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Dr. Andrew Rynne

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Suggest remedies for an abscess in the anus

Answered by
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Dr. Ramesh Kumar

Gastroenterologist

Practicing since :1986

Answered : 1958 Questions

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Posted on Mon, 3 Apr 2017 in Lump
Question: Hi Doctor,

I am 31 years old male. I have a small a abscess in my anal region for almost a year. I had a consultation with my general physician he thinks it's a peri anal fistula. I have been having pus drainage from that abscess every now and then but it is not really hurting. However in my country's medical rule I have to wait for 12 to 18 months to actually get a surgery for this. I am concerns about the possible complications if I waited that long. Could you advise ?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Complications in detail.

Detailed Answer:
Hello,
Thanks for posting your query on this forum.

Before coming to complications i would like to give you a briefing about what is pus and what does it indicate,This will help you to understand the intensity of your problem better.Pus is a thick, whitish to yellowish material composed primarily of dead cells that generally forms as a byproduct of bacterial infections. The inflammatory cells that participate in the body’s immune response at the site of an infection eventually degrade and die, creating the substance known as pus. When pus forms within enclosed spaces in the tissues, it causes abscesses.Formation of pus with pain indicate active bacterial infection.Agony is that antibiotics are not effective if pus formation is there.Only thing which can help apart from surgery is Draining pus regularly from abscess.

Anal fistula is a chronic abnormal communication between the epithelialised surface of the anal canal and the perianal skin,In a lay mans language it is breach of external skin and this breach results in direct communication of your anal canal with external enviroment and pathogens.It can be a potential source of infection if left untreated.Its just like a open wound where skin is breached this break in the skin provides a route for the germs to travel from the outside to the inside.
Even the pus inside the fistula can spread further leading to formation of multiple tracts and several opening in the skin around the anus. This makes the fistula more complex and further difficult to treat.
There is a risk, though low, of cancer formation in the long standing Anal Fistulas. Therefore, Fistulas should always be treated at the earliest.
If some how the bacteria's come in contact with blood this may result even in life threatening condition like Sepsis also.Mortality rate of patient landing up in shock due to sepsis is as high as 90%.

I hope i answered your query well,Feel free to ask follow up questions.

Regards.

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 36 minutes later
In my country the only option I have is to wait for atlest 12 months , I do have a option of coming to XXXXXXX for treatment but I am still looking at 2 months of wait time. Could you eloborate on how I can handle/maintain this abscess till then ? Also What is the possibility of sepsis with in this wait period is there any symptoms that I can watch for ?In other words what should I do with this period so that I don't complicate this fistula into multiple fistulas or sepsis.
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi XXXXXXX
Canada is a poor nation when it comes to medical sciences,I can understand your problem,

As per your query,
Pus should be drained out regularly if possible every alternate days.
Mupirocin antibiotic should be used twice daily locally over the area.
Proper hygiene should be maintained,Any oozing pus etc should be cleaned up immediately.
Any broad spectrum antibiotic like Cefixime should be taken in low prophylactic doses as adviced by your gastroenterologist.
Try to take a healthy diet,Immune booster and natural anti oxidants should be taken regularly to boost immunity.
For pain analgesics can be taken as and when required.
Abscess area should be cleaned with Betadine solution daily.
As long as an abscess is drained adequately and the correct antibiotic regimen is prescribed, the abscess will heal well and resolve.
Take vitamin C and folic acid supplements they promote wound healing.

As per your query regarding sepsis,It can not be calculated,Its a matter of chance.Naturally bacreia's can not enter our blood vessels because of presence of natural barrier lining vessels but if some how pus or bacteria comes in direct contact with a bleeding mucosa or injured vessel it can infect blood and cause sepsis.
So this is something which can't be predicted.
In case you have other query feel free to ask.
Good luck.
Regards

Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 34 minutes later
Thanks for the detailed advise doctor.

1) so far , I was only examined by a general physician and I am not even sure I have fistula or not. But for a fact I have an abscess for a year now. Do you think it could have been a fistula ? or what testing should be done to determine that it is an anal fistula?

2) Is surgery my only option ?

3) I have been doing weight lifting for more than two years. Do you think is it safe for me to continue doing weight lifting ?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Follow up answer

Detailed Answer:
Hi,
Physical examination by atleast a Surgeon should be done to see if its a fistula or not.Please post a small video or high resolution clear photos for any professional comment,It can be pilonidal sinus also so i need to see photos(atleast) before giving you a differential.

Physical examination by a Surgeon should be done to diagnose it as a fistula.


Yes according to guidelines of modern medicine surgery should be done.However many alternative therapies claims to provide beneficial results however documented proofs are still lacking.

Yes exercises and weight lifting can be done.

Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 21 hours later
Hello Doctor,

I have uploaded the pictures of the abscess please let me know what you think it could be.
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Its a peri anal fistula.

Detailed Answer:
Hi dear,
Its a perianal fistula.
In case you have any other query,I would be glad to help.

Regards
Dr Kumar
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 43 minutes later
ok what testing should be done to detect the fistula track ? Would be surgery be performed under local or general anesthesia?

For the past 3 days I have been feeling a pricking sensation in my anal canal, Could it be a fissure ? Is there a medication I can take for this ? Also what is the possibility that I may have a crohn disease ?Also , after the surgery what is the reoccurance propability?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi again XXXXXXX
As per you query answers are-

1)CT- Fistulogram is a easy test to find the course of fistula.A radioactive XXXXXXX is injected and Scans are taken by CT machine,Track of fistula can easily be seen in this procedure.

2)MRI is the method of choice for evaluating perianal fistulae due to its ability to display the anatomy of the muscles , with high resolution contrast.

There are various types of surgeries for fistula,However all of them are done under General anaesthesia.

Most likely the pricking sensation is becuase of infection and inflammation caused by fissure.
Yes Aceclofenac with a combination of Serratiopeptidase can be taken twice daily for few days along with a antihistamine like Allegra for symptomatic relief.

Crohn's disease is very unlikely as patient usually present's with initial symptoms of refractory loose stools,along with severe abdominal pain and cramping associated with apthous ulcers.However you have not mentioned any of the above mentioned symptoms,Therefore it being because of inflammatory bowel disease is highly unlikely.

After surgery recurrence rate is as high as 20-30%,Depending on the type of surgery your surgeon is opting.

In case of any other query,Feel free to ask.
I hope i answered your query well.

Regards,
Dr XXXXXXX

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 20 hours later
Hi Doctor,

if I understand correctly there are many types of anal fistula right ? How serious would you classify this peri anal fistula ? Would the track be deep for this ? As you saw in the picture there are two abscess adjacent to each other , after the surgery what would be the healing time ? Also do you recommend to get the surgery done by a colon rectal specialist or a general surgeon would be able to do it ?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello XXXXXXX
Yes there are many types of anal fistula.
As already told either a MRI or Fistulogram should be done to classify the fistula.Seriousness can not be predicted without knowing the path of fistula,Its origin and termination..The only way to see the path is MRI or Fistulogram.I can't make any comment on the deepness of path because neither i have examined you physically nor Has any radiological test been done on you,So just by seeing two photos no one can predict the path or seriousness.
Generally performed surgery is fistulectomy.Cances of Fecal incontinence post surgery due to Fistulotomy is the most effective treatment for Closely located anal fistulas.Healing would take about 5-7 days along with medications.
Fistulectomy can be done even by General surgeons however if colorexctal surgeon is available its always better to go for them as they have exclusive training in these operations only.

Thanks.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 2 days later
Hello Doctor,

I am deciding to get the surgery done in XXXXXXX I have came across VAAFT treatment which clams minimal incision. What are you thoughts about it ?
Appreciate your opinion in this.
doctor
Answered by Dr. Ramesh Kumar 5 hours later
Brief Answer:
Follow up answer.

Detailed Answer:
Hi,
Good to hear from you,

Yes VAAFT is safe, feasible, day care, painless procedure with promising results in short term follow up.However long term studies are still required.Success rare is almost 97%,Recurrence rate varies from about 10-15%
post operative.
However as you are comming to XXXXXXX you can also go for Kshara XXXXXXX sugrery.

Its also very promising surgery

Regards.
Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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Follow up: Dr. Ramesh Kumar 22 hours later
Thanks Doctor,

Is VAAFT recommended for both low and high fistulas?
Assuming if I have low fistula, based on the track record of the surgery and sphincter damage which surgery would you recommend?
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
follow up.

Detailed Answer:
Hi
Dear yes it is a painless and very safe surgery and you will be dischraged om the same day of surgery.
In case if its low fistula i would recommend you to go for fistulectomy.

Regards
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Ramesh Kumar 47 hours later
Dear Doctor,

Thanks for your response.

Do you have any recommendation about any surgeon who can do fistula surgery in XXXXXXX surgeon who can do VAAFT is ideal as a worst case preparation. Preferably in XXXXXXX or XXXXXXX
doctor
Answered by Dr. Ramesh Kumar 1 hour later
Brief Answer:
Follow up answer.

Detailed Answer:
Hello again,
Medanta the medicity is a world renound centre in New XXXXXXX
You can contact Dr Adarsh Chaudhary.
Good luck.
Hope you get well soon.
Above answer was peer-reviewed by : Dr. Kampana
doctor
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