Question about abscess in genital area ( particularly ladies)!?!?

[Ihurt]

Question about abscess in genital area, could this be a fistula?!? ( particularly ladies)!?!?

Hey there,

I have been a member on this forum for a few years now. I have not been diagnosed with Crohns though. I started having intestinal issues back about 5 years ago. I would get awful pain in my intestines( though at the time my stools were normal, I did Not have any diarrhea or anything.) My main symptom was pain and cramping feelings. I was given the whole IBS diagnosis. I kept having symptoms so my GI doc finally did some testing which at the time all came back normal( CT scan, MRE of small bowel, colonoscopy, blood work) so he stuck with his diagnosis of IBS. Anyhow fast forward, about 6 months ago I was taking a medication for one of my other illnesses( Interstitial Cystitis) and after being on it one day out of the blue I had some diarrhea. My bowels were not right for the next few months. I was still only having one BM daily, but it would be very soft and like pudding( sorry for the description). I had my regular doctor order a fecal calprotectin test and it was 348.5 where anything under 160 is considered normal. I showed this to my GI doc and he was not concerned and said it was only slightly elevated and lots of things could cause this. I also asked my regular primary care to do a C-reactive protein on me and it was elevated( at 158 ( normal is under 50). I am not sure if the medication I was taking( uribel for urinary tract) caused my bowels to get inflamed or what. I did have my primary care doc redo my c-reactive protein and it was normal 2 months later. This was like 5 months ago.

Now for my situation today. A few weeks ago I noticed a little lump under my skin kind of near the vagina( but not in the vagina) like on the right side of the vagina near the perineum . At the time it did not hurt at all and was small( like pea size). I figured it was an ingrown hair follicle as I had something similar three years ago and it just disappeared on it's own. Well about two weeks ago I woke up and was in the shower and all of of sudden I noticed this lump had gotten bigger like the size of a grape. I stared putting hot compresses on it thinking I could get it to come to a head. It did get a little white head and started leaking, but very little. I was afraid to pop it so I went to my dermatologist and she lanced it and drained it( this was this past Wednesday April 6th). She said probably an ingrown hair that got infected and turned into an abscess, so she sent a sample of the fluid to culture to see what bacteria it was. She gave me a ointment called municporin( I probably spelled that wrong) to put on it for a week. I called today to get the results of the culture and the nurse said it showed E-coli. Almost all Abscesses/boils caused by ingrown hair follicles or glands are usually all caused by Staph, so this is odd. I even asked the nurse if this was not common and she said, it is not as common as staph since staph is what is normally found on the skin in ingrown infected hair follicles.

I am a super clean person( meaning, when I have a BM, I wipe very very well and bottle wash as well as shower immediately afterwards). I have to do this because I have IC of the bladder and am very prone to UTI's so I make sure I stay very clean after having a BM. I am perplexed at how e-coli could have gotten in this lump from the outside with how clean I am. Also, this abscess was in-between where the anus and vagina is, except more towards the right side . I could see if it was right next to my rectum how e-coli may have gotten in it when I used the toilet, but this is not right next to the anus. I am going to see my gyne on Thursday to have her take a swab of my vagina to see if maybe I have e-coli colonizing the vagina . If that proves negative, then what are the chances this is a fistula?? How would I know? Where do Abscesses/fistula's usually appear? I may be way off here, but I just do not know what to think and am worried. Do Abscesses/ fistulas usually show up close to the vagina in women?? I have not ever experienced an abscess before. Like I said, I had a lump under the skin about three years ago, though this lump was a little closer to my anal area and at the time I showed it to my GI doc and he said it was nothing to be worried about. That lump just disappeared on it's own, I mean it never even came to a head at all. Due to the culture showing e-coli in this abscess worries me since staph is the most common bacteria to find in infected hair follicles. What are your thoughts on this??

 

[Grumbletum]

Hello there. Yes, abscesses/fistula are fairly common in the vaginal area. I think the best thing would be to see if you can get an appointment with your GI. Some people can actually see a small hole when it's a fistula and well get drainage from it. Otherwise, they will show up on an imaging test such as a CT scan or MRI.

 

[Ihurt]

Thanks for the reply Grumbletum. I have an appointment with my Gynecologist today( Have to do my pap test anyhow and will talk to her). I called to get an appointment with my gastro but cannot even get in until the middle of May! I do not think he will be of any help though. He believes I Have IBS.

How would he be able to tell if this was a fistula? I went to the dermatologist last week and she lanced and drained the abscess. It was on the right side of the lower right labia. She said she thought it was a hair follicle that got infected and developed an abscess. I just do not know. I mean why would it have E-coli bacteria in it as that is what was found on the culture of the stuff that came out? I asked the dermy that and she said it would not be uncommon due to it being in the genital area where e-coli is normally found. I am just a very clean person( shower 2 x daily and always after I have a BM) so I am perplexed.

The dermy lanced it Last Wednesday. It closed up like two days after she lanced it and seems to be healing. The skin is purplish color there now where the abscess was and I still can feel a little lump underneath but nowhere like it was. How does one tell between a fistula and just an abscess that was due to infected hair follicle??





QUOTE=Grumbletum;930011]Hello there. Yes, abscesses/fistula are fairly common in the vaginal area. I think the best thing would be to see if you can get an appointment with your GI. Some people can actually see a small hole when it's a fistula and well get drainage from it. Otherwise, they will show up on an imaging test such as a CT scan or MRI.[/QUOTE]

 

[MeLee38]

It could be a fistula, or a bartholin cyst. I doubt it was a hair follicle based on your description. Fistulas and cysts are often (trust me I KNOW) misdiagnosed initially. Especially if you see a GP for the issue. I would get into see your specialist asap, make an appointment now and asked to be put on his cancellation list so if an appointment opens up sooner you may get in sooner. Best of luck!

 

[Ihurt]

Hey there. I know it is not a Bartholins cyst as I went to my gyne yesterday. She said it could have been an infected hair follicle/gland. She said it was already healed from what she could tell( all closed up). I asked her about the possibility of it being a fistula and she said fistulas usually present with stool coming out of vagina and such.

I have an appointment with my GI doc but cannot get in to see him until next month. He will likely not be much help. He thinks I have IBS based on tests I had in the last 3 to 4 years were all normal.

How would one tell if it is a fistula?

I do not think a cyst because cysts do not usually produce puss or infection do they?

Bartholins cyst are usually in the entrance of the vagina. Mine was like on the lower right labia majora.

It could be a fistula, or a bartholin cyst. I doubt it was a hair follicle based on your description. Fistulas and cysts are often (trust me I KNOW) misdiagnosed initially. Especially if you see a GP for the issue. I would get into see your specialist asap, make an appointment now and asked to be put on his cancellation list so if an appointment opens up sooner you may get in sooner. Best of luck!

 

[MeLee38]

I have had a Bartholin cyst 4 times, and every time they ran alongside the outside of my labia, one was as large as a chicken egg when it burst and resulted in massive amounts of puss and infection leaking out, they were never inside my vagina. There are Bartholin glands externally outside the vaginal opening that can become clogged or infected which result in the Bartholin cyst. Mine was misdiagnosed by my GP and OBGyn. It wasn't diagnosed properly until I landed in the emergency department when pain became too much. With fistulas (I have 2 - one is a recto-vaginal fistula which did leak fecal matter out of my vagina before my flap repair surgery. The second one is external almost in the exact spot my Bartholin cysts were and it is oozing infection daily but no fecal matter. The only way to know if it is a fistula is to have examinations done. My first one was easy to diagnose as it was leaking fecal matter and I could see the opening at the base of my vagina, The second one I am waiting on exploratory surgery under anesthetic to determine where it originates as there is no visible tract/tunnel that my surgeon can feel or see. Hope this info helps, I know and understand your fears, but keeping pushing til you get the answers you feel are right.

 

[MeLee38]

http://www.crohnsforum.com/showthread.php?t=20887

The above link may help answer some of your questions

 

[Ihurt]

Wow, that is terrible when an OBGYN cannot distinguish a bartholins cyst! I tried googling images of Bartholins cyst and everything I see shows the cyst grown in the labia minora. My abscess was not not near the entrance of vagina, it was more on the right side of the labia but a lower.

I am so sorry for what you are dealing with. I have not even been dx with Crohns disease. I started having issues like intestinal pains that were terrible like 5 yrs ago. I did not have any diarreha or constipation, in fact my bowels looked normal and I only would go once a day. My gastro finally did some tests. Back like 4 years ago I had an MRE of the small bowel and that was normal. I also had a colonoscopy about 2/12 almost three years ago and it was also normal. My blood work was also normal, though back in July of last year I woke up and out of nowhere had a bout of diarrhea. At the time I had been taking a medication for my other illness( I have Interstitial Cystitis of the bladder) called Uribel. I think it may have upset my intestines. Well my bowels were messed up for like a few months( I was only going once a day still, but it was very soft and sickly like). MY Gastro doc at the time still said it was all IBS and maybe the uribel upset things. I asked my Primary care doc to order a Fecal calprotectin test and it was some elevated ( 348.5 where normal is 162.9 or under). When I brought the results to my Gastro he was not overly concerned, he said lots of things can slightly elevate the Calprotetcin level. I even had an elevated CRP level, but that has since went back to normal( at least it was 2 months ago).

So right now, I feel I am stuck in limbo. I mean this is the first abscess I Have ever had. Well honestly, I did like three years ago have a very small hardish lump under the skin show up down there and at the time I went to my Gastro doc and he said it was Not an abscess and likely a cyst or ingrown follicle. That one actually just disappeared on it's own eventually. So right now with no diagnosis of Crohns or anything, my GI doc will more than likely say it was an infected gland or follicle.

Right now it is sealed. It sealed like 2 days after she lanced it. It was not big, maybe size of a grape. After she lanced and drained it, I did not get much discharge from it afterwards. Only tiny tiny little blood stains the first day and half on the little gauze pad I had on there and that was it, then by third day it had already started healing and sealed over.

I worry because I have health issues ( Interstitial Cystitis, Fibromyalgia, skin issues, chemical sensitivities, I mean I am allergic to most all antibiotics out there and get crazy odd reactions to medications, Supposed IBS, Possible chronic Lyme disease though no concrete diagnosis, etc..). I mean could I have Crohn's that has just been missed?

Are there any tell tale signs I should watch for that would be tell tale signs of a fistula versus just an abscess that was from an infected hair follicle or gland??

I have had a Bartholin cyst 4 times, and every time they ran alongside the outside of my labia, one was as large as a chicken egg when it burst and resulted in massive amounts of puss and infection leaking out, they were never inside my vagina. There are Bartholin glands externally outside the vaginal opening that can become clogged or infected which result in the Bartholin cyst. Mine was misdiagnosed by my GP and OBGyn. It wasn't diagnosed properly until I landed in the emergency department when pain became too much. With fistulas (I have 2 - one is a recto-vaginal fistula which did leak fecal matter out of my vagina before my flap repair surgery. The second one is external almost in the exact spot my Bartholin cysts were and it is oozing infection daily but no fecal matter. The only way to know if it is a fistula is to have examinations done. My first one was easy to diagnose as it was leaking fecal matter and I could see the opening at the base of my vagina, The second one I am waiting on exploratory surgery under anesthetic to determine where it originates as there is no visible tract/tunnel that my surgeon can feel or see. Hope this info helps, I know and understand your fears, but keeping pushing til you get the answers you feel are right.

 

[MeLee38]

I also have still not been diagnosed, I go for my Colonoscopy in May and hope to be diagnosed then. My specialist already believes it is Crohn's though because of the 2 seperate fistulas that have appeared. My Bartholin Cyst also did not look like Googled pics (which I find never resemble mine or are very extreme cases) Mine was like I said on the outside of the Major Labia running down along the crease of my leg almost to my Anus. Like a long narrow sausage. I was told first it was hemorrhoids, then an abscessed hair follicle and finally THE bartholin cyst, Ugh! It has recurred 4 times over 10 years. Good luck, I don;t want to scare you but mine too has been a long road of misdiagnoses until I lucked into my current specialist who actually knows and specializes in Crohn's and fistulas.

 

[Ihurt]

Thank you for the advice and info. Are you seeing a regular gastroenterologist now? Also, from all I have read, you need a colon-rectal surgeon to diagnose fistulas is that correct?

Do you have any symptoms of Crohn's?

Wow, okay so I guess it is possible to have an infected Bartholins gland and it not be in the entrance of the vagina. That is good to know.

Geez, I guess I could call my gastro doc on Monday and see if I can get an earlier appointment. I think I need to find a new GI doc. Mine is like the head of Gastroenterology at a Huge teaching hospital here. He is older and only works now part time and see's patients only on Friday Mornings. Or should I just go see a colon-rectal surgeon? I wonder if I would need a referral to see one though, I am guessing I would.

Sorry you are dealing with all this and also do not have a diagnosis. This is so frustrating.










QUOTE=MeLee38;930531]I also have still not been diagnosed, I go for my Colonoscopy in May and hope to be diagnosed then. My specialist already believes it is Crohn's though because of the 2 seperate fistulas that have appeared. My Bartholin Cyst also did not look like Googled pics (which I find never resemble mine or are very extreme cases) Mine was like I said on the outside of the Major Labia running down along the crease of my leg almost to my Anus. Like a long narrow sausage. I was told first it was hemorrhoids, then an abscessed hair follicle and finally THE bartholin cyst, Ugh! It has recurred 4 times over 10 years. Good luck, I don;t want to scare you but mine too has been a long road of misdiagnoses until I lucked into my current specialist who actually knows and specializes in Crohn's and fistulas.[/QUOTE]

 

[MeLee38]

The OBGyn didn't diagnose properly because as with everything in my life, she said it was NOT a "normal" showing of the Bartholin cyst. Mine was very deep under the skin, and due to the fact I have no labia minora and a very small labia majora, the cyst formed inward not outward (until it was ready to burst). So they can display differently for each individual, just like fistulas do. Hope yours is just a hair follicle and continues to heal for you

 

[Ihurt]

Thank you. I hope everything works out for you too. I guess I am not surprised that your Gyne did not diagnose the Bartholin's Cyst. I have other health issues and have seen lots of doctors over the last 12 years and I have seen my share of "bad" ones. I have been diagnosed with stuff I actually found out later that I do not have ( Lupus, Scleroderma, Barret's esophagus, Acid reflux). I also have been misdiagnosed as well. When I first had symptoms of Interstitial Cystitis the first urologist I saw said that there was no such disease as Interstitial Cystitis that only women over 50 get bladder issues/diseases!! After seeing two other uro's I finally found one who diagnosed me. I actually diagnosed myself before any doctor did as sad as that is.

I am going to look for another Gastro doctor. Mine seems like he is just not interested in looking deeper into things. Anytime I have something pop up, he immediately blames it on IBS! I mean sure, I could have IBS( even though my symptoms are not typical for IBS) i just feel he fluffs off most of my concerns. He is probably ready to retire in the next couple years anyways.

Thanks again for your replies and support. I hope you get relief and answers soon too.

The OBGyn didn't diagnose properly because as with everything in my life, she said it was NOT a "normal" showing of the Bartholin cyst. Mine was very deep under the skin, and due to the fact I have no labia minora and a very small labia majora, the cyst formed inward not outward (until it was ready to burst). So they can display differently for each individual, just like fistulas do. Hope yours is just a hair follicle and continues to heal for you

 

[MeLee38]

I am going to look for another Gastro doctor. Mine seems like he is just not interested in looking deeper into things. Anytime I have something pop up, he immediately blames it on IBS! I mean sure, I could have IBS( even though my symptoms are not typical for IBS) i just feel he fluffs off most of my concerns. He is probably ready to retire in the next couple years anyways.

Thanks again for your replies and support. I hope you get relief and answers soon too.

I definitely sympathize with your issues. My physical symptoms were often brushed off, due to the fact I suffer from General Anxiety Disorder (diagnosed and medicated for it), it seemed anytime I brought up physical symptoms or issues they were dismissed as if I was a hypochondriac, or as having been aggravated or intensified by my anxiety, now after several years of physical issues I finally have a specialist who does not dismiss me, but actually takes my concerns seriously and what a difference!! Hang in there, there are good doctors out there.

 

[Ihurt]

That is terrible, I am sorry to hear that. I am glad you found a good doctor who cares. Hope I will be lucky to find one too. Thanks again for all the support.

I definitely sympathize with your issues. My physical symptoms were often brushed off, due to the fact I suffer from General Anxiety Disorder (diagnosed and medicated for it), it seemed anytime I brought up physical symptoms or issues they were dismissed as if I was a hypochondriac, or as having been aggravated or intensified by my anxiety, now after several years of physical issues I finally have a specialist who does not dismiss me, but actually takes my concerns seriously and what a difference!! Hang in there, there are good doctors out there.

 

[Mondowicked]

Oh my gosh, this is like a mirror of my story. I had an abscess that was misdiagnosed as a Bartholin's cyst (or was it actually that first...?) and is actually a 10 cm fistula from my rectum to my left labia. My doctors finally did an MRI to view it, and I actually have two other small fistulas forming in other places. I don't understand why they didn't do an MRI when this all started. I ended up having two gynecologist surgeries to try and fix it, and no one realized it was my Crohn's.

Now the doctors don't know what to do with me. I'm going to start getting my Entyvio twice as often (monthly), and I've done antibiotics. I have horrible side effects from Flagyl, and they are worried about me getting C-Diff again from other antibiotics. I finally got approved by insurance to try Rifaxamin, but I'm not sure it will help. Right now I don't know what to do because the hole has closed and now my farts/puss build up until it's painful. I've been using a needle to poke and drain it, which I'm sure isn't a good solution. GI doc said it was too big for a seton. Not sure what to do about this...?

I'm seeing two GI docs. The most specialist one of them all, OHSU Doc, just wants me to wait and see how the Entyvio double dose goes. My local GI had admitted many times that she doesn't know what to do, but the OHSU doc wants her to still be in charge of my treatment. Ugh. I'm also seeing an infectious disease Doctor. She is the one who finally correctly diagnosed me with a fistula. I'm so tired of getting the run around and hearing things like, "I don't know what to do," "I am indifferent on whether or not you take antibiotics," "I've never seen someone with fistulas in Crohn's that is being treated as aggressively as yours." What are we missing? What is science missing!?

 

[MeLee38]

I came across the following article during one of my research attempts...it came out in 2001 and yet there are still a large number of doctors who don't seem to connect the dots between women's gyny issues and Crohn's. Found it to be an interesting read, a very heavy read full of medical terminology, but informative none the less.

http://www.aafp.org/afp/2001/1115/p1725.html

 

[Ihurt]

Wow, I am so sorry to hear about this . How scary. Did your fistula you have on your labia leak anything? I have not even been dx with Crohns, my GI keeps saying I have IBS. I have been having issues with intestinal pain on and off for the last 5 years. I do not have Diarrhea or constipation really, though my stool when I go can be very soft (like Pudding) at times. I usually go to the toilet once a day, but can have that feeling like I always have to go. My gastro doctor is always saying IBS. I had tests done ( last test was colonoscopy three years ago) and it was normal. I also had MRE and CT scans before that and they were normal. However back in July of last year I did a fecal calprotectin test and it was a little elevated( 348.5) where normal is 160 and under. My GI was not concerned with this. I just asked my primary care to redo my calprotectin level and am waiting for those results now.

I recently developed a hard lump under my skin on my right labia. It was just a small firm lump, there was no pain or anything when I first noticed it. It was like that for weeks. Then one morning it was bigger so I started putting hot compresses on it three times a day to get it to come to a head. It finally started draining but only very little. I then went to the dermy to have her lance it. She thought it was a infected oil gland. She sent the gunk to be analyzed by the lab and it showed moderate E-coli growth. She said this would not be uncommon due to the area being highly bacterial( vagina, rectum). Anyhow, after she lanced it it healed over in like three days. It has been three weeks now and yesterday I took a shower and noticed it was a little irritated so I took a look. Well I saw like a tiny red spot there. I had my hubby look with a magnifying glass to see if it was a hole or anything. He said it just looked like a crack in the skin. I started putting the antibiotic ointment the dermy gave me after she lanced the thing three weeks earlier on the spot. Now the red spot has disappeared for now. I am not sure what it was. How do you know if you have a fistula? What would be the signs?

Oh my gosh, this is like a mirror of my story. I had an abscess that was misdiagnosed as a Bartholin's cyst (or was it actually that first...?) and is actually a 10 cm fistula from my rectum to my left labia. My doctors finally did an MRI to view it, and I actually have two other small fistulas forming in other places. I don't understand why they didn't do an MRI when this all started. I ended up having two gynecologist surgeries to try and fix it, and no one realized it was my Crohn's.

Now the doctors don't know what to do with me. I'm going to start getting my Entyvio twice as often (monthly), and I've done antibiotics. I have horrible side effects from Flagyl, and they are worried about me getting C-Diff again from other antibiotics. I finally got approved by insurance to try Rifaxamin, but I'm not sure it will help. Right now I don't know what to do because the hole has closed and now my farts/puss build up until it's painful. I've been using a needle to poke and drain it, which I'm sure isn't a good solution. GI doc said it was too big for a seton. Not sure what to do about this...?

I'm seeing two GI docs. The most specialist one of them all, OHSU Doc, just wants me to wait and see how the Entyvio double dose goes. My local GI had admitted many times that she doesn't know what to do, but the OHSU doc wants her to still be in charge of my treatment. Ugh. I'm also seeing an infectious disease Doctor. She is the one who finally correctly diagnosed me with a fistula. I'm so tired of getting the run around and hearing things like, "I don't know what to do," "I am indifferent on whether or not you take antibiotics," "I've never seen someone with fistulas in Crohn's that is being treated as aggressively as yours." What are we missing? What is science missing!?