or ingrown hair, fistula discharge and discomfort are chronic until medical attention is sought. Furthermore, pain from fistulas will reach further than a simple skin problem, and will have an opposing opening which may hurt.

Recto-vaginal fistulas: Fistulas between the rectum and lining of the vagina usually present themselves similar to a fistula in ano, except usually with more stinging around the exit wound. Recto-vaginal fistulas can present themselves as a simple infection, as they may not be visible.

Colovesical/Enterovesical Fistulas: Fistulas between the colon and bladder, or small bowel and bladder, respectively. Symptoms include recurrent urinary tract infections (UTI's), symptoms of a UTI without actual infection, bladder urgency and frequency, pain in pelvic area/pain when passing urine, cloudy or bubbly urine and debris in urine.

Abscesses and Fistulas should ALWAYS be examined by a doctor…


Procedures

A note from butt surgery experts: try your hardest to see a colorectal surgeon, as opposed to a general surgeon!


Observation:

Abscess and fistula observation can be a pain, as most patients want the issue solved immediately, as opposed to examined and scanned. However, doctors usually start by performing a visual observation, sometimes feeling the problem area for indications. Abscess can usually be felt by touch, or in the case of intestinal abscess, viewed VIA colonoscopy/laproscopy/fluoroscopy (a moving x-ray, in which the patient ingests a contrast, or a contrast is administered VIA enema). Fistulas can often be determined by viewing the opposing openings with nothing more than the eye. However, many doctors opt to see the entirety of the fistula, and perform a fistulagram, in which a contrast is injected into a fistular opening, and the area is x-ray’d. Fistulas can also be viewed via an MRI (such as a pelvic MRI for perianal fistulas) with the added bonus that you get to keep your underwear on! MRI's however, are expensive, so don't be surprised if your doctor first opts for a simpler route of examination.

tl;dr: if you are uncomfortable about your body, then i'd suggest getting over it. Your doc is gonna want to look at parts of you you've never even seen.


Treatment:

Abdominal Abscesses/Lower Abdominal Abscesses: Antibiotics to fight infection. Surgery to remove or drain the abscess is likely. Biologics, such as Remicade, cannot be used when abscesses are present, as they have a chance of closing them.

Anal Abscesses: Antibiotics to fight infection. Anal abscesses almost always require surgical drainage via lancing or incision. In non-IBD patients, the abscess may heal over properly, or form a fistula (because of the lancing). In IBD patients, abscess drainage is almost always followed up by a fistula. Because of the complications of IBD, abscesses in patients with IBD may not drain entirely, thus forming a new abscess every time the ends heal over. This is rectified by something called a seton. A seton is a thread that goes through the newly fistula'ed abscess, and out the other opening. It is then tied on the outside of the abscess. More on setons in the fistula in ano section. Like abdominal abscesses, anal abscesses prevent the use of biologics until they are turned into a fistula.

Abdominal Fistulas: Can be treated with antibiotics, or biologics. Surgery usually involves resection of the connecting piece(s) of bowel.

Fistula in ano/Recto-vaginal Fistulas: Fistula in ano/Recto-vaginal Fistulas are often the result of setons, a thread like apparatus meant to create a non-healing fistula, preventing recurrent abscesses.

These types of fistulas are usually fixed by invasive surgury, in patients without IBD. However, because it is very dangerous to cut the sphincters in a patient WITH IBD (think of the diarrhea), medical professionals prefer initially to try medicinal therapy, followed by surgical therapy. Antibiotics (often Cipro + Flagyl) are usually the first line of attack. Medicinal therapies can then progress to immunomodulators (such as imuran), which have a slight chance of healing fistulae in these areas. From there, biologics are chosen, because they tend to have a healing effect on fistulas in the anal/genital region. Surgical removal of fistulae can involve the use of cutting setons (tight setons, meant to slowly lay open the fistula, allowing it time to heal from the back forward, and hopefully preventing incontinence), mucosal plugs (which plug the fistula and stimulate permanent healing) or flap procedures (which close the fistula from the inner opening (preventing bowel discharge and abscessing).

Colovesical/Enterovesical Fistulas: Treated with the same steps as fistula in ano, or recto-vaginal fistulas. Because these fistulas involve the colon and small bowel, biologic and antibiotic therapies are not as successful, and the healing process usually involves surgical removal.

A bit about Biologics (and immunomodulators): These two types of drugs have shown some ability to heal lower-body fistulas (recto-vaginal, fistula in ano). Immunomodulators are relatively inexpensive, and work by suppressing the immune system entirely. They have a small chance of healing a fistula. Biologics are very expensive, and work by suppressing any damage the immune system tries to inflict. They block something called Tumor Necrosis Factor (the alpha variety, if you care), which are involved in destroying infection/foreign materials, as well as in ulcering and fistulizing (if you have IBD). Biologics have a fairly good chance of closing the fistula. Both of these will suppress your immune system, and will make you susceptible to infection or other illnesses, as well as increase your chance of cancer. Talk to your doctor.

tl;dr Abscesses and Fistulas usually take a while to heal and treat, so don’t assume you can go to the doctor for a band-aid. Also, they're going to be a pain in the arse, so you might wanna take up drinking.


What to do while you’re waiting for a doctor


This list is meant to be comprised of various forms of pain-relief/promotion of healing as recommended by Crohnsforum.com users.

Perianal Abscesses:
- Hot compresses (hot water + clean cloth) on affected area help to ease pain. Will also break down skin, and dilate openings, so as to let infectious fluid out. Don't compress too often, or you'll end up with burns.

Perianal Fistulas:
-Sometimes, after a seton is put in place, granulation tissue will appear. This is pre-healing tissue, and can be very sore. Sitz baths will help heal the granulation tissue (which is good), or alternatively, you can apply a mixture of water/epsom salts to the opening of the fistula with a cotton ball. Do this right before bed, as well as wear loose undies to bed, for best granulation tissue healing.
-Also, sometimes with a seton, the knot can move itself up into the fistula. This can be quite painful, and difficult to take care of. It is recommended that you first get into a hot bath, and soak for atleast five minutes. Then, you can reach down with one finger, and slowly slide your finger along the seton, towards your bum hole. The friction this causes will slowly pull the knot out of the fistula. It should be relatively painless.

Vesical Fistulas:
- Drink plenty of fluids - water, cranberry juice, lemon barley water are best.
- Avoid tea, coffee and fizzy drinks - they are diuretics.
- Try not to eat too much sweet, sugary food.
- Keep warm and a heating pad or hot water bottle might help with the pain and urgency.

Want more Info? Try:

http://www.fascrs.org/physicians/education/core_subjects/2009/anal_fistula_abscess/

http://www.fascrs.org/physicians/education/core_subjects/2011/Crohns/

http://www.nacc.org.uk/downloads/factsheets/Fistula.pdf
 
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It's very informative and it's a good guide. I've often wondered what a fistula is and how you can tell you have one
 

DustyKat

Super Moderator
My son recently had a fistula and abscess in the ileum and was I was told by a number of different colorectal surgeons and GI's, Crohn's specialists included, that these type of fistula's will not respond to medicinal treatment and surgery is the only option. I think it is also worth pointing out that if you do have an abscess then that rules out using the biologics.

Dusty. xxx
 
My son recently had a fistula and abscess in the ileum and was I was told by a number of different colorectal surgeons and GI's, Crohn's specialists included, that these type of fistula's will not respond to medicinal treatment and surgery is the only option. I think it is also worth pointing out that if you do have an abscess then that rules out using the biologics.

Dusty. xxx
Thanks for the info! I forgot to mention about abscees and biologics. I had no idea about the illeum abscesses.
 
Oh, this is great, how did I miss this?? It would be really good to have a sticky, especially as we now have the Fistuls and Abscesses sub-forum ( thank you very much, you Admin guys xxx. )

Could I add a bit for Colovesical ( colon to bladder ) and Enterovesical ( bowel to bladder ) fistulae?
Signs that you may have one:
* recurrent urinary tract infections
* symptoms of a UTI without the actual infection
* bladder urgency and frequency
* pain in the pelvic area or when passing urine
* cloudy and/or bubbly urine
* debris such as food particles in the urine

Drs may prescribe antibiotics and possibly Remicade to see if the fistula(e) will heal, but it is highly likely that surgery will be required.
What to do? Must be treated by a doctor, but taking the steps that you would if it was a UTI might give some relief:
* drink plenty of fluids - water, cranberry juice, lemon barley water are best
* avoid tea, coffee and fizzy drinks - they are diurectics
* try not to eat too much sweet, sugary food
* keep warm and a heating pad or hot water bottle might help with the pain and urgency
 
Helen, I'll get right onto adding your info :) Atleast, I'll try. I can't seem to edit it anymore, so I'll PM David.
 
Thanks very much :) I don't think this will freak people out. Well, fistulas are pretty freaky things anyway :eek: but I think, as I did, that you'd want to know if you had one and what if anything you could do about it, the implications etc. I really like the idea too that new posters/enquirers can get the information they need here on the forum rather than having to be redirected to other sites.
Thanks again.
 
Thanks very much :) I don't think this will freak people out. Well, fistulas are pretty freaky things anyway :eek: but I think, as I did, that you'd want to know if you had one and what if anything you could do about it, the implications etc. I really like the idea too that new posters/enquirers can get the information they need here on the forum rather than having to be redirected to other sites.
Thanks again.
No problem! It's nice to be able to contribute something. BTW: When I mention freaking out, I mean people who suddenly have a large boil of pus or strange oozing hole and have no idea what to do with themselves :p The thread is now editable :) But any likes or subscriptions are reset because David had to move the thread, or something like that. Just in case you were confused :)
 
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this looks really helpful!!

you could maybe add about pelvic MRIs been used to see perianal fistula under the observation section?
i had an mri after my surgeon didn't see/find any fistulae during an EUA. it's just a normal mri, no weird prep or anything. i had most of my images taken without contrast and then the last few with contrast which was injected through an iv thingy in my arm. it was all very stress free and i even got keep my underwear on!! haha :D
 
:lol: Lol, Kate. I've yet to have a colonoscopy and am hoping I can get through my whole Crohn's experience without one. Good point about the MRI. My enterovesical fistula didn't show up on ultrasound or Barium FT. It was confirmed by CAT scan i.e. signs of gas in the bladder.
Are you going to add that in, Ben my man? :)
 
Sorry guys! I've been a little stoned lately. Painkillers <3


Yeah, I'll absolutely add that bit in ;)

EDIT: Kate, can you clarify one thing: For your pelvic MRI, they did both non-contrast and contrast?

thanks,

Ben.
 
yep, i had both. it was a bit weird, they put the iv cannula in but didn't inject anything into it in before my scans and then about the 3/4 of the way through actually taking them the lady paused everything came in, injected the contrast and then took a few more scans.

when i first arrived she said they would only use the contrast if it seemed like it would be helpful, so if nothing was showing up on the images without contrast i don't think i would had any contrast. (my fistula wasn't actually confirmed before my MRI, even after my abscess surgery and a second EUA, so i think that's why everyone was a little skeptical of it showing up on the MRI)

haha you asked one question so i gave you a huge story!! :D
kate
 

DustyKat

Super Moderator
Hey Kate,

Matt has had all his scans done that way. They cannulate and set up the pump, then they do a run without the IV contrast, so just with whatever you have taken orally if anything, and then they will come in and start the IV contrast and do another run of films.

Dusty. xxx
 
I am glad to see this thread. I would be glad to do some research for the portion on abdominal fistulae. My experience in the area... I had one.
 
Kate, what's an EUA? I never heard of or had one of them.... I think!
Ben, honey, why are you on painkillers? Are you having a hard time? Well, a harder time than usual? :hug:
 

Astra

Moderator
Hiya Ben

It's great for someone to explain these in more simple terms for me.
Can I just say
I've read some threads by yourself and muppet about the importance of getting a colorectal specialist ( a bum surgeon) to do these procedures, and not a general surgeon who doesn't know a bum from his elbow!
I'm so glad this was mentioned in another thread, it's something that I will never forget if I ever have a fistula/abscess.
It's frightenng to think that some random doc in ER would conduct such an op and ball's it up!
xxx
 
Kate, what's an EUA? I never heard of or had one of them.... I think!
Ben, honey, why are you on painkillers? Are you having a hard time? Well, a harder time than usual? :hug:
My butt hurts, and I've run out of salofalk. I never thought it did anything, but now that I'm off it, I'm getting alot of cramping and blood. Plus, my seton stuff is finally starting to heal over with granulation tissue. Which hurts like heck. lololol...
 
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I've done a session of Tisseel. It sealed up one fistula. Unfortunately, at the time, they couldn't clearly see my other fistula. Remicade failed to close up the hidden fistula, and now it is another candidate for more Tisseel, once I get my abscess cleared out.
 
Granted, my TISSEEL application was more off-label, as my fistula is internal without any external drainage.

<<>>

CONCLUSIONS: Fibrin-glue treatment of anal fistulas is successful in up to 69 percent of patients if initial failures are retreated. This sphincter-saving technique is associated with minimal complications and no functional detriment. Late recurrences are unusual.

http://www.springerlink.com/content/ltd4f1qwklfxx0u4/
 
Excited about potential new effective surgery

Floating around on the web, and being a 20 yer Crohnie, with advanced peri-anal-fistulas, I found something that is exciting for the cure and prevention of the before mentioned. Too bad from what I have read that it's been developed in India and the USA is now looking into the equipment and procedures safety that will prolly take ten years, lol but I wanted to share with you.


http://www.ncbi.nlm.nih.gov/pubmed/22002535

http://www.karlstorz.com/cps/rde/xch...s.xsl/8684.htm

http://up-surge.com/blog/2012/01/31/...ment-by-vaaft/

http://news.amrita.edu/news/2012/02/...med-at-amrita/

This is the best link detailing studies.....

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3226694/
 
Recto-vaginal Fistula

has anyone had surgery for this? my Dr is sending me to a surgeon to look at it, not sure what they are going to do about it, just wondering if anyone knows the hospital stay, how much healing time, things like that :sign0085:
 
has anyone had surgery for this? my Dr is sending me to a surgeon to look at it, not sure what they are going to do about it, just wondering if anyone knows the hospital stay, how much healing time, things like that :sign0085:
What's the surgery? Like, what is he going to do?
 
has anyone had surgery for this? my Dr is sending me to a surgeon to look at it, not sure what they are going to do about it, just wondering if anyone knows the hospital stay, how much healing time, things like that :sign0085:
It usually depends how severe your abscess/fistula is. I've had six operations. All were conducted by my colorectal surgeon, most of them were outpatient at surgery centers, but two were done in the ER and required one night in the hospital.
 
So yesterday was my fourth operation for abscesses within the last month. The first abscess (I believe he said it was the "horseshoe" kind), which still has a seton/drain, the surgeon went in to check on it while he had me in the operating room for abscess number three. He said the cavity of the original abscess is growing. Even though it's still draining and isn't filling back up with puss, the cavity is still expanding. Is this common, is it cause for concern, and is there anything that can be done about it??
 
So yesterday was my fourth operation for abscesses within the last month. The first abscess (I believe he said it was the "horseshoe" kind), which still has a seton/drain, the surgeon went in to check on it while he had me in the operating room for abscess number three. He said the cavity of the original abscess is growing. Even though it's still draining and isn't filling back up with puss, the cavity is still expanding. Is this common, is it cause for concern, and is there anything that can be done about it??
That's... Weird. Maybe it's necrotic, and rotting :eek:

Did he not offer any explanation as to why?

I'm interested as to what is going on.
 
No he didn't offer much explanation, and my GI just said it was a sign of my crohn's advancing out of control. :(

Kinda starting to worry about it though. I actually never felt any pain from the perianal horseshoe one, I've been feeling pain in my right cheek the entire time... but now I have strange, dull pain near my tailbone. Feels like when you have a broken tooth and the root is exposed. Except it's not a tooth, it's my spine. Eek!
 
I need help....

I had 17 perianal abcess surgeries and 5 that drained on their own.. I had a seton drain installed for several months, hemmroids and fissures... This has been going on for about 10 years now... I have been tested for crohn's, IBS, pretty much everything related to this and docs don't know what's going on... I have blood in my BM every time. (not drops, large quantities) and am always in pain...

I have noticed a routine over the past years... I will heavily bleed with every BM then all of a sudden it stops and a abcess forms within a day or two... Gets drained and the process starts all over again...

Here is a list of things i've gone through:

17 Abcess Surgeries + (5 that drained by themselves)
6 colonoscopies
3 MRI
2 under anesthetics manual examinations
1 contrast x-ray (upper) through nose
1 contrast x-ray (lower)
2 endoscopies
1 fissure surgery
1 seton drain surgery (2 months)

Hemorrhoids during the whole time


Now the problem is that i got operated so many times at the same spot that my skin doesn't heal anymore... I basically have a permanent hole where the seton drain was... I can literaly see my muscle tissue in the hole (kinda discusting and painfull).

If anyone has anything, please let me know... I have top gastro docs looking after me and don't know what's going on.

Please help.
thanks
 
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So yesterday was my fourth operation for abscesses within the last month. The first abscess (I believe he said it was the "horseshoe" kind), which still has a seton/drain, the surgeon went in to check on it while he had me in the operating room for abscess number three. He said the cavity of the original abscess is growing. Even though it's still draining and isn't filling back up with puss, the cavity is still expanding. Is this common, is it cause for concern, and is there anything that can be done about it??


I would ask your doc to do a MRI for a fistula...
 
**Very Important**

Anyone experiencing a fistula please read this and take to heart. I had fistula for 18 months on my backside, one of the most morbid things I've ever experienced. I'm a very spiritually strong person and have endured a lot physically as I'm sure many of you have, but this was starting to weigh on me mentally. I had visited multiple GI doctors, and a surgeon who said it surgery wasn't even an option due to having it so long and its position. They had no answers for me and told me to expect to live that way for the rest of my life because they typically don't heal and if they do they reoccur. I was at the end of my rope and one night reading online and researching like I often do I discovered a miracle diet called the SCD Diet. After being on the diet it was completely healed in less than a month, God as my witness.

The specific carbohydrate diet is the best diet out there for IBS/Crohns Disease period. Take it from someone who has delt with a very progressive and early stage Crohns Disease for 14yrs. I went to one of the leading and most renowned places in the United States for Crohns and Colitis during a lot of my childhood (Cleveland Clinic), and even there they didn't focus on diet being a lead cause to symptoms, the speeding up of damage and autoimmune responses, and irregular bowel movements/internal and rectal bleeding (you should only be having 1 bowel movement in the morning with zero pain and no bleeding).

Make sure you all purchase and read this book Breaking the Vicious Cycle by: Elaine Gottschall, all the research was done for us to be learned and applied to our everyday diet for vast improvement. You can also google SCD Diet A-Z and get a solid list of what to and what not to eat if you'd wish to start the diet before the book arrives. This woman changed her career and became a biochemist and cell biologist to keep up studies for a Elderly New York GI doctor who passed away that she had visited with her daughter. He was doing extensive research with food and its correlation to IBS related diseases and she wanted to continue his research in hopes for her daughter who had Colitis and was looking at losing her colon potentially which thankfully didn't happen because of diet corrections. God bless Elaine, she has given me a entirely new outlook on life and I hope that every one of you who reads this goes to the website and reads about her Biography and all the information she put together to improve IBS diseases dramatically for everyone.

I'm currently 25 years old and of the 7-8+ GI doctors I've spoken with over the course of my years, and countless numbers of nurses, none of them even knew about it. It's a damn shame it is up to us to discover a lot of this stuff, but the blame cannot be placed entirely on the medical community because they don't live and experience the diseases like we do on a daily basis. That said, it doesn't excuse them for typically ignoring diet to the extent they do. I could go on all day, but the rest is up to ya'll please check out the website ***( I urge ya'll to google Elaine Gottschall and read all about her )***. One thing I would like to add as well is the diet must be followed to a T, if you're into cheating on diets or don't have the will power it won't be for you. We all have the will power within us though, best wishes and God bless you all. Jeff-
 

Zaf

Location
Syracuse, NY
Thanks for all of the information! I am on my 26th year with CD (diagnosed in 1986 at the age of 12). I have had one bowel resection in 2009 and have managed the disease fairly well. Recently, I have developed perianal abscesses. I have had to get it lanced twice in two weeks. That was an eye popping experience at the CR surgeon's office to say the least. It is always reassuring to hear from everyone on here, and to see what is working (or not working) as far as treatment and prevention (or mitigation). While this is a new "area" for me with Crohn's, it is just another hurdle. It was nice to tell my boss why I was out of work yesterday....Sorry dude, my ass fell off.
 
I have a fistula going from my colon to my bladdar and I am not in any pain, nor do I feel like I have a UTI, but when I went for me routine blood work and urine sample a week ago my GI doc saw that I still have an infection. So I am on the cipro + flagl combo for the next four weeks and I have to go every Friday for a urine test for the next four weeks. I am beginning to wonder if it is time for surgery, or should I wait a little longer? I have also been on the Humira + Imuran combo since August. I can already tell a HUGE differnce with my fistula since I started my injections. Any thoughts?
 
I guess it you're not having to many symptoms and that you feel there's been an improvement, it might be worth waiting a bit longer? If it's small, it could possibly heal up with the meds.
 
It must be small because I have never actually seen food particles pass, but I have seen mucus and other random things that should not be there. Guess I just need to be more patient. Thanks grumble!
 
It's good that they are doing the urine tests. One of the reasons my consultant recommended surgery was that I was getting repeated UTIs and he was worried that this could lead to damage to my kidneys. I know intestinal fistulae are pretty hard to heal with meds, but you might be lucky.
 
Hi Emily and a big warm welcome to the forum. I'm going to attempt to move your post to its own thread on this subforum, because I think you might not get many replies here on this sticky thread.
 
Hi there,

Just to start off, huge thank-you to all who post on here! Comforting when something new happens.

I had never heard of Perianal abscesses before last week. Turns out what I thought was hemorrhoids, turned out to be a good size perianal abscess. I am sure others have had DVT's associated with Crohn's disease but I am on warfarin which always is out of control when Crohn's flairs up, so they would not lance the abscess until it my warfarin levels were good. It burst on its own the following day, and I get to see my gastro (appointment was made 6 months ago, so good timing on that) later this week. However I am concerned with the healing process, what do the abscesses feel like when they are healing? Mine isn't really shrinking anymore, while it is not painful, it is hardening, normal?

Thanks
Mike
 
Hi Mike
And a very warm welcome to the forum. Glad you found us. I have copied your post into a thread of it's own ('New with abscess healing question' ) Sometimes posts that are tacked on to the end of this sticky get a bit overlooked.
 
I just wanted to say that it is extremely important that if you have anal abscesses to see a colorectal specialist,I have had Crohn's for over 20 years and had so many abscesses over the years.Two years ago I developed anal cancer,the surgeon told me it was caused by all the abscesses I had over the years.I thank God I went to the specialist because the cancer was a stage 2,I went through chemo and radiation and the cancer is now gone.I do have other complications but thankfully not cancer.
 
Has anyone had problems with enteroenteral fistulas showing up in scans? I was in soo much pain and scans showed nothing. After exploratory surgery they found enteroenteral fistulas between the ascending and transverse colon and from the ascending to the caecum.
 
Has anyone had problems with enteroenteral fistulas showing up in scans? I was in soo much pain and scans showed nothing. After exploratory surgery they found enteroenteral fistulas between the ascending and transverse colon and from the ascending to the caecum.
That was me, only it was my small intestine. I did a small ball barium pass through in 15 minutes. The other scans showed nothing.
 

723crossroads

Banned
Location
USA
can you have abscesses from crohn's not in the anal area? Like on your stomach? I get them and they take forever to heal. Is this crohn's related? What should I use on them? I have been cleaning with peroxide and applying antibiotic ointment.Is this good ar bad?
 

Jennifer

Adminstrator
Location
SLO
First thing that comes to mind are boils/skin abscess (very common with an impaired immune system so if not from Crohn's then definitely from certain medications used to treat Crohn's such as Prednisone and other immune suppressants) but have a look see at this as well just in case: http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818

Here's info on treatment for boils: http://www.medicinenet.com/boils/page3.htm

If they are recurring then it would be good to have them cultured to see what you're actually dealing with so you can receive proper treatment. What has your doctor said about them?
 

723crossroads

Banned
Location
USA
First thing that comes to mind are boils/skin abscess (very common with an impaired immune system so if not from Crohn's then definitely from certain medications used to treat Crohn's such as Prednisone and other immune suppressants) but have a look see at this as well just in case: http://www.mayoclinic.com/health/hidradenitis-suppurativa/DS00818

Here's info on treatment for boils: http://www.medicinenet.com/boils/page3.htm

If they are recurring then it would be good to have them cultured to see what you're actually dealing with so you can receive proper treatment. What has your doctor said about them?
Dr said maybe a round of ANTIBIOTICS WOULD HELP. BUT, i DON'T WANT TO TAKE THEM AGAIN UNLESS i HAVE TO, YA KNOW?Sorry hit caps again. Thanks for your help Jen!
 
i had an absess between my vag and butt hole...Im sorry tmi. i am already on a lot of med for Ibd..so they gave me 2 weeks of cipro and flagyl and that seemed to help. it was gone but Im starting to see it come back. praying it dont get any larger or i am off to see wjat a surgeon thinks.
 
Wow, this blog was amazing. I had surgery at the end of January and it ended up they had to remove to fistulas while they were doing a right colectomy. I never knew there were different kinds of fistulas. I now wish I would have asked the surgeon what kinds of fistulas they were. I will definitely be inquiring about this with my GI doc. Thanks for the great info about fistulas. :)
 
I have just had a huge anal abscess removed and am in recovery - as soon as I've recovered I'm having an op to remove a transsphincteric fistula ( goes through my inner and outer sphincter muscle )
Does anyone know anything about this type of fistula?
Anyone had the op?
Any advice?
Thanks xx
 
Does anyone know how quickly fistulas can form? The doctors want us to be very aggressive in treating my newly diagnosed teenager, but other than one fistula/abscess, the doctor said her intestines don't look too bad. I'm thinking if we opt for a milder treatment, how soon would she need an MRI or scope to be sure new fistulas are not forming. I am also wondering what percentage of Crohn 's patients have fistulizing form of the disease.
Thanks
 

theOcean

Moderator
They progress very quickly, from my experience. I would absolutely be aggressive in treating it, because there's a chance it may not ever heal, and aggressive forms of treatment (biologics and immunosuppressants) increase your chances of it healing.

Definitely get it checked out and treated as soon as possible.
 
ANYONE ANYONE? I am an ulcerative Colitis a jpouch survivor I have had real serious pain going on in inside opening. I don't know if its a fistula or an abscess this has progressively gotten worse over the past 7 years and is now shooting pain up into my groin I have acute pain like ice pick in side of my ass and a deeper hollow pain. it takes my breath away and I am so fatigued. i don't have fever and no obvious discharge just deep itch. what ever it is, It is not showing up on MRI or any other scans and they cant see anything is what i am being told. I have been begging to have some kind of ultrasound done on the area and I keep getting shut down and side tracked into something else that wont work. the pain is so bad and I have been given every topical ointment under the sun and even put on gabapinton because DOCS were trying to say it was neurological. NEUROLOGICAL MY ARSE! I am so debilitated my life is a travesty and all I want is to be well. someone has got to know how to deal with this help
 
I don't have crohns, at least i don't think. a few years ago i got a colonoscopy and they said i had ibs and hemmorhoids that were causing discomfort. I was okay with that diagnosis. I have endometriosis and have gotten two laparoscopies and my pain has gone away for the most part. However, I still have a burning sensation in my private area all the time. I used to think it was just endometriosis or me having a sensitive bladder but I'm starting to think I have a fistula. The reason is because when I pass gas, I swear it comes from the other end sometimes. I used to just ignore it because my doctor told me my colon was very close to my uterus and whatnot but I still don't think thats a good enough reason. Can't doctors, like those who have done my colonoscopy, have spotted this "fistula" or is it not very visible? My gyno also never says anything but I'm wondering is there something visible to be looking for? Im pretty embarassed and feel i have enough problems as is, especially for how young i am. Ive been researching and getting freaked out, does gas from the vagina and burning pain sound like a fistula? I don't think ill go to my gyno for this, too embarrassing. I think a colorectal surgeon from what i've read would be a better option? If anyone with any experience or what to visibly look for please tell me. I don't have any other symptoms and this has been going on for like 4 years now.
 
Hi,
I am new to this forum. My son has Crohn's disease, is age 32, and was diagnosed 20 years ago. Still struggles with this awful disease. He recently had his 5th surgery, in NYC, and had stricture plasty and resection. He was hospitalized for 8 days, came home, and now, a month later, is back in the hospital here in the suburbs of Philadelphia. The Drs. are saying they THINK he has two abscesses around the surgical site and he is on iv antibiotics, a picline for nutrition and , of course, opiates for the pain. He has been in 8 days now, and even after ct scan and MRI, they say the situation is stable. WHAT DOES THAT EVEN MEAN????? Still want him to continue the antibiotics, which causes diarrhea. He is currently on cimzia as well. He said he is tired of all this and wants to be done with the antibiotics. He is hypersensitive to meds and he can't eat all foods-has allergic reactions. He was started back on liquid diet and says even that can cause spasm, while the Docs say it is just his intestines waking up!!!! any ideas?
Thanks,
Andrea (Jake's MOM)
 
I've been told recently (well, June, which counts as recent in terms of the medical 'machine'!) that the inflammation in my small intestine is pressing against the wall of my bladder. There's no fistula present yet but I'm guessing it's just a matter of time until the tissue binds and a fistula develops. I'm keeping a weather eye on it by doing the poppy seed test, something I read about in one of the endless journals & articles I've trawled through. Basically, we don't digest poppy seeds and because they are so small they will pass through a fistula and appear in one's urine. It's rather weird gazing at your own pee, looking for small black seeds but it's by no means the strangest thing I've done since being diagnosed....

This might be useful for someone who's concerned they're developing a colovesical or enterovesical fistula.
 
I have had corhns for 17 years and a month ago I had a large bump form to the right of my belly button and had a fair amount of pain. The pain did start a few months back but it was bareable. Once in hospital CT showed a abscess. Had it drained they said there wasn't enough fluid to put a tube in. That night ran a high temp and had some pain. In the morning the resident G I seen me and said sometimes that the fluid can get sprayed around causing the temp to be high. About 4 hours later I felt a lot of pressure to my right and above my belly button when t tried to pass gas. GI doctors came back and sent me for another CT and it showed abscess was bigger. So I had it drained and a drainage tube in. I was let out of hospital two days after draining. After about a week of being home the skin to the right of my belly button turned and started to boil. It popped and pices of corn, green beans and carrots came out also. Now 2 and a half weeks later the draining has slowed. But two days ago there was a pice of corn that came out and other pices of skin. And today I had a pea and some skin come out too. All of this I haven't ate for two and a half weeks. Anyone ever had food come from an abdominal fistula, abscess? I'm on 4 different kinds of antibiotics. 2 for abscess and 2 for fistula.
 
Jeff,
Thanks for sharing your story. Were you on the intro scd diet when your fistula healed? Or which portion?

Hard for me to do intro due to being mostly vegeterian, though I do eat eggs and fish

Appreciate your support
 
I am currently taking prednisone for an abscess in my small intestine. Stayed in the hospital for 5 days over thanksgiving npo with a drain being inserted by interventional radiology. I was discharged on Percocet and prednisone and sent home with my drain having clear and very little output. After ten days of antibiotics the pain got worse again. Came back to the ER for them to repeat MRI and now not only has by abscess grown from 4 cm to 6 cm, there is a new one next to it. I am 22 weeks pregnant with my third child. My gi dr started me on entyvio and I have had two loading doses/ infusions. They were hoping the entyvio would help but I have read it takes along time to start working. Clearly it hasn't yet. Now I am in hospital trying to decide between surgery / resection of part of my si or doing two more drains and waiting until the end of my pregnancy to operate. I have no idea what to choose. The drains are horrible. I have one and I can't imagine having two with a baby getting bigger and causing more pressure. They said I could need more drains between now and end of pregnancy if another abscess pops up.
Any advice on trying surgery during a flare? I know I don't want surgery but it is seeming that it is eventually going to happen according to surgeon. Any advice greatly appreciated. Scared that if I do surgery I could end up with ostomy? And if I opt to do drains i stead of surgery they will not operate in third trimester, due to baby's being too big to have clear margins.
 
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