Is draining an abscess always necessary?

[Octobergirl]

I have had several abscesses before, two which developed into fistulas. One of the fistulas I have has seemed to have branched out and created two abscesses. The abscesses I've had before were so painful that I had to have them drained right away or else they burst on their own.

The most recent ones I've had get a little painful then they actually started to subside, but now they are starting to bother me again. I think I've had them for about 2 months now. One time when I went to get one my abscesses drained, I had another that the doctor said he couldn't really drain since there wasn't much there to drain. I kind of feel like the two I have now are of the same size.

Is it bad to just let these go? Is it possible they could resolve without draining? I am on Imuran and started Entyvio a few months back, but nobody seems to know if Entyvio is helpful for fistulas and abscesses.

I'm not quite sure what to do. The last thing I want is another fistula, but I have heard that they form both from the abscess popping by themselves and from having them drained.

One more question, how likely is surgery to close a fistula? I have had a fistula for almost three years, and for a year or so of that I was in remission, and it didn't close. I'm assuming I'd have to have surgery to have it close, but I'm afraid of incontinence or more pain. Does anyone have any insight on the best way to handle a fistula that won't close? The colorectal surgeon I saw last didn't really mention surgery but biologics, and I've failed the other biologics (TNF blockers).

 

[idlebrain]

From my knowledge and experience of fistulas and abscesses, it is recommended to drain an abscess to prevent internal infection and mitigate pain. If it is in early stage, antibiotics such as flagyl can help. I had an abscess drained once which later recurred but drained on its own during some physical activity. The CRS examined and said that there is no need to surgically drain like in your case but prescribed a course of antibiotics.

The recommended treatment option for fistula seems to be biologics for Crohns patients. If that doesn't work, I believe seton placement is something to consider. Although it does not close the fistula, it will at least prevent recurrence of abscesses and infections. Surgery is probably the last option but as you know it comes with its own set of complications and disclaimers.

Lastly but importantly, consider seeing another experienced GI if you are not truly comfortable with your current one as sometimes a different perspective can help. Hope this helps.

 

[Octobergirl]

Hi Idlebrain,

Thank you for your reply. I ended up going to see my GI's physician's assistant today, since I couldn't get into to the colorectal surgeon until July. I'm going to try a round of antibiotics to tide me over and then see what the surgeon says. I'm not sure how much he'll be able to drain, but they do get pretty painful on an off.

I'm hoping maybe Entyvio will help with the fistula, but I think it's too soon to tell. I'm not sure if it's just the TNF-a blockers are the only biologics which help with fistulas. I wonder if those that were on Tysabri had help with fistulas. Maybe that would give an idea of it can help or not.

Anyways, thanks again for your response. I'm really hoping these things go away without forming another fistula.

 

[droopymonthly]

Instantly drain an abscess is usually necessary if it creates too much pains. To close a fistula is not an easy thing for CD. First, you need to control CD and the second, you could consider to close fistula by Remicade(1st preference) or surgery(last resort).
If CD is in remission, surgeon will consider surgery if you failed in Remicade or other biologics. If CD flares up, a single surgery itself is hard to close fistula since CD continuously creates problem.

 

[It takes Guts]

Hello all

I've had an abscess for the last four weeks ... I hoped it would go of it's own accord but it's been a very painful time.

I saw a colorectal surgeon today and I've been called back in first thing tomorrow for a general anaesthetic. They are going to drain the abscess and also have a look to see whether a fistula has formed. Touching wood as they did say it doesn't appear to be the case but they are being cautious. If there is one they will perform a seton.

Not looking forward to tomorrow but in terms of having Crohns diagnosed for over two years now, today it feels like this is real.

I know it's only as abscess but it does feel like a whole nightmare is about to start. I have a fear of needles and blood tests and am totally stressed about the routine ones. I can't wait till it is over and I'm back home tomorrow.

Thanks for listening

 

[It takes Guts]

Hello all

I've had an abscess for the last four weeks ... I hoped it would go of it's own accord but it's been a very painful time.

I saw a colorectal surgeon today and I've been called back in first thing tomorrow for a general anaesthetic. They are going to drain the abscess and also have a look to see whether a fistula has formed. Touching wood as they did say it doesn't appear to be the case but they are being cautious. If there is one they will perform a seton.

Not looking forward to tomorrow but in terms of having Crohns diagnosed for over two years now, today it feels like this is real.

I know it's only as abscess but it does feel like a whole nightmare is about to start. I have a fear of needles and blood tests and am totally stressed about the routine ones. I can't wait till it is over and I'm back home tomorrow.

Thanks for listening

An update!

Thank you for the lovely folks who supported on my post. It is great to have the kindness of ' strangers'. Though we are not strangers where it matters!

Well I am home from hospital and in a lot less pain. They drained the abscess as planned and did check for a fistula. There was no sign but they want to talk about doing a further investigation. I don't know what this entails but have a further appointment in two weeks. I'll cross that bridge when it comes to it.

A great nursing team, surgical team and anaesthetists helped with their gentleness towards my fear of needles. I truly was blessed. And thanks to morphine I am painfree touchwood. I had a single 6.5 dose at 11am and it's now 13 hours later and still feel fine. The grogginess has gone and aside from all the bandaging around my rear it's all good. Move over Kardashians, there's a bigger butt in town!

Next time if there is an abscess I will call the clinic straight away. God bless the NHS. I could not have had better treatment.

And now to bed

 

[Madhu]

My husband has 2 fistulas. He had surgery and now 2 setons have been placed. It is better to do that since it helps in drainage and the infection can be controlled before you are started on immuno suppressants. He is starting Remicade next week. Fingers crossed, and good luck to all you brave ppl out there

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Hubby dx with Crohn's in Feb 2015
2 anal fistulas (setons placed)
Taking INH for Latent TB since we're from India
Meds - Cipro, Apriso, Bentyl, Tramadol, Vit B6, B12 and Vit D