What is a perianal abscess?

First of I will start by telling you what an abscess is: an abscess is a collection of pus. It has some resemblance with for instance a pimple. Except an abscess can grow really big and it's more like a capsule filled with pus due to an infection process. It can be caused by an infection, bacteria or even a splinter.

And what is pus? I know this can gross some of you out, but I really had no idea what I had to picture myself when they were talking about pus. In my mind it had some resemblance with the white stuff from pimples. Don't worry I'm not gonna show you any pictures (you just youtube 'abscess drainage' and you know why not;)). I think I can describe pus best as a light pinkish milky fluid with a particular smell that I recognize immediately.

Back to the abscesses.. As I said earlier I have had several perianal abscesses.

A perianal abscess can be formed when for instance a hair has grown into your butt and started to infect. It can also be caused by an anal infection, fissure or STD. I've had three male hospitalroomies with an abscess due to ingrowing hair. That's the most common abscess. That's also why more men than woman have abscesses. My abscesses are caused by the fistula as a symptom of Crohn's.

When you have a perinanal abscess you start to feel a horrific pain in your ano, in your butt, near your butt, etc. Especially when you sit down or walk. I once asked my surgeon why it hurts so badly, I mean, it's in my butt and that's mostly contains fat. How can something in fat hurt? She told me, that it hurts simply because the abscess creates a whole in a space where there's no space to make a whole. It keeps growing and growing, trying to make a way out. And that way out is usually the skin on your butt. That's when you start feeling a bumb. Besides the pain you can start feeling sick, get a fever, chills and the bumb can turn red.

Sometimes an abscess can burst by itself. But most of the time you really have to go see a doctor who then will drain the abscess. With a 'simple' abscess it can be done without any anesthetics. I've read blogs with people telling they just drain an abscess themselves. (Un)fortunately my abscesses can only be drained in the hospital by a good surgeon.

As soon as the abscess is drained you will feel the worst pain is gone. What's usually left is the pain of the surgery itself. You will come out of the surgery with an open wound. When the abscess wasn't to deep you can leave the hospital the next day. They will probably let you choose between taking care of the open wound yourself by showering the wound twice a day or get homecare. Homecare means that you get a nurse twice a day who will clean out the open wound with (salty)water. The nurses will use a drain or catheter to get into the wound so it can be flushed properly. I've had some bad experiences with the catheters and flushing because it just kept hurting so much. Eventually they gave me a morfine injection half hour before they were gonna clean the wound(s). When the wound is cleaned you get a bandage that will protect the wound from outside infections.

Sometimes they also use gauze that they will stuff into the open wound, just to keep it from closing. When a wound is still not infection free when it closes you will soon be having another infection. The problem with gauze is, that it has happened numerous times that someone forgot to take it out while taking care of the wound. In that case the pain will increase and the wound will get infected again. I've had that ones, omg that started to hurt after a few days, after that my surgeon decided not to use homecare anymore but wanted me to shower the wound myself.

I've also had surgeries were they drained the abscess and left the wound open with a drain in it. I guess it's different each time depending on the place, severity and size of the abscess.

In my experience the open wounds will heal in about a month, depending on the size. With a drain and all inside it takes longer. I still wasn't able to sit for a long time, but that's because my fistula keeps producing pus and the wounds can't heal properly.