Hi everyone,

I'm a healthy, 32 year old male and it's been nearly a year since I had my perianal abscess incised and drained (it developed in mid-October and the surgery was on Halloween itself) and 10 months since my fistulotomy. It all healed up by mid-April 2015 and, barring a small dimple and occasional stretching pains at the beginning, I've had no physical problems. The problems I HAVE had are mental- I keep worrying that I could have Crohn's disease despite not having any symptoms other than the abscess. I have talked to multiple experts and they all say that between 95% and 99% of all perianal abscesses are not related to Crohn's...this provides me some relief, but I still find myself worrying.

I suppose I should discuss my history- I have NO family history of IBD or any other bowel-related disorders; however, I DO have a strong family history of hemorrhoids and skin tags (I have had a skin tag for about 20 years and internal hemorrhoids, I've only had an external hemorrhoid once an I will detail it in a bit). It turns out my uncle (he's 57 years old) had an abscess/fistula a few years back (they used a cutting seton on his) and he has not had any problems since (he does not have IBD).

The following details are a tad embarrassing, but its possible they might be important details with any of you helping. For years prior to my abscess formation I would often have very poor rectal hygiene; sometimes I would do really heavy workouts (power-lifting) in tight, heat-capturing pants and I would literally stew in my juices for often hours afterwards while sitting on my computer working. Often I would hold my stool in while I worked and it would leak into my perianal area. Eventually I would shower, but I would often go 12 hours before that. In addition, the girl I was dating at the time preferred me to shave the entire area clear up to the rectum, so there were constantly "razor-burn" cuts in the area and there was always blood on the towel after I'd get out of the shower. I also had hemorrhoids and possibly even a fissure from the weight-lifting. When my abscess developed I had my first external hemorrhoid and also at the same time developed intense groin itching (like jock itch on steroids) and some weird red spots on my arm. Once I took the antibiotics these both disappeared but the abscess remained. It grew quite large before I actually had it drained because, for some reason, the pain was minimal (except when I would fart, there would be a sharp, stabbing pain). So I had the surgery and it all went well, they packed it for 2 weeks and then decided it was best to just leave it open to heal. I changed my hygiene and shaving habits completely....I became super obsessive about rectal cleanliness and stopped shaving completely. The wound healed up until there was just a tiny red dot left that just refused to heal, and this was when the doctor informed me I had a fistula. He performed a normal fistulotomy, the wound was quite large and deep but apparently not deep enough to require seton or anything else. It took approximately 3 months to 100% heal and left a very tiny dimple behind. The only problems I have no are the extra cleaning required in the dimple (often 15-30 minutes later I will need to go back and clean some of the light residue out, even though I use only wet-wipes and a shower head...doesn't seem to make a difference).

So, I suppose my question is, should I be worrying constantly about IBD? I had a blood test specifically for IBD (looking for antibodies) and also a stool test and both came back normal. I do not have intestinal cramping or diarrhea. My stools are usually looking like number 4 or 5 on the Bristol chart and I usually go between 1-3 times per day (depending on my body building diet). I've also noticed no weight-loss. I did have minor stomach issues for about a month after returning from Indonesia (I had one or two loose BMs) but I'm assuming that's something else. What do you guys think? Do you think my poor hygiene and physical factors resulted in the "perfect storm" to develop an abscess? My doctor keeps telling me that hygiene has nothing to do with it, but I find that hard to believe.

I have Behcet's Disease that gives me all sorts of problems, including GI ones. I don't worry about it, but that is just me.

Personally, if the doctors had told me that I do not have IBD, or Crohn's, I would go with what they say. Also, if hygiene were what made these problems, half of the 'third world' would be suffering from these things. We worry too much about cleanliness, and as you have travelled in Indonesia and possibly other parts of the east, you probably know that it is not always easy to stay clean when you are living in poverty.

I don't clean my arse in an extreme way, if I can put it like that. I do make sure it is clean - yes - but I don't spend time worrying about it after that...I only use water, and have done for about three years, and am quite happy with it. Am very gentle too when I clean after a BM, using only the softest TP (I use Cottenelle with Aloe and Vitamin D...), never wiping, just dabbing, and wet sterile gauze pads to make sure everything is gone.

So, what I would say is try not to worry if you are doing well. If you are not doing well, that is a different story. Then go to the best doctor that you can for whatever you think is still wrong, and get a second opinion. Life is too short.

Hope this helps!