- Joined
- Apr 25, 2012
- Messages
- 7
Hi All,
Let me start by saying I'm embarrassed to be posting here and I hope I won't offend anyone: though I have suffered off and on over the years from IBS/IBD, it has been under control through diet and exercise for about 5 years and I have no reason to suspect a Chron's or diverticulitis or related diagnosis. If I shouldn't be here, please let me know. From what I've read about Chron's, I have the utmost respect and compassion for those of you dealing with it; frankly, you're kind of heroic, to me.
But I'm here because it seems like one of the better places to get information on anorectal/perianal abscesses and fistulae. I have (at least one of) the former, and it may be developing into one of the latter, as a result of post-surgery complications. First time I've ever dealt with anything like this; past experiences with hemorrhoids obviously pale in comparison.
I'm an otherwise health 43 year old male, 6 ft, 193lbs. Family history of diabetes and intestinal "issues," but no diagnosis (beyond the catch-all IBS) for me of any of those at present.
Did contract HPV about a year or so back, or, at least, had a presentation of the virus about that time. (With up to 90% of the sexually active US population having at least one strain of HPV, and with it capable of laying dormant for over a decade...well, who knows exactly where/when I was exposed...) In my case, the virus presented as condyloma acuminata, aka anal warts. I opted to go after them "aggressively" with laser removal surgery performed by an anorectal surgeon, specialist in this procedure, affiliated with a well respected hospital in my area.
Surgery, on April 6, went well. More bleeding, and more warts, than expected as per the prior anoscopy. But no serious concerns or obvious complications. Discharged home after a few hours.
Six to eight hours later, back in the ER with shaking chills, 103 F fever, and severe, widespread swelling/edema throughout perianal region and scrotum. Diagnosis: transient bacteremia. Suspects: candida albicans yeast infection on skin, or some intestinal flora, or, of course, something I picked up in hospital. We'll never know.
Four nights in hospital. IV antibiotics (Cipro, Flagyl, Vanco), stool softeners, laxatives, pain meds (Oxycodone and Tylenol, after morphine, initially). Discharged with noticeable reduction of swelling and pain, no sustained fever, "successful" bowel movement (OUCH!!!!!), gram-negative test results, normal white blood cell count, negative MRSA test, normal urinalysis.
At home recovery going okay from that Thurs-Sunday. Monday morning woke up to see "drainage" had gone through underwear pads, through towel, through sheet, onto mattress pad. Also notice right side of anus pain and swelling and scrotal swelling considerably diminished. Went to feel around down there and....holy geez, is that HOLE in my body???? AHHHHHH!!!
[Brief freak out. Hand held mirror. Freak out worsens. Memories of every David Cronenberg film I've ever seen. Slow return to sanity....]
Surgeon confirms, yes: I developed, and opened/drained, a sizeable perianal abscess. At first I'd say the opening was the size of a large almond. Now I think I could drive a Matchbox car in there, maybe two.
Surgeon, whom I like and trust, not yet ready to confirm/diagnose it as fistula. Though I think I've had some small fecal matter migrate through, I can't be sure. It's so close to actual anus that I can't be totally certain I don't inadvertently transfer it there myself, even in my very, very careful attempts to clean with flushable wipes. Surgeon reports no visual signs of fecal matter in abscess bed, no smell of fecal matter, no other putrid smell.
Surgeon is, in fact, so damn thrilled every time she sees it--"Oh, this is coming along marvelously! Really interesting!"--that I'm getting vaguely proud of having ripped myself a new one.
Induration persists to greater extent on the other, right side of anus. Surgeon discerns three very, very small "barely worth the name abscesses" openings there along anal verge; evidence on my pads confirms that area is, in fact, slooowly draining on its own. No obvious place to go in for an old fashioned I&D at present--remaining fluid could be honeycombed. Seems to be draining. Taking Amoxicillin/Augmentin to prevent any spread of infection; no fever, diminishing pain.
For now: watchful waiting. Grrrr. So bad a that. Despite my last surgery experience, part of me wants her to just go in there, "lay open" both areas areas as tracts, and let them heal from bottom up. She says "No. Way. Not until and unless we need to. And we may not need to." She says "six to eight weeks--but don't hold me to this--would be reasonable timeframe to say you'd be totally back to normal. But you could be back at work well before that."
Currently working from home, because each bowel movement has the potential of becoming a 20 minute production involving a bath and repacking of gauze.
Currently packing the large abscess as needed, at least twice a day, usually at least once or twice by myself at home (amazing how quickly that's become "normal") and every day or at least every other day having surgeon or nurse at my GP look at it. She has cut off some necrotic tissue at margin/just inside wound bed. YOWTCH. Cauterized with silver nitrate.
So: is six to eight weeks reasonable? For a non-Chron's, non-diabetic patient like myself?
Should I push back/get a second opinion on the pack, watch, and wait treatment for the abscess? Am I dooming myself to recurring abscesses there and, eventually, a fistula and required surgery anyway? Why not get it over with?
How long should I stay on antibiotics? (I know they can't treat/penetrate an indurated infection site--merely keep it from spreading.) Current RX due to run out on Saturday. As I've been tolerating them fine, I'm nervous to go off...
How quickly can you really notice healing starting on an abscess? Is it wishful thinking on my part that I think that while it is larger in diameter it is also shallower?
What the heck do you tell people?
Thanks for any advice you may have...
Let me start by saying I'm embarrassed to be posting here and I hope I won't offend anyone: though I have suffered off and on over the years from IBS/IBD, it has been under control through diet and exercise for about 5 years and I have no reason to suspect a Chron's or diverticulitis or related diagnosis. If I shouldn't be here, please let me know. From what I've read about Chron's, I have the utmost respect and compassion for those of you dealing with it; frankly, you're kind of heroic, to me.
But I'm here because it seems like one of the better places to get information on anorectal/perianal abscesses and fistulae. I have (at least one of) the former, and it may be developing into one of the latter, as a result of post-surgery complications. First time I've ever dealt with anything like this; past experiences with hemorrhoids obviously pale in comparison.
I'm an otherwise health 43 year old male, 6 ft, 193lbs. Family history of diabetes and intestinal "issues," but no diagnosis (beyond the catch-all IBS) for me of any of those at present.
Did contract HPV about a year or so back, or, at least, had a presentation of the virus about that time. (With up to 90% of the sexually active US population having at least one strain of HPV, and with it capable of laying dormant for over a decade...well, who knows exactly where/when I was exposed...) In my case, the virus presented as condyloma acuminata, aka anal warts. I opted to go after them "aggressively" with laser removal surgery performed by an anorectal surgeon, specialist in this procedure, affiliated with a well respected hospital in my area.
Surgery, on April 6, went well. More bleeding, and more warts, than expected as per the prior anoscopy. But no serious concerns or obvious complications. Discharged home after a few hours.
Six to eight hours later, back in the ER with shaking chills, 103 F fever, and severe, widespread swelling/edema throughout perianal region and scrotum. Diagnosis: transient bacteremia. Suspects: candida albicans yeast infection on skin, or some intestinal flora, or, of course, something I picked up in hospital. We'll never know.
Four nights in hospital. IV antibiotics (Cipro, Flagyl, Vanco), stool softeners, laxatives, pain meds (Oxycodone and Tylenol, after morphine, initially). Discharged with noticeable reduction of swelling and pain, no sustained fever, "successful" bowel movement (OUCH!!!!!), gram-negative test results, normal white blood cell count, negative MRSA test, normal urinalysis.
At home recovery going okay from that Thurs-Sunday. Monday morning woke up to see "drainage" had gone through underwear pads, through towel, through sheet, onto mattress pad. Also notice right side of anus pain and swelling and scrotal swelling considerably diminished. Went to feel around down there and....holy geez, is that HOLE in my body???? AHHHHHH!!!
[Brief freak out. Hand held mirror. Freak out worsens. Memories of every David Cronenberg film I've ever seen. Slow return to sanity....]
Surgeon confirms, yes: I developed, and opened/drained, a sizeable perianal abscess. At first I'd say the opening was the size of a large almond. Now I think I could drive a Matchbox car in there, maybe two.
Surgeon, whom I like and trust, not yet ready to confirm/diagnose it as fistula. Though I think I've had some small fecal matter migrate through, I can't be sure. It's so close to actual anus that I can't be totally certain I don't inadvertently transfer it there myself, even in my very, very careful attempts to clean with flushable wipes. Surgeon reports no visual signs of fecal matter in abscess bed, no smell of fecal matter, no other putrid smell.
Surgeon is, in fact, so damn thrilled every time she sees it--"Oh, this is coming along marvelously! Really interesting!"--that I'm getting vaguely proud of having ripped myself a new one.
Induration persists to greater extent on the other, right side of anus. Surgeon discerns three very, very small "barely worth the name abscesses" openings there along anal verge; evidence on my pads confirms that area is, in fact, slooowly draining on its own. No obvious place to go in for an old fashioned I&D at present--remaining fluid could be honeycombed. Seems to be draining. Taking Amoxicillin/Augmentin to prevent any spread of infection; no fever, diminishing pain.
For now: watchful waiting. Grrrr. So bad a that. Despite my last surgery experience, part of me wants her to just go in there, "lay open" both areas areas as tracts, and let them heal from bottom up. She says "No. Way. Not until and unless we need to. And we may not need to." She says "six to eight weeks--but don't hold me to this--would be reasonable timeframe to say you'd be totally back to normal. But you could be back at work well before that."
Currently working from home, because each bowel movement has the potential of becoming a 20 minute production involving a bath and repacking of gauze.
Currently packing the large abscess as needed, at least twice a day, usually at least once or twice by myself at home (amazing how quickly that's become "normal") and every day or at least every other day having surgeon or nurse at my GP look at it. She has cut off some necrotic tissue at margin/just inside wound bed. YOWTCH. Cauterized with silver nitrate.
So: is six to eight weeks reasonable? For a non-Chron's, non-diabetic patient like myself?
Should I push back/get a second opinion on the pack, watch, and wait treatment for the abscess? Am I dooming myself to recurring abscesses there and, eventually, a fistula and required surgery anyway? Why not get it over with?
How long should I stay on antibiotics? (I know they can't treat/penetrate an indurated infection site--merely keep it from spreading.) Current RX due to run out on Saturday. As I've been tolerating them fine, I'm nervous to go off...
How quickly can you really notice healing starting on an abscess? Is it wishful thinking on my part that I think that while it is larger in diameter it is also shallower?
What the heck do you tell people?
Thanks for any advice you may have...
