Perianal abscess Fistula Problems

Hi there,

My wife has had an perianal abscess fistula for about 5 years now in the lower groin area. It's been years since it got so large that doctors lanced it and drained it. The last couple of years we have tried to just manage it by regularly Epson salts baths and hot compression followed by squeezing out all the puss and materials.

We have chosen not to proceed surgically right now because it's a deep complex fistula which can lead to incontinence.

recently the abscess seems to have come back due to one of the 2 exists closing up. We have been trying to drain it with the bath/compression technique but not really getting lucky.

Does anyone have any tips on managing these things long-term? Any tips on how to drain or bring it to a head easier? Has anyone lanced or pinned these things themselves?

thanks so much.

Hello Tman and welcome, sorry your wife is haveing a hard time. My hubby has been dealing with perianal fistulas since 2005 we have never lanced them our selves but he has went to his CRS and they lanced them in their office he also went to the ER and they lanced it a couple of times as well.

Other than the sitz bath I don't know of any other technique. Hubby has had his surgical removed 3X's now. How sure do hope she finds comfort soon.

Thanks so much for the info! Hope his spirits are up.

How did they try to remove them? Fistolotomy? etc? Ever tried just living with the seton in place?

That is a awful long time for the same passage to exist. I would recommend getting that looked at by a surgeon. They should give you a good reason why it isn't closing up by now? And if it doesn't, they usually scrape it clean and give it a chance to close, or just cauterize it closed. If the source is still there, they may want to remove that area.

I have opened my own fistula before, but after 10 years of this I am aware of when I can get it and when I can't. I didn't use lancing. It takes a lot of patience and many soaks. During the hot soaks the area is massaged as much as you can take, and the surface area where it feels like it will be coming out is cleaned often and thoroughly with a washcloth and soap scrub. Just scrub good and vigorous. The lye in the soap will soften up and remove any older skin from the surface. I think it is the hot water and the motion that works over time. It is really a miserable time up until they open and start draining. However, I agree with the above, once opened, keep it draining with a seton, or have it cleaned out and sealed up.

I have so much scar tissue now that they try to find other ways out and it has become very hard for them to surface and drain. Many times the draining goes into reverse and it will come out with the stool.

A word of CAUTION, I have also been septic a couple of times, which is immediate ER, no messing around with that. I have a picture on my page of what my eye looked like septic. Fever, chills, shaking, passing out, really bad headache, body aches, horrible taste in your mouth. So don't try to mess with the fistula unless you are already on some form of antibiotic like Cipro. If that stuff gets into your blood, you will certainly know it right away. Please don't sit around at home thinking it will go away if you get a fever, even if you are on antibiotics. A fever needs to be looked at if it doesn't go away or gets worse.
There are some really good videos on Youtube of the whole procedure in case you wanted to watch Dr. Gupta work on a fistula.
http://youtu.be/5QoJEGZRnPs