Enemas for treating abscesses / fistulas

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*Phoebe*
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Date Joined Sep 2005
Total Posts : 769
   Posted 3/13/2009 4:29 AM (GMT -7)   
Hi everyone, I hope you are all well.

In November of last yr I had a hellish experience which I now know to be a peri anal abscess. It took weeks and weeks, and many courses of ineffective antibiotics before I ended up in the ER and spent close to a week waiting for the stupid thing to burst. I was treated ‘conventionally’ as the doctors did not want to cut it unless necessary for fear of further damage/infection or incontinence
The abscess burst through just hours before my scheduled surgery and now I have a fistula.
I have been on flagyl for a couple of months now and thought it was doing the job of keeping the abscess under control. But over the last couple of weeks the pain has been slowly growing, until today, the 2nd day at my new job, it was unbearable. I had to take 3 lots of neurophen (codeine) and even then I was still wincing and limping in so much pain – normal paracetamol doesn’t do a thing.
When diagnosed with fissures I was prescribed a steroid enema which seemed to help bring down inflammation a bit and so I am going to try and get another one of those hoping it will help.

I am worried the abscess is re-blocked – when I push on the fistula stuff comes out – but only very limited amounts, it used to be a lot more ‘free flowing’ – and I feel like there is a hard mass under the skin. And the stuff that comes out is blood/pus. I don’t know whether the pain I am having is due to the abscess/fistula or a fissure – I have a small tear in the skin above the fistula, which causes a lot of pain also. Maybe it’s a combination of the two.....

My question is: how do you get relief from or cure these issues? (Apart from sitz baths which in know well). I have used a liquid (salt water) enema before and used one again tonight hoping it would ‘flush out’ the fistula passage/abscess. It was excruciating and stung like hell, but maybe that’s a sign that its flooding it out and that’s a good thing? Does anyone use liquid enemas for relief from abscesses? If so, what do you put in the enema bottle? Do you use hot salty water?

Thanks all, I hope you can shed some light on this awful problem for me – I know I can’t keep dosing myself up on pain killers, and they only slightly dampen the pain anyway. It is excruciating and makes me pretty much immobile. I am petrified it will get bad again and I will end up in ER – just started a new job 2 days ago so cannot afford for this to happen.

Many thanks,

P

chroniemomx2
Veteran Member


Date Joined Apr 2005
Total Posts : 2346
   Posted 3/13/2009 7:28 AM (GMT -7)   
I have a seton in my fistua and have not had an abscess since. The seton keeps the fistula track open and draining, so an abscess can't form. If you have the seton put in on a Fri. (it's an outpatient procedure), you will be fine for work on Monday. I would call your colo rectal surgeon immediately.

FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 3/13/2009 1:48 PM (GMT -7)   
Hello Phoebeskye,

I am so so sorry you are experiencing this!! I experienced exactly what you are describing. My abscess hadn't healed because my first doc didn't treat it properly (he didn't know CD). It sounds like the abscess has not healed and needs to be taken care of ASAP. And you need antibiotics.

ER doctors may not have the experience you need. It is typical to treat an abscess by draining it and flushing it out. But that may not work for CD people. I strongly suggest you see a colo-rectal surgeon who knows CD as soon as you can. He/she may find that the abscess is small and just a seton will do -- just like Chroniemomx2 said. If that won't do, he may have to open it up in the OR. It will take time to heal but it will be GONE!! I am sorry that this could impact your job. But please, please your health is more important and you want to get rid of this BEAST for good!!

If you don't have colo-rectal surgeon, try calling your GI's office. Ask them to help you get an appointment ASAP. If they call, the surgeon's office will get you in (its called professional courtesy).

Please let us know how you are doing!
Diagnosed with rectal Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


Trigirl
Veteran Member


Date Joined Jan 2006
Total Posts : 768
   Posted 3/13/2009 3:52 PM (GMT -7)   
I had the same problem and had the surgery. it helped and was such a relief but did get incontinence that is lousy to have. Guess you have to weigh the options but do something ASAP. That much pain killer can't be good! God Bless and hope you are feeling better soon.

*Phoebe*
Veteran Member


Date Joined Sep 2005
Total Posts : 769
   Posted 3/13/2009 6:41 PM (GMT -7)   
Hi everyone thanks for the replies. I just found out my dog died this morning too, to make things even worse. All night I was in pain, but this weird thing; Blood kept coming out, lots and lots of it. I’m not sure if this is a good thing or a bad thing; good I guess that SOMETHING’s coming out, but why blood?? Where would that be coming from? Sometimes its thick, sometimes runny....
I don’t have a colo rectal surgeon, and its Saturday now so I cant call my gastro. Unless I call his mobile but he is an incompetent specialist and most of the time I cant even understand him through his bad take on the English language. The first time I saw him with an abscess he didn’t even look at it, just said ‘aww you have a sore bum??’ and sent me home with another round of antis that didn’t work.

Trigirl, what kind of incontinence do you have now? Everyday loss of bowel control?

I’m spending my whole weekend lying down in bed, very depressed

ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 3/13/2009 7:21 PM (GMT -7)   
(((Phoebe))) I'm so sorry about your dog.

I did write you a proper reply earlier this morning, but for some reason it didn't appear on the forum (weird, yes?).

It sounds to me as if you have been stranded in a shonky suburban system. My feeling (inexpert, and from the other side of the country) is that you are being undertreated, that you need to be plugged into some specialists who actually have some expertise in severe Crohn's, and that your own gastro is not willing to pass you on to a better doctor. My feeling is that it may be time to take matters into your own hands, and find those specialists for yourself.

Anyway, Phoebe, where are you this morning? Are you at home with your parents, or in Brisbane? If I lived in Brisbane and were in your situation, this is what I think I'd do:

* pack a bag and leave it with someone who can bring it to you later if you are admitted to hospital
* check your own wallet and make sure you have your Medicare and HCC cards and medical details with you
* shove a Walkman, some menstrual pads (for the blood) and a book and a few other essentials in a backpack
* go into the centre of town, as if you were going there for fun, to see a movie or something
* succumb to the pain, or feel extreme concern about the blood that you're discharging (and yes, I think you shoud be concerned: something's obviously going on)
* take yourself to the Emergency Dept of the biggest and best teaching hospital in Brisbane and beg for help. I'm not talking about a little suburban hospital here, I'm talking about a big hospital that is connected to the medical departments of your universities there. It should be big, they should have a lot of specialists, and, most importantly, they should have many colorectal surgeons on staff.

NOBODY can criticise you for doing this or for bypassing your real doctor or hospital. You were in town, you needed help, you went to the nearest hospital. Once you're there, you can tell your surgeons that you need their help and maybe another / better gastro attached to their hospital, if that's what you want. Either way, you stand a good chance of getting the help you need, now, instead of having to wait until next week (or later) to see your own doctors. It's miserable being stuck without help and in huge pain.

I really do think you should go to hospital, Phoebe - not your own; a better one. I think you need a lot more help than you're being given at the moment. At the very least, you need some better pain management, but it does sound to me as if a seton or something simiilar might be needed too.

***hug***

Ivy.
Co-Moderator Crohn's Forum.


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 3/13/2009 7:34 PM (GMT -7)   
ps. Here you are, I just did a quick Google. There's at least one colorectal surgeon who works at the Royal Brisbane Hospital, and he runs a clinic on Mondays. http://www.davidclark.net.au/appointments.php

Princess Alexandra also sounds as if it could be a good bet.

If you got yourself admitted today, you could see the registrar or whoever over the weekend, and maybe be operated on very early next week, and back at work soon after... That's *if* they decide to do surgery, of course.

In saying all of this, Phoebe, I must stress that I've never been to Brisbane so don't know it well. If you do decide to go to hospital it would probably be best to follow your instincts... but, that said, please do try to get yourself to the very best hospital possible. It sounds to me as if you need expert assistance, not just an ordinary doctor or a general surgeon.
Co-Moderator Crohn's Forum.


FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 3/14/2009 7:48 AM (GMT -7)   
I totally agree with Ivy!! A big teaching hospital is a great idea!! They will have specialists or will get one for you!!!

It is good that it is draining but a lot of bloody drainage means the abscess is big. This really needs to be taken care of ASAP!! I remember all too well how "toxic" I felt with a big, bad abscess. I felt weak and depressed and didn't even want to move. But then I realized that it was all because of the #$@%! abscess and I hated it and getting rid of it was what I needed to do before it got worse (it nearly went septic -- which can be life-threatnening). Don't underestimate how sick an abscess can make you. And no apologies needed for going to a big teaching hospital for help.

Please go!! You will feel so much better!! Soon it will be GONE and healed and you can go out and play!!
Diagnosed with rectal Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


ivy6
Elite Member


Date Joined Sep 2005
Total Posts : 10404
   Posted 3/14/2009 3:57 PM (GMT -7)   
... And, Phoebe, the good thing about having surgery is that it sounds very impressive. No employer can reasonably condemn an employee who is away because she had to have some emergency surgery.

Ivy.
Co-Moderator Crohn's Forum.


crohn's pt mom
Regular Member


Date Joined Nov 2008
Total Posts : 86
   Posted 3/14/2009 7:07 PM (GMT -7)   
my daughter is in the hospital right now.  She had a drain put in in July - then taken out  and put back in in October then in Feb this year they did a vigorous irrigation of the whole abcess but that did nothing.  She can't take Flagyl it makes her stomach sick.  Thurs her GI told her to go directly to the ER and had the GI fellow and the colo rectal surgeon ready for her.  This time they scraped it out and packed it with something.  Both the surgeon and the covering GI said the best thing for her is whirlpool bathes.  No one mentioned it before.  She is still in excruciating pain but we are hopeful this is the answer.
 
Don't let yours get bigger or worse - do whatever you have to.
 
Has anyone else been told whirlpools are good for perianal abcesses?

FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 3/15/2009 5:13 AM (GMT -7)   
Hi Crohn's pt mom,

Sitz baths are recommended by good doctors. Actually sitting in a tub in hot water for at least 10 minutes several times a day. It helps the blood get flowing and healing. I suggest using a hand-held shower sprayer to clean out the wound after every toilet use. It is a gentle way to completely clean up and you don't have to use toliet paper. I straddle the side of the tub and spray out the wound. I still do it today (even though my wound is healed) to clean up around my setons.

Drains may work sometimes, but opening up the abscess and scraping it out really works. If the wound is large, it will take many weeks to heal, but then it wil be gone. Done!

I'm praying the pain will subside soon and this is the end of her problem!!
Diagnosed with rectal Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 3/16/2009 6:47 PM (GMT -7)   
Hi phoebeskye86,

How are you doing??? Just worried about you!
Diagnosed with rectal Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


*Phoebe*
Veteran Member


Date Joined Sep 2005
Total Posts : 769
   Posted 3/17/2009 2:38 AM (GMT -7)   
Hi everyone, sorry its taken me so long to get back to my post. i went to the chemist on Saturday to get a repeat of a steroid enema, and found there was a GP located in the chemist. I made an appointment and after nearly passing out waiting in the waiting room, I was taken to the treatment room where the nurse had a look and confirmed I had an infection..... the doctor had a look next and packed it for me. He said it is already draining which is a good thing, and prescribed me a penicillin-based anti biotic, and told me to take it with 3 flagyl a day to bring down the inflammation. He said if there was no improvement by Monday to go the hospital. I was so scared I would have to, not just for my fear of hospitals and the experience I had last year being stuck bed bound for a week in a tiny room, but I just started a new job last Thursday and being who I am I was desperate to make a good impression – at least for my first week! The thought of calling in sick after two days was too awful! So on Sunday things seemed a little better, although I was still feverish and in a lot of pain, on pain killers constantly and whenever I tried to push the abscess to drain it I felt like I couldn’t breathe, it was poisoning my system and making me seriously unwell.
It took SO much strength to get myself to work on Monday. I thought I was going to throw up. I took a sitz bath in the morning for ten minutes and afterward quite a quantity of red runny blood came out of the fistula hole, and (this is going to sound really gross: warning) – it smelt bad – like it was infected liquid.

Things today are still definitely tender and I have had to take strong pain killers constantly, to get through the day....... I also took a prednisone Monday morning and this morning to help me through. I know it sounds so stupid to push myself so hard, but this is so important to me. I know I should be putting my health before everything else but this is just the kind of person I am I guess..... desperate to make a good impression with my new workplace and I didn’t want any one finding out about my crohn’s or my abscess....... I did let them know I had been sick all weekend in case I needed to leave work early. It was so tough, and it still is, I don’t think I could have done it without the prednisone.....

Honestly I am just taking it one day at a time at the moment. I know I have to find a new gastro to go to (my current one is hopeless) – so hopefully I can locate one in the city but I have no idea how to go about getting a new gastro, I don’t know if I’ll need a referral from my old one? And I also want to find a coro-rectal surgeon, because my gastro hasn’t even LOOKED at this abscess yet, he obviously is completely clueless about them. I mean he said we would just ‘wait and see’ how many times it became infected before he referred me to a surgeon? That is just too cruel! But I guess I can’t expect him to understand since I bet he’s never had to deal with the pain of an abscess, let alone how sick they can make you. I mean I wasn’t even strong enough on Saturday to shake my enema bottle..... I fell asleep in my car once I parked it at home because I was so cold from fever and so tired. I couldn’t hang my washing out and I almost passed out just going to the toilet. I’m only 23 this shouldn’t be happening to me.

I hope the week will see it improve further and god knows what I’ll do after that...... I’m just trying to take my mum’s advice and take it one day at a time......... this job is important to me because I need that sense of direction, having crohn’s is depressing enough without enabling it to hinder my life. I know I push myself way too hard but I do think its part of my nature. What I really need to do now is get my medical attention in order and find a GOOD gastro and a GOOD surgeon. I like the idea of having a seton and some kind of long-term treatment for this blasted thing. My gastro hadn’t even heard of a seton before!

FallColors
Veteran Member


Date Joined May 2007
Total Posts : 1220
   Posted 3/17/2009 5:53 AM (GMT -7)   
I am really concerned for your health. I am glad you are on flagyl because it is good for the type of bacteria found in the rectum. But it won't heal the abscess. The fever, pain, and weakness are serious signs. You need to take this seriously. We all wish abscesses would heal on their own, but they just don't. You need to take the doctors advise and go to the hospital. Please read Ivy's advice above about which hospital to go to.

I know you are wanting to save your job. The bad thing about this illness is sometimes we are forced to let go of situations in order to seek medical help. The job may end -- but it may not. You don't know that it will. I'm sure they have experienced other times when brand new employees had to go out on leave. I know of two such times and they didn;t loose they job. Your bosses will know that this is not your fault. They are people too and hopefully they will have compassion. You can make a good impression on them when you return healthy -- propably better than you are now because I'm sure you can't be performing at your best with such an infection! Please, please let the job situation deal with itself -- tell them you have an emergency situation and must go to the hospital now.

Take care.
Diagnosed with rectal Crohn's in early 2007.  Several peri-rectal abscesses and two fistulae with setons.  Allergic to Remicade and Humira.  Currently on 6MP, and vitamins D and B-12.


*Phoebe*
Veteran Member


Date Joined Sep 2005
Total Posts : 769
   Posted 3/17/2009 3:50 PM (GMT -7)   

The inflammation is right down today and I am functioning without the help of a steroid – I know it seems stupid from the outside in but I would be so miserable if I had to go into hospital right now when I’ve only just started this position. Call me stubborn but I am not willing to give up a normal life…. I will see my gastro as soon as I can and get a referral to a colorectal surgeon. But I cannot give up on my hopes of a career – leaving this job to go into hospital would make me lose all sense of purpose and I cannot function without that. I can’t just pick up and leave and pack a bag and say ‘they can just deal with it (at work)’ because that’s not the kind of person I am. I will try my hardest and just keep hoping that these antibiotics will momentarily give me some quality of life back – and then I will see my GI and take time off work to see a surgeon – not to go and lie in a hospital bed for a week waiting for surgery like last time. I know they would be understanding but I don’t want anyone’s sympathy – I just want a normal life like most 23 year olds.

 

I know this is very difficult to understand but I cannot just pick up and leave at this moment. Maybe my priorities are not right but I am doing what I feel will make me less stressed – because picking up and leaving this position (which had hundred and hundred of applicants and they chose me after careful consideration) would leave me stressed and depressed – I honestly think I would have a break down if I had to go into hospital right now. I mean even if I’d been in the position for a month, they would at least have the chance to get to know me. The inflammation is down today so if I went into hospital they would be asking why – I think what I really need to do is see a surgeon about a long-term solution to this problem.

 

Ivy – I’m sure you’re right with the hospital situation – if I ever need to run to the ER again I will try the PA – I’ve heard it’s very good. The QE2 was good too, but I don’t know much about these things so any medical treatment to me is a blessing!

 

I know I am so stubborn – but I am very independent – I live alone and away from my family and struggled through university being poor and being diagnosed with crohn’s – and I am never one to ‘give up’ easily – hospital for me is always a last resort – I just hope I can see a colo rectal surgeon asap.

 

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