Perianal abscess

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nogutsnoglory

nogutsnoglory

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Just found out I have a perianal abscess. I never had one before and I'm not sure what to do. Do I need to act quickly? How quickly? Do I have any choice besides surgery? How long till the area would heal after drainage?

What is a rim enhancing abscess?
 
There are lots of different variables for abscesses. The first thing I would do is get on Cipro and Flagyl and don't waste your time with a 1-2 week prescription because that's not long enough. I had a lot of success with Cipro and Flagyl...but while I was on it. I think if you were on it longer it would therefore allow the medicine to be in your system longer and hopefully heal the abscess. Most people will say surgery is the only option but the medicine would be my first choice.

Now, if you need surgery there are more options. Sometimes it can be lanced in the doctor's office (not surgery) and then you have it packed for like a day and then it just heals on it's own. This depends on size.

I had an actual surgery for my abscess I was actually in the hospital and spent 5 days post surgery in there and then had home care nurses continue to pack the abscess daily for 6-8 weeks. Because of a mistake on their end the abscess got infected again and I needed a second surgery, but much bigger this time. Long story short they were supposed to use a protective gel with the packing they used and they didn't do the packing ended up killing good tissue and allowing the infection to spread.

The second surgery for that left me with a 7.5" incision and I had to spend 5 more days in the hospital. Same thing after I was released and I needed home care nurses daily for awhile. (Longer this time because the abscess was worse) I got different nurses this time luckily.

Now mine was a rare case and you likely won't end up like me, but it is a possibility depending on the size of your abscess. Mine was so bad I couldn't walk...literally. It gave me a 104.7 fever causing my body to go into shock and I took the ambulance to the hospital for emergency surgery.

I can tell you though, the healing process is looonnnnnnggggggggg. After that surgery (December 2011), I just stopped draining around February of 2013 (so a little over a year). Sometimes light, sometimes heavy and I even had to wear menstruation pads in my underwear (you know I'm a guy) because the drainage was so heavy that without the pads it would leak right through my underwear/pants and look like I had an accident. Again, size does make a difference but generally people say they still drain over a month after getting drained.

First though, I would definitely try to get Cipro and Flagyl and honestly stay on it for a few months if you have too to try and get it go away
 
Thanks for sharing your experience and advice. That sounds awful! It does seem from everything I'm reading that these are nasty little critters that don't want to go away.

I would definitely hope antibiotics can fix this but the idea of being on antibiotics at all never mind weeks at a time makes me very nervous. My last flare resulted from using antibiotics and there are so many other potential complications. It also seems from all the literature that antibiotics might reduce the size but won't eliminate the abscess.

Do you recall the size of your abscess?
 
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Personally I think a big problem is that most people are only on the antibiotics for a very short period of time. I can tell you they do work while I was on them, but like I said I don't think I was on them long enough to do any long term help. It changes things that your last flare was potentially caused by antibiotics as well, but just looking at the medicine, I didn't have any side effects.

It honestly depends on how much you want to deal with it as well. Similar to fistulas, there are some people that just leave them because they don't cause many problems for those people. I left my abscess for about 3 years before I got surgery because I could get it to pop on it's own and then the pain was instantly gone. It would take a few weeks "break" and then come back, in which I was able to have pop/drain again.

Warm/hot baths will become your friend (I don't use the sitz bath, I just use the tub) and you can use epsom salt as well if you want but for me it was the heat that allowed it to loosen up and pop (similar to a blister)
 
I'm going to start antibiotics although the doctor said I probably need surgery.

I need to ask them if I can still take my Cimzia while on antibiotics to fight this abscess. I'm not sure.
 
I'm not too sure about that. Even the surgery for most abscesses can hardly be called surgery. A lot are done in the doctor's office with just numbing for the area then they drain it and you go home. My father in law had it for his and he drove there, had the "surgery" and then drove home all in the same morning.

I don't think many people actually have to stay overnight and actually get knocked out for their abscess surgery. Mine was an exception.
 
I will briefly tell you my story about my abscess, although I put it in the other thread as well.
Mine basically came up over a couple of days, one day I was walking around fine, that evening I started to feel something a little strange. The next day it gradually got worse and I stated to worry. All my friends were going out that night and I decided to go along because I thought it would take my mind off it. By the time I was walking home I knew there was something really wrong because it hurt so much to walk.
The next morning I went to A&E. I didn't know what would happen but just had a feeling I would need surgery. I had pain meds which made it feel so much better and then they decided to do surgery. I had it that night at 10pm, I also had a temperature and my heart rate was quite fast.

I stayed in hospital for four nights and I was also on a drip for some of this time. I had a home care nurse come to pack my wound for two weeks and then I started to do it myself. Two weeks after surgery I felt it fill up again but it popped by itself this time. After that I didn't feel it for a few months, but it occasionally filled up and went down again without seeing anything come out.

I had an MRI scan to look for fistulas but I think this was inconclusive. 11 months after my first surgery they did a second surgery in the hope of tackling a fistula which they assumed was there. They lanced it and removed a fissure, this was in Jan and now I honestly feel nothing from it. They have said that the surgery should have fixed that fistula, but obviously with the nature of crohn's it could still cause damage for it to occur again so there are no guarantees.
 
Okay. I am not sure what to think but I am curious, how do you know if you have an abscess or not, not to sound stupid or anything. I am always worried about them and fistulas and not sure how to tell if you have one or not.
 
You'll know.... Lol. Have you have a hemmorhoid? You can pretty much take that pain and multiply it by 100. Abscesses *can* drain but that depends on whether or not it has been opened (can open with doctors).
 
I have had really bad pain for a while but a recent MRE showed it. If its superficial you might see it but if its deeper you may need imaging. They are painful as hell.
 
Hi,
SoccerMom I think you will know after you have a fistula - it was unbearable pain for me. First it is just a spot where it hurts, sometimes burns but it never goes away. It then would feel like I had worms crawling around. At this point the pain was beyond anything I dealt with before. A trip to the emergency room did not do anything. I had lost 50 pounds and they accused me of trying to get drugs. But if you think you might have fistulas, I would go see a doctor. I was finally diagnoised with crohns in 2012. I thought it was just ulcerative colitis (diag with that in 1995). But then again, I've heard stories that did not include pain with fistulas. Hope you don't have these.
 
So I'm gonna be getting it drained. The antibiotics didn't work. I hear once they pop it the pain goes away? So I imagine I won't be limping in pain?

For the drain is there a little container or am I going to be throwing out a lot of underwear?
 
Hi
Yeah, the fistula when its drained is a big relief. You could say its a big zit - most know what this feels like, and when you pop it, there is relief. Just make sure you keep it clean (hot baths work well). Depends on your body, how fast you heal and whether it comes back. When it swells again, get to the bath. I sometimes "milk" mine, but that might not be a good idea cause it might force the puss back into the abscess and away you go. You will learn its cycles and what is best - just be kind to yourself and never ignore it. It might be a while so work with your doctor - keep him informed and ask ask ask ask questions! Good Luck and hope you feel better soon.

Oh yes, you will be throwing away underwear but they are cleanable - nothing really nasty, just puss and a little blood. Some do wear pads. Try to keep it open so it drains freely or it will find another way out! That's my story and I'm stickin to it. The puss is very sticky. Your underwear might stick to it and it might be a little painful pulling it off.

150mg Imuran
Cipro (Flagyl causes a flare up in me, I get sick etc...)
3g Sulfasalazine
Remicade on its way hopefully
tramadol (never start if you don't have to - it has HORRIBLE withdraws) but its a lovely pain killer.
No insurance
 
Hey, NGNG, about 18 months ago or so, could have been earlier, I had an abscess recur, I was constantly getting them every 10 months or so, and I was treated successfully with Cipro/Flagyl. Prior to that though, I had an almighty abscess that was so painful I knew it wasn't a regular one. I examined myself with a mirror on the ground and I noticed this tinchy little "hole" right beside my anus and buttcheek so I prodded at it and I noticed discharge and a little bit of poop ...... I know, rotten! Right then I knew I had a fistula, I could also feel air pass through it when I farted and that was a ...... odd feeling to say the least, lol.

I eventually had the abscess lanced under anaesthetic and two seton put in for the fistula's which were awesome, no pain, but a constant, but very small discharge of puss, no poop because it was "healed" with surgery and anti-biotics. A seton basically makes sure your fistula/abscess never closes over to form another one, with a trade off of, as I said before, a small bit of discharge that can be managed with a bit of gauze that would last the day.

Again, this week, I noticed another abscess, my IBD nurse got me fast tracked (like right away, today) to see a doctor and he fast tracked me (tomorrow) for examination under anaesthetic with the probability of putting in a seton.

Moral of my ramblings, 90% of abscesses need surgery, some small ones will pop and anti-biotics will do the trick and if you leave it too long, you'll most likely develop a fistula.

Hope all goes well for you, I remember your name from the HealingWell forum and it seemed for you, when it rained, it bloody poured.
 
Hey thanks I'm going to be getting it surgically drained. Hope it heals fast. I don't use the healing well you must be thinking of someone else. My abscess isn't draining at all, I wish it was but its internal.
 
NGNG, the draining definitely relieves the pain/pressure, but if you have to have the wound packed afterwards it still isn't fun times until it has healed up or you can stop using dressings!

I think its the way to go though if it is persisting. Much better to get rid of it!
 

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