Have abscess on labia,could this be a fistula!?!? Help please!

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 to about a year ago, I was taking a medication for one of my other illnesses( Interstitial Cystitis) and after being on it for 6 months, 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) a couple times it was close to water. I thought it might have something to do with the drug I was taking so I stopped the drug. 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 back to normal, this was last month.

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) on the labia 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 bacteria, 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. It also showed other bacteria. This is what the report said:
Aerobic culture/SMR

Gram Smear:

Few polymorphonclear cells
Few Epithileal cells
Rare yeast
Very rare gram positive cocci
Very rare gram negative Bacilli

Culture:
Moderate Escherichia Coli( e-coli)
few mixed flora consisting of 3 type(s) of gram positive organisms
No staphylococcus Aureus, group A Streptoccoccus,Vancomycin resistant Enterococci or Pseudomonas Aerugihosa isolated.

So there was obviously some different bacteria involved. The thing that is concerning is that they found moderate e-coli. Everything I read says skin abscesses usually are from Staph bacteria. .

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 on the right lower labia . 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 that I had in the past 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 and the report? The nurse at the dermys office was not to helpful. She just said to put the antibiotic cream on it for a week. She offered me Bactrim antibiotic if I felt I needed it, but I declined due to the severe reaction I Had to it in the past. She said to just use the cream for 1 week on it. I am worried sick over this. I need some advice and help.

Given the tons of different bacteria that normally grow in that region of the body, I'd say it's a little soon to be worrying so much about a fistula in the absence of other fistula symptoms.

I suggest trying some antibiotic creams until you find one you can tolerate and see how it goes. If that doesn't work the next step may be to ask your doc for some antibiotic pills.

Thank you for your response.

What would be the other symptoms of a fistula? I guess I worry because I have no idea how this abscess even came about. Just one day I felt a hard small lump under my skin. I did not think anything of it since it did not hurt ot bother me at all. It stayed that way for like 2 to 3 weeks probably or more. Then out of the blue I woke up and took my shower and noticed it was bigger. That is when I started doing the hot compresses on it. It looked like a blister at first, not red at all. After I started putting the compresses and also neosporin ointment it developed a little hole and was leaking some puss and clearish fluids, but it would not drain out. That is when I went to my dermatologist to have it lanced and drained this past Wednesday. It has closed up already( it actually closed the third day after she lanced it). I can still feel something under the skin( like a lumpy feeling) but nowhere as big as it was before. It looks kind of purple in color too and is sore at times.

I just worry because I do have all sorts of health issues( Interstitial Cystitis, CFS, Fibromyalgia, supposed IBS, gut issues, skin issues, chemical sensitivities etc..).

How does one know if their abscess is due to a fistula or not? Sorry, I am just worried about all this. I know my tests did not show Crohns, though the last test I had was a colonoscopy and that was almost three years ago now. I just do not believe my gut issues are IBS related as I do not have the typical IBS symptoms.

Scipio said:

Given the tons of different bacteria that normally grow in that region of the body, I'd say it's a little soon to be worrying so much about a fistula in the absence of other fistula symptoms.

I suggest trying some antibiotic creams until you find one you can tolerate and see how it goes. If that doesn't work the next step may be to ask your doc for some antibiotic pills.

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I had exactly the same thing that you're describing, and the key results that my GI saw were "Few Epithileal cells" and E coli that made him diagnose this thing as a fistula. Mine, too, have closed for now.

That is what I am worried about. The dermatologist does not seem overly concerned though. What other symptoms did you have with your abscess? How can you tell if it is a fistula or just ingrown infected hair follicle that caused an abscess?

Salad_Shooter said:

I had exactly the same thing that you're describing, and the key results that my GI saw were "Few Epithileal cells" and E coli that made him diagnose this thing as a fistula. Mine, too, have closed for now.

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The drainage from the area was the same color as what was in my ostomy bag, but that doesn't apply to you. The fistulae hurt badly before they opened, and the drainage irritated the surrounding skin..which makes sense because of the bile and stuff the drainage contained.

I wouldn't worry too much right now if I were you. Take the information, though, to your GI doc if you have one. The results will help him in diagnosing you. He should have the lab results, for sure.

Oh, and with me there wasn't any Staph or Strep, either, just the occasional Gram somethingoranother....can't remember if it was + or - . It didn't matter because it wasn't an infectious agent, it was a fistula.

I called the dermatologist today and talked to her about my lab results. She said that having e-coli bacteria cultured from the abscess would be pretty common because of it being on the labia. Her claim is that the genital area have these bacteria down there in abundance due to being close to the vagina and rectum. I asked her about the other bacteria's and she said there were other isolated bacteria's but the only one that grew was the e-coli, the others were isolated whatever that means. She claims it would be common to have these bacteria down there being in the genital area where these bacteria are abundant. I am unsure what to think at this point. She said she is thinking that I had a hair follicle that got infected and that caused the abscess. I am just so clean down there I cannot figure out how I could have got anything infected. It started out with a small lump under the skin there( no pain at all whatsoever when the hard lump first appeared. It was only after a few weeks went by that it grew and started getting fluid inside. How the hell would a hair follicle get infected though if I am a super clean person( shower twice daily and especially after every BM? I do not remember cutting myself down there or anything.

I do not have an appointment with GI doc yet. I am going to see my gynecologist though on Thursday and am going to mention it to her. My GI doc I am certain will just brush me off. When I first started having intestinal issues 5 years ago( mostly just awful pain and cramping without any diarrhea or constipation), he dx me with IBS. I then just felt worse and worse so he did tests ( CT, MRE small bowel and then colonoscopy) and they were normal so he just keeps saying I have IBS. Even when my fecal calprotetcin level was some elevated ( I actually asked my primary care doc to order it for me) he said it was not concerning to him at all as he felt it was not that elevated. He thought it may have been due to a medication I was taking for my Interstitial Cystitis( Uribel) which is a urinary pain reliever than contains both an antiseptic and a salicylate, that maybe it irritated my bowels. I will have to eventually get another GI doctor probably as mine is probably going to retire soon( he is only there part time now as it is).

I dont know what to think really. Do fistula's leak? I know when she lanced the abscess she squeezed the gunk out. Afterwards I only had very little drainage( maybe just a little blood for the most part and the tiniest amount of yellow puss). The area she lanced closed up like the third day. It looks to be healing, but still a tiny bit sore at times. She was going to give me Bactrim antibiotic to take but I cannot take it as it almost caused me Steven Johnson Syndrome and was told Never take it again. She was also concerned because the e-coli bacteria I have is resistant to most of the antibiotics and the 2 that is is not resistant to, well I cannot take. She said to just use the antibacterial ointment she gave me and to maybe wash the area with Hibiclens. She said she would only give antibiotics if it was absolutely warranted and that she would have to send me to Infectious disease since I am resistant to so many and allergic to a lot as well.

So that is where I am at. I asked the dermatologist if she thought it could be a fistula and she said no, she thinks an infected hair follicle. I am confused and worried and do not know what to think really

Salad_Shooter said:

Oh, and with me there wasn't any Staph or Strep, either, just the occasional Gram somethingoranother....can't remember if it was + or - . It didn't matter because it wasn't an infectious agent, it was a fistula.

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My drainage was watery. There was no pus. And yes, they leak. If yours had pus in it, then I question whether it was a fistula. I'm confused now.

Fistula is a serious complication of fairly advanced Crohn's. Given that you have not been diagnosed with IBD, and you had clean colonoscopy, clean MRE, and clean CT scan plus normal CRP, and an only modest elevation of the FCP, plus it is common for those bacteria to be normally present in that part of the body, taken together I'd say that the chance this is a fistula is pretty low at this point.

I suggest to keep an eye on it. Use the prescribed medicines. And if it doesn't heal up after a couple of weeks, or if it gets worse, or if you develop a fever, contact the doctor again.

Thank you for the response. That is pretty much my plan for now. I just feel uncomfortable down there all over( like my anal area even feels irritated). I will keep an eye on it and see what happens. Thanks for the support and advice.

Scipio said:

Fistula is a serious complication of fairly advanced Crohn's. Given that you have not been diagnosed with IBD, and you had clean colonoscopy, clean MRE, and clean CT scan plus normal CRP, and an only modest elevation of the FCP, plus it is common for those bacteria to be normally present in that part of the body, taken together I'd say that the chance this is a fistula is pretty low at this point.

I suggest to keep an eye on it. Use the prescribed medicines. And if it doesn't heal up after a couple of weeks, or if it gets worse, or if you develop a fever, contact the doctor again.

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Big hugs extremely common bacteria there which is why little girls tend to get UTI more than little boys

^Agreed with MLP.

When I first read it I also thought of bartholin abscess. E coli is common with those as well.

And although staph is most common, ecoli as well as others isn't necessarily rare.

My little penguin and Clash: thank you for the replies. I guess I will keep an eye on it and see how it goes. I dont think it is a Bartholin's gland as I think the dermatologist would have known that( at least I hope she would have). Everything I read shows the Bartholins gland on the inner labia minora near the entrance of the vagina. My abscess was like on the outer labia close to the perineum.I am seeing my gynecologist this Thursday for my pap test and will mention it to her too and see what she thinks.

My little penguin: yes, I guess your right about the whole UTI thing. I have gotten UTI's and usually always with E-coli bacteria. I probably have it in my vagina. I just cannot figure out how I could have gotten the infection in a hair follicle as I do not remember cutting myself or anything like that. It is odd how it started off as a little hard lump under the skin and stayed that way for a few weeks and then it got bigger and developed into an abscess.