Hey Hope,
I also got an abscess at the incision site a couple weeks after LIS. Different doctors will sometimes have different opinions on how to treat them. So please consider the following my opinion only.
ANTIBIOTICS
Some doctors opt for antibiotics as first line treatment for abscesses that they consider superficial. That is, it's just a swollen pocket of pus on the surface of the skin and there's nothing more going on behind it. The antibiotics of choice are Flagyl (metronidazole) and Cipro (ciprofloxacin), sometimes both. So you're on the right stuff for superficial abscess treatment. I've never taken Cipro but have taken other fluoroquinolone antibiotics and the side effects were rough on me -- hope you're doing okay there :)
SURGERY
Ok, so no one wants to hear the S-word so soon after LIS. I definitely didn't. But the truth is that the medical literature almost universally agrees that perianal/anorectal abscesses are a surgical condition. The reason is that they can lead to the formulation of a fistula if they're not simply superficial. In your case, it seems doubtful that a fistula would develop in such a short period of time, but it's important to treat the abscess properly so that one never forms.
Some doctors will simply opt to drain the abscess. That can work at times, but doesn't address any fistulous tract that may have already formed. If there is such a tract, then the abscess will simply return after a period of time. I have a coworker who had this done 5x before finally having surgery to correct the underlying fistula.
In my case, I basically had a second minor surgery to treat the abscess and make sure there wasn't a fistula tunneling away behind it. I had the abscess incised and drained, and then the surgeon checked for a fistulous tract so that it could be disrupted if one were found (fistulotomy). This is the by-the-book approach according to the vast majority of medical literature (I'm obsessive about this sort of thing and double check everything against UpToDate.com). It may well be that your case is superficial and you'll never get to this point, but if you do, you're definitely not alone!
Anyhow I don't mean to try to scare anyone or come across as being negative, but I did want to be honest about the info I've gathered on perianal abscessed based on my own research and experience. Here's to hoping you're feeling better already and that I've just blabbered on for no reason!

NG - thank you so much for all this useful information. I actually feel vindicated because I'm pretty sure, based on everything I've read, that my abscess needs to be surgically drained. In fact, I'm doing everything I possibly can to get that done. I'm not looking forward to it (after having read your and other posts about the procedure!), but I do think this is the best course of action. It turns out getting treatment isn't easy where I live! Here's a long story with TMI coming up, so skip what follows if you like.
Last night the pain was getting slightly worse - kinda tight, raw, swollen and a bit like a knife was up my butt. I took a look at around 10pm and thought I saw the area where the incision site was looking a bit pinker and more swollen than it should. Decided I would contact my doc in the morning.
This morning I woke up with the same sensations, took a look and saw that the area was definitely pinker than it should be, quite tender, and there was what looked like a small pimple just inside the anal verge (you'd have to spread the anus to see it). Decided to go to emerg. Got in quickly because it was so early in the morning. The first doctor to see me remembered me from my ambulance adventure. She took a look and then went to find the surgeon on call. She came back a few minutes later to tell me that the on call surgeon doesn't want to see me because he didn't perform the LIS - I have to go back to Dr. McKenna at the Rudd Clinic. My husband and I argued with her for a long time, and all we got was "surgeons prefer ...", "this is how surgeons do things ... ", "you have to go back to the Rudd ..." until finally I had a total meltdown. I mean sobbing, hyperventilating, shaking, the works. Nurses were scrambling to put paper bags over my head and shove ativan down my throat.
They were going to send me away without treatment!!!! They were going to make me go back to Dr. Death!!!!
I had a full-blown anxiety attack.
The doc who initially saw me went back to beg the on call surgeon to come to see the crazy hyperventilating woman, which he did eventually. He checked me out and said that he saw no evidence of infection or abscess. Perhaps there was some scar tissue from the LIS. I should stop the cipro and take warm baths. He said that my reaction is quite out of proportion to my problem and that I need to stop focusing on that area. He said that his office will call me for a follow up appointment. (I later got an app for Monday)
I left the hospital pretty pissed off at doctors, but not too strung out because the happy pill made me mellow.
Got home, took a short nap, then went to check out my butt. Looked in the mirrow and saw a distinct red blister. When I touched it, it oozed brownish pus mixed with blood.
Since the surgeon didn't believe that I had an abscess, I took pictures of it with my iphone, and I collected the exudate and put it in a small container (I'm beyond squeemish now!). I am bringing all that to my appointment on Monday when I see the surgeon.
Saw my GP this afternoon and he gave me more happy pills, some painkillers, and more cipro. He agrees that my abscess should be drained surgically and told me that the on call surgeon is the best guy in town, so, as long as he believes me that I have an abscess, I may actually get proper treatment before this develops into a fistula - if it hasn't already!
Sorry for the very long post. I really don't know what to think. Part of me thinks that the abscess is pretty superficial and so should clear up soon with proper treatment. Another part of me is worried because the pus initially came from inside (as far as I could tell), but now there is an unmistakable external boil-type-thing and I don't know if that means a fistula has already formed.
I guess it's time to take more happy pills!
Sorry again ... I've feeling pretty down :(
Thanks to NG and everyone else, I will be able to go to the appointment Monday armed with knowledge!

Oh no Hope, what a horrible time you've had. :( Why do doctors always think they know better than we do. Its a good thing you've taken a photo - they cant argue with that. Blimey, the things we have to resort to, just to get proper treatment. Remember, if you get a fever or begin to feel really unwell, go see someone urgently - you know your own body better than those idiots. How could they possibly want to send you back to that butcher, that's absolutely terrible.
I hope you feel better soon, and that you get proper advice and treatment on monday.
Take care.

Yeah, Val, I can't believe docs sometimes. Actually, my hubbie went out and bought me the movie "The Doctor" (with William Hurt) after my LIS so we could fantasize about a CRS getting ass surgery! You're very right, we know our own bodies better than anybody! You are such a sweetie for holding my hand while you're recovering from surgery yourself What you say is true, and very reassuring!
NG - I've never seen you blabber! You are a wealth of knowledge and I always learn a lot from your posts. I'm grateful you are still here helping others, even though you are dealing with your own life right now. I definitely value all your contributions. Thanks again for all the trouble you took writing all that up for me. It adds significantly to my own research and, if you don't mind, I will be taking a modified copy of it with me to my appointment (I find notes help keep me focused when I'm dealing with doctors).
Boardies are great!

Hey Hope,
One thing I'd probably push for would be at least a proper exam of the area so the docs can see what they're dealing with. It's very difficult to tell without actually "spreading things out" and getting a good look inside. This type of exam is a simpler procedure than actual surgery and can be done using mild sedatives and painkillers.
In fact, when I was first going through fissure hell and presented to the ER in extreme pain, that was the very first thing the ER doc wanted to do. So they put a couple IVs in me with benzodiazepines and fentanyl, then pried my butt open and had a look at the scenery. I was awake the whole time, just woozy. Even cracked a few jokes, they tell me :)
This was before I had LIS, so there was no infection to be found. But the doctors went through the proper procedure, because the one thing they don't want is an infection to go systemic. A localized infection will just irritate you, but a systemic one that mobilizes via the bloodstream is a serious problem.
If the doctors aren't even doing a proper exam to take a look, they either aren't taking you seriously or are ignorant. Most likely it's just the former, and I suspect your visit next week will go well and someone will finally realize that there's an issue.
BTW, do doctors get sued a lot in Canada? Just curious. Here in the US, doctors have a healthy fear of lawsuits and generally won't screw around with patients who may have serious conditions. It seems (from what I've read here anyway) that maybe Canadian doctors have a more casual attitude? I don't know if that's a fair assessment or not (and don't mean for this to offend anyone), but was just wondering. It may also just be a general cultural difference, as there's nothing that says US doctors' approaches are the best, after all. But it certainly seems that we go in with similar problems but the treatment plan doesn't always match that closely.

Hey NG! Thanks so much, again, for the excellent advice! I haven't had a doctor explore the "terrain" in there since before the LIS - I just got the finger pokes (what fun!). I'll make sure the dude on Monday gives me a proper examination, with sedation! I really do want a thorough exam so that I know that I am being treated for the right problem!
It's actually really hard to sue doctors here in Canada. Canadian doctors are actually in private practice, they just bill the provincial govt. So we don't have socialized medicine, per se, but rather we have a 'single payer' system. I"m pretty sure it works something like this: Doctors in private practice (all of them) must get their liability insurance from the Canadian Medical Protection Association. Since in our system, the loser of a law suit must pay the legal expenses of the winner, the CMPA can make legal fees too high for patients to consider suing. Also, the Supreme Court of Canada set caps on how much can be paid and on which types of cases that can go forward. So it's really damn hard to sue a doctor up here! I'm starting to think we should just put the really bad ones on ice bergs and let them float away!
No offense, NG - I've gotten into many spirited debates with my mother about health care in the US and Canada. My mother moved to Florida relatively recently and just loves the health care system down there - and with the quality of care and service she describes, I can understand why! But she has come to recognize some serious problems with insurance companies too.
Personally, I think the problem with high health care costs has to do with mega profits made by pharmaceutical corporations ... but then, I'm a raving lefty, tree-hugging, pot-smoking pinko from the Great White North, eh?

hopetoheal wrote:I'm a raving lefty, tree-hugging, pot-smoking pinko from the Great White North, eh?

What??? You didn't tell me you were Californian

Ha ha! I'd love to live in the California with the lovely weather!

Hoe gaan met jou? Hope you're feeling a bit better today. What a palava! Hope the trip to the doc on Monday goes well, but that you are ready to rant this weekend if the infection seems worse. What we have to go through, and sometimes, when I read my medical records after a visit to a dr, I wonder if some of them saw someone else instead of me, from what they have written. Not all of them. But have had some great ones where instead of saying I react badly to a specific anesthesia, they had a cancer medication there, as an example...
Really sorry you're going through this. Keep your spirits up. Soon be better. 

Ek is 'n bietjie better vandag, dankie! :D
(Ooo - ek kan nie so baie goed Afrikaans skryf nie!)
It looks like the infection is under control, but not completely gone. In a way, I kinda prefer that, since I'd feel better if a surgeon deals with it to make sure it's all gone. That being said, I'm like you when it comes to doctors. I've met too many who seriously shake my confidence in the medical profession! Cancer medication???? WTF?? Sheesh! I've learned to pay careful attention to doctors when they deal with me, after all this fissure mess. You must have some doctor phobias by now! I sure would. I'm certainly quite ready to pull another fit at the hospital if need be (I'm learning!)
How are you doing, Em?