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Perianal abscess surgery - healing just won't happen. Scared.

Hey, signed up after Google constantly directed me here!


So I'm scared. Nearly 2 months ago, I had an I&D under general anesthesia for a perianal abscess - it was approximately 25cm deep - according to the surgeons that's considered very deep.


The wound was packed daily and healing well for a few weeks, going down to 5cm depth in 2 weeks. Back to work after 4 weeks (wound at approximately 1.5cm at that point) and packing was stopped due to overgranulation.


In the last 4 weeks, healing has stalled. We've been using silver nitrate for overgranulation but the wound has remained open at 1cm, still draining, and bleeding.


Saw the surgeon again 2 weeks ago and he said if it's not healed by next week (3 weeks total) we'd have to discuss other options for treatment. They said they may have to figure out if I have Crohn's disease also. I was told by my GP a decade ago that I have IBS but was never given treatment bar peppermint oil capsules.
As gross as it sounds, I don't know if I was correctly diagnosed with IBS because no tests were ever done, I was just told I had it. I've had a "solid" stool once in my entire life, to be totally blunt. They're ALWAYS erm, loose.. and with cramps when I need to go.

I'm not being told anything tbh. Everything I know, I know from bloody Google!


The nurse this morning told me it's very strange that it's still draining and that the silver nitrate hasn't fixed the overgranulation, and even more strange still that the wound has remained at 1cm depth for weeks.



What does this mean? Does that sound like a fistula?


I'm very scared of needing more surgery, especially if it's a fistula because of the associated risk of losing bowel control.

Selfishly too, I'm annoyed because I was told I'd be fine in a week! And now it's been just under two months of no sex with my partner (because they haven't told me if I'm allowed!), not being able to sit on the toilet lest the dressing fall off, pain from the silver nitrate, pain in work, pain when I walk, etc.



Can someone please tell me what I can expect now and what questions I should be asking because I'm being told nothing and I'm starting to panic myself now reading worst case scenarios online. :(


Thank you!
 
Hey there. I dont have any bowel disease or crohns and have always had relatively normal stools and still am. Dont worry too much, just try to get a rectal exam under anesthesia and figure out whats going on. I just found out today i have a fistula and had a rubber band seton placed. Im not in too much pain (yet) and im waiting an appointment with a colorectal surgeon to see if they can operate since the general surgeon didnt feel comfortable. The whole exam experience wasnt too bad and my mind is much at ease now that i know whats going on. Hang in there
 

cmack

Moderator
Staff member
Welcome MissEire,

I think you need another doctors opinion on whether you have been diagnosed properly. A referral to an IBD or GI specialist would be a great start. That does NOT sound like IBS to me because IBS doesn't cause that type of damage. I agree with Ek, try not to worry. An MRI or EUA- (examination under anesthesia) should help figure things out. There is no need to be afraid, you are in control. Nobody will make you do anything you aren't comfortable with. You have my support, if you have any questions I'll help you as best I can.


Kind Regards,

Chris
 
Hey, signed up after Google constantly directed me here!


So I'm scared. Nearly 2 months ago, I had an I&D under general anesthesia for a perianal abscess - it was approximately 25cm deep - according to the surgeons that's considered very deep.


The wound was packed daily and healing well for a few weeks, going down to 5cm depth in 2 weeks. Back to work after 4 weeks (wound at approximately 1.5cm at that point) and packing was stopped due to overgranulation.



In the last 4 weeks, healing has stalled. We've been using silver nitrate for overgranulation but the wound has remained open at 1cm, still draining, and bleeding.


Saw the surgeon again 2 weeks ago and he said if it's not healed by next week (3 weeks total) we'd have to discuss other options for treatment. They said they may have to figure out if I have Crohn's disease also. I was told by my GP a decade ago that I have IBS but was never given treatment bar peppermint oil capsules.
As gross as it sounds, I don't know if I was correctly diagnosed with IBS because no tests were ever done, I was just told I had it. I've had a "solid" stool once in my entire life, to be totally blunt. They're ALWAYS erm, loose.. and with cramps when I need to go.

I'm not being told anything tbh. Everything I know, I know from bloody Google!


The nurse this morning told me it's very strange that it's still draining and that the silver nitrate hasn't fixed the overgranulation, and even more strange still that the wound has remained at 1cm depth for weeks.



What does this mean? Does that sound like a fistula?


I'm very scared of needing more surgery, especially if it's a fistula because of the associated risk of losing bowel control.

Selfishly too, I'm annoyed because I was told I'd be fine in a week! And now it's been just under two months of no sex with my partner (because they haven't told me if I'm allowed!), not being able to sit on the toilet lest the dressing fall off, pain from the silver nitrate, pain in work, pain when I walk, etc.



Can someone please tell me what I can expect now and what questions I should be asking because I'm being told nothing and I'm starting to panic myself now reading worst case scenarios online. :(


Thank you!

I recently replied to Ek1996, You may find something there. ( my personal experience )
What your saying happened to me back in 2008, though yours seems more severe. Why aren't they using suture/ string, its more reliable for healing permanently.

Hang in there.


angree rabbit
 
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Thank you so much for your responses guys, it really reassured me!


Unfortunately healthcare works very differently in Ireland (where I am) than in other countries.


I don't know if the surgeon who did my surgery was a colorectal surgeon or a general surgeon (I'd imagine he was a colorectal surgeon given my abscess was 25cm deep and I had sepsis so was an emergency case).

So I'll ask my general physician to refer me to a colorectal specialist depending on how my meeting with the surgeon goes on Thursday, and I'll ask for a referral to a GI specialist. Dr. Google has been helping me and my specific symptoms are indicative of IBD rather than IBS (exhaustion, daily diarrhea, b12 deficiency etc) so I'll try to get that looked at too so that I know for sure what's going on with my body.


Thanks for your replies. At least I know what to be asking of the doctors now :)
 

Lynda Lynda

Senior Member
Location
N/A
MissEire :
Sending you my support 💕
I had a fistula 26 years ago. Treatment has changed since then. I had an anal fistulectomy, but now they have setons.
Hope you feel better soon.
 
Thanks again for your replies guys.

Saw a nurse again this morning for wound check and dressing change (the wound is in a very awkward spot and I can't bend enough to see it due to spinal injury lol).


She said based on how much it's still draining, I absolutely need more packing and that I need to bring my removed (used) dressing to hospital on Thursday with me because she doesn't think they're taking me seriously, lol!


She said until then there's very little she can do for me so I'm to insist that come up with a treatment plan because the nurses hands are tied to their diagnosis and treatment plan legally.


So I'm gonna go have a conversation with them on Thursday and hopefully I'll have a clearer idea of what's going on then.
 
MissEire.
I'm looking for help with my mothers Crohns when I came across your post.
My youngest daughter developed a perianal abscess when she was 11, and she had years of surgery because it wouldn't heal. She missed so much school because of it.
What started out as an inch wound/scar, at the end became a 6 inch wound as they dug deeper and deeper removing scar tissue and infection.
Then her surgeon told us he was using a new technique, and he was filling the sinus cavity with something called fibrin glue, instead of leaving it open and packing it!
My daughter had this done when she was 15, she's now 24, and hasn't had one since!
 
MissEire : Hope your appointment was a successful one.
Are you healing any better / faster ?
Take Care. 🌻
Thanks for your message :)

No change here really. The surgeon's team suggested three more weeks of packing, then postponed my next appointment so I'll be having 5 weeks of packing total.
The nurse said it's not 1cm depth any more, but it's still open and still draining 4 weeks on.


Back into the nurse again today, I'm going to ask her to measure the depth. Drainage has reduced somewhat, but is still on-going.


If it's not closed by the 19th, I'll be given an MRI to check for a fistula. So I'm preparing myself for the likelihood of fistula surgery.


Getting a bit down about it now because it's massively impacting on my long term relationship, but there's nothing I can do for now I guess!
 
Saw the nurse again (it's 9am here). The wound is at 1/2cm depth now, down from 1cm 5-6 weeks ago.

She said I MAY still have a "narrow tunnel" (fistula) but that so far, it seems to be finally healing.

She said if it closes fully, it means no fistula? Is this correct?

Drainage has reduced quite a bit in the last two weeks, although it IS still draining.
 
Hey guys, thought I'd update because you have all been so helpful :)

Saw the nurse again last week and she measured the depth again, no change. I'm seeing her again in an hour. She said that she thinks I have a fistula, which will be confirmed by MRI when I see the surgeon in a few days.

She said that if I have one, it's "small." Dunno if that makes much sense or how that'd impact recovery time for fistula surgery tbh.

She said I don't have the bad symptoms (no fecal draining etc, the only symptoms are the wound not closing, and still draining with some blood draining daily).


I'm now being referred to a GI specialist to test for Crohn's and UC because I have most of the symptoms of UC (never had a solid stool in living memory, severe diarrhea, b12 deficiency, extreme exhaustion, blood every time I wipe, mucus occasionally, etc), and I'll be most likely getting an operation for the fistula.


Don't know much about fistulas and recovery time because Google is telling me anything from 2 weeks to 8 months recovery!



Anyway, that's the update. I'll keep updating here in case it helps someone in my position in future, with no clue about what's happening in their body lol
 
Another update lol.


Saw the surgeon this morning. He used a different type of swab to measure the wound. And unfortunately it's not only 1/2 a cm like they thought, it's just so narrow the other swabs didn't fit. It's still 'very' deep apparently.

I'm on a waiting list now for an MRI to confirm a fistula. Waiting list is up to 2 years!

So in the meantime, I'm going to try save or borrow 500 euro to go privately and get one within a few weeks. He's told me that reducing my smoking from a pack a day to a pack a week isn't enough too, so I'm coming off the cigarettes entirely.
 

cmack

Moderator
Staff member
I'm sorry to hear that the wound is deeper than was previously thought. I hope you can get the private MRI soon and get some answers. Two years is too long to wait. Best wishes with the smoking and everything in general. I quit smoking a few years ago and I'm glad I did. You have my support.
 
Further update :)

Had my MRI a few days ago. They actually did two, one normal and one contrast. The radiographer accidentally said "this will show up the fistula and infection better" when explaining the contrast injection to me.

I wasn't being checked for infection but I guess that means I have both the fistula and the infection lol.

Back with the general surgeon on Thursday morning, so I'll hopefully get the results then and get the ball rolling on treatment. I hope.
 
Saw the surgeon for my results. Not good!

They confirmed a fistula and said that a seton won't work for it. So I've to have a fistulectomy, I think that's the name for it? Cut open and surgically removed.

The MRI also showed a lot of inflammation so I need a colonoscopy because they think I have Crohn's or colitis.

Oh and the wound is draining so much that he said I may need another op to drain it again before the fistulectomy.


Not a great day!
 

cmack

Moderator
Staff member
Sorry to hear that you need surgical procedures. I have had several similar surgeries, they are a little invasive however they usually worked. I hope things get better for you soon, keep in touch.
 
Still waiting to see a colorectal surgeon, yay for waiting lists!

Since the MRI, the wound is bleeding profusely and is so narrow my nurse can't pack it.


I've been told now I need to get bloods done to check for b12 deficiency (I've always had that so I'm not too worried, I just need to start my b12 injections again lol) and also for anaemia because I'm sleeping all the time since the bleeding started.


It's one delightful surprise after another haha
 
Another update lol.


Being tested for Crohn's disease via colonoscopy in a week and a half.



No appointment with a colorectal surgeon for another 6 months due to my country's amazing waiting lists. No surgery for up to 2 years. Open draining wound til then! No GI for 15 months. Again, waiting lists.



So I'm stuck at the moment. No treatment, no surgery, draining is very bad the past few weeks since I had a flare.


I'll probably see if I can seek treatment elsewhere in the country. I live in the capital city, waiting lists may be shorter if I travel :)
 
Similar situation I seem to be in.
I have never had any problems and out of nowhere developed a large Perianal abscess. I landed at the hospital in major pain and fevers. My abscess was drained in emergency surgery that left me with 2 open wounds for drainage.
This was done coming up to 6 weeks ago. With daily packing 1 wound healed with no problems. Unfortunately the 2nd wound is causing some issues and I am not sure what is happening.
Still have slight discomfort around my anus and the wound is only around the size of pin head, but puss is still draining.
Due to my concerns I went back to my specialist 1 week ago and all he said was to wait another 3 weeks and come back. If things arent better by then he will investigate more.
My concern is in regards to a fistula. Should I be concerned at this point or could it just be healing slower?
Any advice would be greatly appreciated!!!
 
If the wound is deep, it can take longer to heal. My last one took 3 1/2 months to close. I was also on antibiotics the whole time. Did the doctor tell you to have sitz baths? You don't want it to close if it's still infected, or you could end up with another abscess.
 
If the wound is deep, it can take longer to heal. My last one took 3 1/2 months to close. I was also on antibiotics the whole time. Did the doctor tell you to have sitz baths? You don't want it to close if it's still infected, or you could end up with another abscess.
Im not exactly sure how deep the wound was to start. Im gussing around 20cm because the majority of the packing rope length would be used by the nurse. Yes I have been taking about 3 sitz baths a day and was on antibiotics for the first two weeks. When i went back to the doctor last week he didnt think i needed antibiotics again. Sometimes the pain isnt too bad, then during the day i can feel pressure build up and the pain worsens.
 
Im not exactly sure how deep the wound was to start. Im gussing around 20cm because the majority of the packing rope length would be used by the nurse. Yes I have been taking about 3 sitz baths a day and was on antibiotics for the first two weeks. When i went back to the doctor last week he didnt think i needed antibiotics again. Sometimes the pain isnt too bad, then during the day i can feel pressure build up and the pain worsens.
My own abscess was roughly 25cm deep, and it was around the 6-8 week mark of recovery that they started to mention the possibility of a fistula.


They did the same to me as they are to you, sent me home for a few more weeks - twice actually. After that I had an MRI to confirm a complex fistula.


You may not have one, because the deeper wounds are slower to heal, but approximately 50% of abscesses result in a fistula so there may be something there.
 
My own abscess was roughly 25cm deep, and it was around the 6-8 week mark of recovery that they started to mention the possibility of a fistula.


They did the same to me as they are to you, sent me home for a few more weeks - twice actually. After that I had an MRI to confirm a complex fistula.


You may not have one, because the deeper wounds are slower to heal, but approximately 50% of abscesses result in a fistula so there may be something there.
So I have been back to the General Surgeon and currently I am now on a 3 month wait list for him to “attempt” fistula repair. As he is only a General Surgeon in a regional area he can only repair lower fistulas. No MRI but he has decided to put me under and do exploritory first. If he discovers it is in the area thats safe for him to fix he will do it then and there, if not i will need to be referred to a Colorectal Specialist in the next largest city. Fingers crossed he can repair or I will have yet another wait period ahead of me. At time of drainage i had 2 drain holes. The one that had repaired has since ruptured again. Both holes are both rather small but currently have continual discharge and constant pressure pain. I am certainly becoming well acquainted with the home nurse as they still have to come daily to change dressings.
 
So I have been back to the General Surgeon and currently I am now on a 3 month wait list for him to “attempt” fistula repair. As he is only a General Surgeon in a regional area he can only repair lower fistulas. No MRI but he has decided to put me under and do exploritory first. If he discovers it is in the area thats safe for him to fix he will do it then and there, if not i will need to be referred to a Colorectal Specialist in the next largest city. Fingers crossed he can repair or I will have yet another wait period ahead of me. At time of drainage i had 2 drain holes. The one that had repaired has since ruptured again. Both holes are both rather small but currently have continual discharge and constant pressure pain. I am certainly becoming well acquainted with the home nurse as they still have to come daily to change dressings.
Strange that they're going straight for exploratory surgery rather than an MRI! They did an MRI on me (the waiting list was 2 years so I paid to have it done privately) and immediately referred me to a colorectal surgeon because mine is complex. My waiting list just to see the surgeon is 6 months, then up to 18 months for the surgery itself!


3 months feels like a super long time but I promise it'll go by fairly quickly. Mine has been a problem since April and honestly, it doesn't feel like it's been over half a year, you get used to it tbh!
 
Strange that they're going straight for exploratory surgery rather than an MRI! They did an MRI on me (the waiting list was 2 years so I paid to have it done privately) and immediately referred me to a colorectal surgeon because mine is complex. My waiting list just to see the surgeon is 6 months, then up to 18 months for the surgery itself!

3 months feels like a super long time but I promise it'll go by fairly quickly. Mine has been a problem since April and honestly, it doesn't feel like it's been over half a year, you get used to it tbh!
I thought it was strange about the MRI also from everything i have read.
He seems pretty confident from the location of my drainage wounds that it is a low non complicated fistula.
Compared to your wait times and time dealing with yours so far, mine all of a sudden doesn’t seem as bad.
I think Im struggling with it more because it rules my day to day activities due to the wounds very close proximity to my “poop shute” i am unable to have any bowel movements without assisted tidy up and a dressing change.
Lucky i work from home or i doubt i would still have a job.
I wish you the best in your process and hope it all is fixed with no complications once your wait period is over.
 
I thought it was strange about the MRI also from everything i have read.
He seems pretty confident from the location of my drainage wounds that it is a low non complicated fistula.
Compared to your wait times and time dealing with yours so far, mine all of a sudden doesn’t seem as bad.
I think Im struggling with it more because it rules my day to day activities due to the wounds very close proximity to my “poop shute” i am unable to have any bowel movements without assisted tidy up and a dressing change.
Lucky i work from home or i doubt i would still have a job.
I wish you the best in your process and hope it all is fixed with no complications once your wait period is over.
I understand your frustration. Mine is in the same area and I have to literally time my bowel movements for before a dressing change. I also can't sit to urinate (I'm female) because the dressings fall off lol! You'll get used to it, I promise. I'm lucky that because I'm from Ireland, my job is protected and they essentially can't fire me for all the appointment time I need, but it's extremely difficult working in a physical job with this because every time I bend, I risk the dressing falling off.

After about 3 months, my nurse taught me a way to do the dressings myself (I have a spinal injury and I can just about manage it with a good tweezers!), you could ask yours about demonstrating how to do it. It requires lots and lots of weird bending and contorting but I can manage it in desperate situations!
 
I understand your frustration. Mine is in the same area and I have to literally time my bowel movements for before a dressing change. I also can't sit to urinate (I'm female) because the dressings fall off lol! You'll get used to it, I promise. I'm lucky that because I'm from Ireland, my job is protected and they essentially can't fire me for all the appointment time I need, but it's extremely difficult working in a physical job with this because every time I bend, I risk the dressing falling off.

After about 3 months, my nurse taught me a way to do the dressings myself (I have a spinal injury and I can just about manage it with a good tweezers!), you could ask yours about demonstrating how to do it. It requires lots and lots of weird bending and contorting but I can manage it in desperate situations!
Lol I am female also and it sounds like we are having the same bathroom struggles!
My housemate and I have unexpectedly become VERY well equanted! I also have an injury (leg) from childhood that prevents me from getting into certain positions but thanks to my housemate and home nurse i have someone available at all times for dressing changes.
Thats great that you are covered for work. Here in Australia I would be covered to a certain extent. My job includes sitting 8 hours a day which gets extremely uncomfortable but at least i am able to grab my laptop and get off my butt for a bit while still working.
My boss very understanding as he has been through this himself.
 

cmack

Moderator
Staff member
I hope things get better for you soon, MissEire. I really feel for you. I'm a guy and my bandages were always falling out of my pant leg in public. It was really, really embarrassing at the time. Big hugs.
 
I hope things get better for you soon, MissEire. I really feel for you. I'm a guy and my bandages were always falling out of my pant leg in public. It was really, really embarrassing at the time. Big hugs.
I am not sure if these would be available to you, but worth a try if you can find them.
I use a dressing called Aquacel foam that i cut to size and it soaks up the discharge and I attach it using a tape called hyperfix. These get provided to me from my community nurse but you may be able to find them to purchase online.
The hyperfix tape holds really well compared to other dressings that were being used to start with.
Good luck!
 
I am not sure if these would be available to you, but worth a try if you can find them.
I use a dressing called Aquacel foam that i cut to size and it soaks up the discharge and I attach it using a tape called hyperfix. These get provided to me from my community nurse but you may be able to find them to purchase online.
The hyperfix tape holds really well compared to other dressings that were being used to start with.
Good luck!
Yeah, the aquacell foam dressings are great! As are another brand of silicone ones called Allevyn, they're similar but seem to have better sticking power.


For me, my wound drains so much that they'll fall off and need changing several times a day, so as my nurse can't actually afford to give me that many, I alternate with regular cloth dressings that I buy myself.
 
I hope things get better for you soon, MissEire. I really feel for you. I'm a guy and my bandages were always falling out of my pant leg in public. It was really, really embarrassing at the time. Big hugs.
Thank you <3


I'm not too stressed about it all anymore. It's already cost me my relationship because sex was too painful and he apparently can't live without it for 7 months LOL! 5 years gone!


so I just figure my job is safe, my family support me, my friends are awesome. It can't get any worse, so I'll wait it out til I'm fixed up and hopefully that'll be the end of it all :)
 

cmack

Moderator
Staff member
I'm sorry about your relationship not working out. You deserve someone who will stick with you through everything, the good and the bad. Don't worry there are better guys out there than that. I hope you keep a positive outlook. Take good care of yourself and concentrate on getting well. Best wishes.
 
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