Hi guys,

I've been battling an abscess in the perineal (rectovaginal?) region. I noticed it perhaps a couple months ago, and I went to my gynecologist for treatment over a month ago. I've had abscesses in the groin and breast areas before and have been diagnosed with hidradenitis supparativa. I assumed that this abscess was no different and could be explained by the HS. My doctor prescribed bactrim for me, which did nothing. I went back to her, at which point she did an incision and drainage and cultured the pus. It came back as E.Coli, which immediately had me thinking possible fistula. I've taken two rounds of Cipro and two other oral antibiotics that target E. Coli, but this abscess isn't going away. It seems to fluctuate in level of inflammation. My doctor has confirmed that it is still open (she does not have to incise it to culture the pus), and it varies between being flat but itchy and red and inflamed with something that looks like a small white head. My doctor did a digital rectal exam and has monitored the area, and she assures me this is an isolated abscess that doesn't seem to be connected to anything. She said she doesn't see a dimple that would be indicative of a fistula.

A little backstory: I was diagnosed with an anal fissure in March '13 and within six weeks had LIS. My CRS assured me by fall '13 that my fissure had healed. I returned to him a few times afterwards with rectal discomfort. It's hard to explain, but it still feels tender to sit at times. I also have a strange lump that surfaces at the base of my tailbone (like a pilonidal cyst). My CRS, gynecologist, and dermatologist all assured me that it was not a pilonidal cyst (I refer to it as my "butt marble," since that's what it feels like). Sometimes the butt marble is there, most often it's not.

I haven't had to strain during BMs (which are always regular), and there's been no blood, pain or discomfort in that regard. I don't wipe "normally" anymore after BMs- I use with hazel wipes when on the go, and at home use what I call my 'Japanese toilet"- basically a bidet attachment that cleanses me with water. So I can't tell you about discomfort while wiping (dunno if that's relevant or not). I don't seem to have any symptoms of Crohn's or IBD, and I've been tested for diabetes, HIV, etc etc. My fissure was initially caused by constipation brought on my fertility drugs (horrible things).

I've been panicking over what to do. Obviously I can make an appt to see my CRS, but I've been putting that off for the obvious reason that I'm terrified and don't relish the thought of a DRE (or it being a fistula).

So how can I tell the difference between a simple abscess and a fistula? Can I? I've done reading of this online- haven't noticed stool passing through the abscess, but it's so close to that general area it's hard to tell for certain. Is there something I should be looking for? How did you feel as a fistula sufferer- is there some tell-tale sign?

I'm so sorry for the lengthy email, and I hope someone reads this. I feel so alone and scared.

[I used to post as "ceeteefeebs," but my account was deactivated sometime after the switch to this new URL.]

Hi C

Gosh it sounds like you've had a lot to deal with. I don't have any answers for u, just my own experience. My fistula came about after I'd had LIS fir a fissure, so this could be the case for you? Then i had an abscess which then seemed to turn into a fistula. In terms of my fistula all i can see is a small hole a little way back from my anus....when it gets infected then it gets a head on it like a spot has. My fistula over the years has just been mildly uncomfortable when sitting and more uncomfortable cycling...but manageable. Ive only ever occasionally had a small spot of blood there, usually just a little gunk like pus. I know you're scared, but I guess your CRS, would be able to tell you what it is, then at least you know what you're facing, rather than trying o guess via the internet. Ive had a recent cutting seton for my fistula (after living with it for years), and before seeing my surgeon I got myself worked up with mis info on the internet. After surgery Ive been given the hope that it might be sorted in 6 wks. I hope you get the answers you need. Best wishes with it all. AA

Thanks so much for writing back! I've made an appointment with my CRS, but he won't be able to see me until the end of August. In the meantime I'll ask my gynecologist if she can order an MRI for me. I have a sinking feeling that I'm dealing with an infected/abscessed fistula. Your description of your abscess sounds exactly like what I'm dealing with. And it's weird because there are times where the lesion (for lack of a better word) is completely flat... red, scratchy, but flat. And then like *that* it inflames and fills with pus. It leads me to believe it's connected to a fistula tract. Ah, we shall see. :/

Can I ask you how you fared with the seton- how bad was the procedure? What was your recovery time like? If you have a separate thread about this, I'll check it out!

I'll admit that I'm very ignorant of fistulas and the procedures used to treat them. During the most hellish days of my fissure, I steered clear of the fistula page out of a medieval fear of "catching" one.

Hi Ceeteefeebs2 ... making the apt is probably the best thing you could do cuz if its a fistula the only way to get rid of it is surgery .... I had an anal abscess when drained turned fistula but i guess the odds of getting a fistula after having an abscess is like 50/50 they kinda go hand and hand ... My fistula would flare up kinda like yours but mine was like 3-4 inches away from my rectum so my track was very long. I had a fistulotomy and a seton placed which stayed in 6 wks ... everything is good these days and i had my seton removed on Jan 23 ... i was terrified of the surgery and actually thought i could of lived with my fistula on the good days but when the bad days hit i was in pain at levels of 8-9 on a scale of 10 ... most times i couldnt walk when it would flare up and then i would have to burst it to get releif ... the pain after surgery was nothing compared to living with the fistula ... even the seton wasnt bad it did kinda dig at my other butt cheek but i think thats normal .... its all a scary mess to deal with but in the end the only way to get rid of a fistula is surgery ... and judging by what you have already come through this would be a breeze for you .. keep us updated .. all the best :)

Hi C,

Yes I have written a little on this forum re seton..I dont know how to direct you there...but theyre on the list under fistula page. Ive only just recnet,y had the seton....lt Tuesday...so a week ago! I have a cutting seton....i have a low fistula and normally they would have done a fitulotomy, but since aive had an LIS before they wanted to make sure my continenece not conpromised, so they felt a cutting seton would be a safer bet for me. I still cant sit down yet, but the pain has lessened a lot over the week and i take painkilers just in the am at the mo, just before a BM....then Im fine for the rest of the day not need painkilers, just sit on my side, i'm off sick at the mo to take it easy and give myself a good chance to heal. With a cutting seton it eventually cuts its own way out and it heals from inside out, since my fistula is a superficial one they say it should only take 6 wks, so i am feeling very lucky to be in this position. Hopefully ive answered all your questions. Keep us updated and good luck. AA

Hi Ceetee, Hope you are well :)
It was evident I had a fistula when mine developed a few weeks after an anal abscess burst because I had a definite "hole" appear just outside my anal opening, which looked exactly just like that - an open head or large pin-prick almost, in the middle of a flat reddened area. Every few weeks the area would then inflame with the pus build up within and the opening would literally pus out all the gunk that built up over 2/3 days. Once this had passed through and cleared out, I would feel OK and then the cycle would start all over again. It wasn't particularly painful, nothing like a fissure, just sore and a bit uncomfortable as everything got inflamed all over again - more irritating and annoying because of the leakage, which I constantly dabbed to try and clean and because of all the antibiotics they kept prescribing me with a potential risk of infection. Surgery is the ONLY way to get rid of these and don't fear it! It is such a simple procedure with a pretty short recovery time. I would say it's great you are getting a second opinion because if this is what you do have and it's been caught early, they are so successful to treat (so much easier in my experience than a fissure!!) Once I developed the original abscess, which was far more painful than the fistula, I was literally monitoring a fistula development because I had read so much about them and bingo, as soon as it appeared, I knew what I was dealing with and got it treated within weeks........I was lucky, the tract was superficial and short and it was all gone pretty quickly...All the very best to you in dealing with what you have and hoping you get it all sorted pretty soon. Please don't worry about it though! Most fistulae are not that bad!!! :)