Perirectal abscess drained... Now what?

[senoraharvey]

Hi all,

Sorry... a long story before my questions...

I'm new to the forum, but not new to Crohn's. I was diagnosed in 2003 when I was 16 and had a resection when I was 18. I was fine for 5.5 years, completely symptom and medication free. Last February I started getting diarrhea 10+ times per day out of nowhere. I waited, hoping I had a stomach bug of some sort and it continued for a few months. I finally went and had a colonoscopy and the Crohn's had returned. YAY.

Anyway, from all of the diarrhea I developed a fistula and a perirectal abscess. I am a big exerciser... a fitness instructor and a high school teacher (great jobs w/Crohn's.. sigh)... and didn't know it until I took a spin class and the abscess became VERY inflamed to the point of extreme pain. The abscess had created a pimple and was draining slowly on its own. I was put on Flagyl & Cipro and felt much better. I started Humira 2 months ago and the abscess came back a week into the Humira, never having been fully drained by a doctor. My diarrhea stopped and my stomach has been back to 100%, but the abscess still lingered. When I physically put pressure on the abscess during a hot bath I could empty it (at the advice of my doctor), but it would recur within 24 hours. My doctor seemed happy it was under control although I had lowered my "standard" of living significantly because of it. Well, last weekend my groin lymph nodes swelled up and the abscess doubled in size, sending me to the hospital to be put in Flagyl/Cipro again and then a day later to have it drained.

Now, I have finished my antibiotics again and I'm in panic mode that the abscess will recur. I have been off of the antibiotics for 2 days and the Humira is supposedly (hopefully) going to start working its magic.

Has anyone has a similar situation to this where it didn't recur after being cut & drained? Humira closed my fistula the last time while the infection was still unknowingly present, causing this mess. I still show no signs of a fistula. Anyone have any words of wisdom? Similar stories? Anything to help me stay positive?

BTW, this forum has helped me tremendously throughout the ordeal.

I appreciate any input...

Thanks,
Vanessa :ycool:

 

[s.a.m.]

Although I am not on Humira, I am on remicade.
I have multiple fistula, and after being on Remicade one has closed completely and gives me no problems at all. I hope you have the same luck.
Unfortunately, I have another that was alright for nearly 3 yrs, but recently started to give me problems again.

 

[Sisyphusismyrrealname]

Hi there,
i'm new to the board, but i've dealt with this for 15 years.. i also have fistulas and have had abscesses. i didn't respond to remicade or humira so my doctor put a seton in my fistula to keep it open and free of abcess. it has worked pretty well. it was kind of uncomfortable at first, but now i don't even know it is there.

i'd really just try to stay calm. i know that is easier said than done, but stressing is only going to make you sick. i am currently in stress mode so i am also trying to follow that advice. i just tell myself it is what it is and i can't change what will happen. i just keep telling myself that even though i have crohn's it isn't all that i am. hopefully the humira will work for you, and keep your abscesses closed. i will send good thoughts your way. keep your chin up.

 

[JohnnyRottenAppleseed]

so what happens once the humira is stopped. do the fistulas come back? is there any cure for the fistulas/abscesses at least? i was approved for humira but decided the time wasn't right for me. i'm on 6mp and weaning off from the infections. i feel like my abscesses and fistulas act up when my immune system becomes compromised from the 6mp.

 

[beth]

Fistulae may come back after stopping any of the drugs because you are allowing you body to produce more inflammatory cells, or haven't enough antibodies (from the remicade/humira) to bind and so inactivate them.

To cure a fistula you need to successfully drain the main trunk and all the little branches of the tract without leaving any pockets of remaining bacteria. Then block up the internal entrance, surgically if you aren't lucky enough for it to close itself, so that new bacteria cannot enter. And meanwhile stop your immune system from attacking you.

A seton is still about the best thing we have to allow the fistula to drain.

 

[noileum]

I've had a seton for 3.5 years (having it rebooted/refurbed/replaced or whatever they find on monday) and to be honest once you get used to having one it's not a problem.

My abcess was so painful that I couldn't walk, sit down or basically move my lower body at all without being in agony. As 'luck' would have it as I sat in the car after the docs appointment waiting for my wife to come back with my perscription that damn thing decided to burst.

Thankfully I had on a pair of tracksuit bottoms which meant I could easily get them down, and as we had a 2 year old we still had spare nappies/baby wipes/nappy sacks in the car.

Was a bit odd though, having what seemed like about a pint of gruesomeness decide to vacate your bum. Thing is that once that had happened, and I got home and had a bath I was like a new man!!

I was so happy at not being in pain (delusional really) that I seriously considered not then going through with the surgery for a day or so, until I thought it through properly and realised that was a very bad idea (my wife would've never let me cancel that appointment, having had to deal with my bum related moans for a week she was damn sure it was getting sorted).

The seton doesn't require any particular care, I'm just a bit careful when cleaning/wiping down there as for some reason I'm convinced I'll pull it out accidentially (although I'm certain that this is impossible during normal day to day activity).

As odd as it sounds to type this, I heartily reccomend having a seton tail. Almost 4 years free of trouble seems a good trade off to the day surgery and associated recovery time.