Crohn's Disease Forum » Surgery » Fistulas, Fissures and Abscesses » Do perianal abscess questions: confused and a little scared

04-13-2011, 01:12 PM   #1
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Join Date: Mar 2011
Do perianal abscess questions: confused and a little scared

Thanks for reading. Not quite sure:

1. Which comes first, the fistula or the abscess. I just got a perianal abscess drained yesterday, is this due to a fistula from inside or is the fear that a fistula is created from this abscess that was drained

1.5 Are all perianal abscesses from fistulas or create them?

2. After the draining, what is it supposed to look like. Before it was a ballooned grape in the perianal region, now it's a soggy grape. But should it be flush (it has been 1 day) or is that normal? Do I squeeze it out more? I know it's still draining

3. the dr put me on Cipro and flagyl. Strangely, Cipro gives me these ulcerative rashes and itches and once again, this happened. If I just take Flagyl, is that enough or if I cut out Cipro am I really killing my chances of preventing a fistula or recovery from the abscess?

4. What is recovery for a fistula operation. this makes me scared the most

thanks again for reading.
04-13-2011, 02:00 PM   #2
Senior Member
Join Date: Feb 2011
Location: Harlow, United Kingdom
Hi and welcome to the forum.

I can't offer definitive answers, so it's just based on my own experience. Have you been diagnosed with Crohn's disease? The reason I ask, is that this can impact on the answers that you will receive.

1. Abscess first. Just because you've had an abscess and had it drained does not mean a fistula will form.

1.5 No, perianal abscess form quite frequently. They can start with a simple, infected hair follicle.

2. It kind of depends on how the drainage was done. Deflated sounds ok and continuing to drain at this point is also ok. Sometime the roof is taken off the abscess to leave an open wound. Sometimes the resulting cavity is packed to keep it open and allow things to heal from the inside out. Gentle squeeze probably won't do any harm, but it's not compulsory! Can you stand the pain that would result?

3. Talk to your Dr! The Cipro/Flagyl combination works well for the types of bugs typically found in this area. Other drugs can be substituted for Cipro if needs be.

4. How long is a piece of string? It all depends on the type of surgery. We are all different in how we deal with things. I'm typically off work for between 1 and 3 weeks. Over the last 6 years I've had 10 surgeries and am expecting number 11 in the near future!

Regardless of if it's a simple abscess or Crohn's related, let hope that you're feeling better soon.

Diagnosed late 1980ís
Azathioprine & Infliximab not tolerated
Humira since Aug 2010, weekly since Jun 2011
12 EUAs, setons removed & fistulotomy Dec 2012
04-13-2011, 02:04 PM   #3
New Member
Join Date: Mar 2011
Thanks Mark, much appreciated. I do have Crohn's disease, but I also feel like the abscess came from a fissure or trauma. Thanks for the insight,

other opinions, answers welcomed too, thanks
04-13-2011, 02:09 PM   #4
Senior Member
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Join Date: Jan 2009
Hi Brin and Welcome,

I will try to answer those of your questions that I can although I don't have all of the answers.

As far as which comes first, it can be either. Usually an abscess will develop and it will break through (either on its own or surgically) to form a fistula. Or you can have a complex fistula that develops an offshoot which can be an abscess as stuff collects in there and there is no place for it to go. It can still drain back through the fistula though, usually if you squeeze it. I think the general consensus is that you would rather have a fistula than an abscess as fistulas can drain, but abscesses that are unable to drain can form dangerous infections.

Cipro and Flagyl are wonderful for keeping abscesses from getting infected. I had a complex fistula and I took them to help the adjacent abscess clean and clear. You do need to consider the effects of their long term use. I alternated between the two when side effects would pop up. I always felt like Flagyl was the "stronger" of the two, but most doctors prescribe them in tandem. If you are have reactions to the Cipro, I would talk to your doc about not taking it. I think Flagyl can do remarkably well on its own.

As far as surgery depends on the type, I guess. I had a flap repair and the recovery time was two weeks off work, about 3-4 to feel completely "normal". Many others get setons placed, which I think is preferable if your Crohn's is very active. There is info on here about both procedures and others. Also, have you tried Remicade or Humira? There are plenty of success stories for these drugs and people with fistulas. There is really a lot of info on the forum. Have a look around...and best of luck!
04-13-2011, 02:47 PM   #5
New Member
Join Date: Mar 2011
I just got off the phone, and here are my dr's answers FYI. Thanks again everyone.

1. Abscess First
1.5. No, it's a 50/50 chance
2. Squeeze if you can, but not necessary. It should decrease in size slowly by itself.
3. Stop Cipro, continue flagyl. no need to substitute Cipro
4. I didn't ask, i thought i would be too crazy mentioning something that hasn't happened yet lol

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