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06-09-2014, 02:35 PM   #1
Cookie
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Peri-anal fistula

For those of you who have had them, how did you know for sure. Did you need to have a doctor confirm it? I have had two recto-vaginal fistulas in the past, and those are pretty straight forward because things are coming from places where they shouldn't be. I think I may now have a peri-anal fistula, but I don't know how to tell for sure. I have a lot of drainage similar to before (mucus/pus like) that just discharges without warning. Also some blood and stool. There is no abscess present, but a do have some pain. I am currently on Remicade, which is supposed to be good for healing them, so that makes me question whether I would have developed one while on it. When I had fistulas in the past, as long as there wasn't an abscess present, my doctor said the best thing is to let them be, so I am not sure it's even worth mentioning to him. Anyone with experience have any thoughts on this?

thanks!
06-09-2014, 04:48 PM   #2
Tuff
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Is the drainage from your anus? My fistulas always made openings around my anus, never drained directly from it. I would mention it to the doctor, because there could be other causes, like an infection.
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06-09-2014, 07:17 PM   #3
Jay Woodman
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For those of you who have had them, how did you know for sure. Did you need to have a doctor confirm it? I have had two recto-vaginal fistulas in the past, and those are pretty straight forward because things are coming from places where they shouldn't be. I think I may now have a peri-anal fistula, but I don't know how to tell for sure. I have a lot of drainage similar to before (mucus/pus like) that just discharges without warning. Also some blood and stool. There is no abscess present, but a do have some pain. I am currently on Remicade, which is supposed to be good for healing them, so that makes me question whether I would have developed one while on it. When I had fistulas in the past, as long as there wasn't an abscess present, my doctor said the best thing is to let them be, so I am not sure it's even worth mentioning to him. Anyone with experience have any thoughts on this?

thanks!
My fistulas to date have always been preceded by perianal abscesses. The abscess develops. I have an Incision & Draininage at Emergency & a fistula develops. The fistula will cause pus drainage for me. They also develop around the anus. Characteristically, you should see a small pinhole. There is usually pus & bright red blood. It may not look significant but I usually feel a significant amount of pressure..perhaps from the build up of pus in the surrounding area before drainage releases...
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06-10-2014, 09:19 AM   #4
Cookie
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The drainage is coming from my anus, like it may be just inside a bit. It is sometimes mixed with stool and blood and other times it is just yellowish or greenish in color, which makes me worry about infection. I don't believe there is an abscess, at least not like I have had them in the past, but I feel a lot of pressure in the anal region, especially just before the fluid releases. I think that sounds a lot like what you are describing Jay Woodman, wouldn't you say?

Is it possible to have an abscess or tract that has not opened on both ends that drains from the inside?

Last edited by Cookie; 06-10-2014 at 10:11 AM.
06-10-2014, 10:44 AM   #5
Tuff
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I've had multiple fistulas, with only one abscess. It's possible to have a fistula that goes to another organ instead of breaking through the skin. It can be infected, which is not good if you're on Remicade. Only a doctor can make that diagnosis by examining the area.
06-10-2014, 12:22 PM   #6
Jay Woodman
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The drainage is coming from my anus, like it may be just inside a bit. It is sometimes mixed with stool and blood and other times it is just yellowish or greenish in color, which makes me worry about infection. I don't believe there is an abscess, at least not like I have had them in the past, but I feel a lot of pressure in the anal region, especially just before the fluid releases. I think that sounds a lot like what you are describing Jay Woodman, wouldn't you say?

Is it possible to have an abscess or tract that has not opened on both ends that drains from the inside?
Sounds like a visit to your Dr. is in order! It seems that my recent abscess was perhaps initially started as a Sinus Tract. As I understand it a Sinus Tract unlike a fistula has one opening rather than the two characteristic of a fistula. Similar to your description my tract also kept draining through the anus releasing pressure but took a few months to finally present as an abscess in the skin of the perianal region which finally required an Incision & Drainage.
Keep in mind, however, that I have not yet started a Biologic. Given that you are on Remicade you need to be very cautious with any infection. Again, our experiences sound similar & I'm glad to share how I felt with this most recent abscess in it's initial manifestation but that doesn't necessarily mean yours is the same scenario.
Please see your Dr. & let me know how you are feeling : )
06-10-2014, 01:16 PM   #7
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Thank you for sharing. I will definitely call my doctor and keep you posted. My guess is that he will prescribe a round of Cipro and Flagyl.

Edit to add: Doc's office just called me back and would like to see me Thursday morning. I am glad to have a very responsive doc. I will keep you posted on where things go from here. Thanks again for your advice.

Last edited by Cookie; 06-10-2014 at 02:25 PM.
06-12-2014, 10:54 AM   #8
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I just got back from the doctor and it was confirmed that I have an anal abscess. Since it is draining and I do not have a fever, the course of action was anti-biotics to keep the infection away. My usual GI is out of the country, so I saw his nurse practitioner who consulted with another doctor on staff. I was prescribed a 30 day course of Cipro. In the past, my normal GI has always prescribed Cipro and Flagyl together, which, from much of what I have read on this forum, seems to be a standard course of treatment. I asked why no Flagyl and she told me that was just what the doctor prescribed without a further explanation. Has anyone ever been prescribed only Cipro for an abscess? Is it effective? Can anyone offer an explanation as to why a doctor may choose not to prescribe Flagyl? Or do you think it is just his standard MO? If it makes any difference, I am currently on both Imuran and Remicade.
06-12-2014, 12:01 PM   #9
Sailorluna
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I thought they were prescribed together as a way to reduce risk for CDif. I have always been given both
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06-12-2014, 03:25 PM   #10
mish2575
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I thought they were prescribed together as a way to reduce risk for CDif. I have always been given both
wouldn't a probiotic be what kept c-diff at bay? I would think the more antibiotics you are on the likelier you are to develop c-diff.

. . . or am I thinking of h.pylori???
06-12-2014, 05:27 PM   #11
Sailorluna
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maybe - I was under the impression that one was known specifically to cause it and the other counteracted that. I could be wrong though
06-12-2014, 07:03 PM   #12
Tuff
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I got peripheral neuropathy from Flagyl, maybe he's had patients get side effects from it?
06-13-2014, 08:53 AM   #13
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I got peripheral neuropathy from Flagyl, maybe he's had patients get side effects from it?
This has always been a concern of mine. I have a lot of tingling in my hands and feet as it is, so when I am on Flagyl I am overly aware of it. I hate flagyl anyway. It makes me feel like crap, but I have always felt that it was the more effective of the two drugs. Although I am not sure why I say that because I have always taken them together, so how would I know?

BTW, I googled the two drugs together and found a site that said they are often prescribed together because one combats gram negative bacteria in the gut and the other gram positive. Maybe this is where you got the info on the C. diff from, sailorluna. I guess it would make sense that if you were only killing off one type of bacteria, it would create a more favorable environment for another type to flourish.
06-13-2014, 02:42 PM   #14
mish2575
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Cipro makes me vomit by day 3. Flagyll has never done one thing for me, at all.

Antibiotics have never worked with my fistulas.
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