Embarresing fistula moments

As I discribed earlier I have a Perianal fistula as a symptom of Crohn's. The most common medical term is a fistula in ano. I have to say it embarreses me everytime I hear or have to say that name. When people ask me what it is I have, I tend to avoid the 'ano' part. I just say I have a fistula. To people more close to me I say I have a fistula in my butt. I don't feel like I'm lying, because it is in my butt, just somewhat closer to my ano..

The first time I had to call in sick for work because of this (and before I knew it was a fistula starting as an abscess) I really had to think hard of what my reason for calling in sick was gonna be. The real reason was that I had so much pain in my ano that I could barely sit. And I work at an office, so sitting is what I do most time of the day. I decided to tell the truth because that usually works best. I think my boss thought it was a little bit strange. My colleagues soon started to make jokes about me maybe start using a inflatable duckring. Funny guys;) I don't mind that type of jokes, if someone I know told me they couldn't sit i'd probably make the same kind of jokes.

I don't like people to see me naked. I started to lock the bathroom door when I was 12 years old and only my boyfriends have seen me naked. I even avoid sauna's because of this. Don't ask me why, I just do. It's not that I dislike my body or anything, I just don't see the point in walking around in your naked butt. When you have a fistula in ano, that whole I don't want anybody to see me naked part becomes kind of a problem.. It seems like everytime I have to visit a doctor they want to see my butt! The first times this felt really uncomfortable, but when your in so much pain, you actually forget the whole showing your naked butt thing. If I had to count I think about 100 doctors and (home)nurses have seen my butt and I can keep counting. I've gotten used to it, and actually I'm kind of proud of my butt..

It's not only my butt. When your in the hospital, you're privacy is gone. Sometimes I was to weak to take a shower so a nurse would wash me in my bed or a nurse guided me to the shower and stayed there to help me take a shower. And although this also was something I had to get used to, I was actually glad they helped me taking a shower. I forgot about beeing naked. So in the end, this stupid fistula has helped me get over the whole naked thing and I am proud to say I'm not scared of sauna's anymore:)

What I can't get used to is when they have to feel or look inside my ano thing. I know it's just a hole, just not the hole I want people to take a look at. It's not pretty or anything, I don't know.. For a doctor an ano is probably just as normal as a finger or something, at least that's what I keep telling myself. It just keeps beeing awkward. One nurse told me I should kinda be glad they can operate on me through my ano, otherwise they would have to make cut's in my belly. I guess I'am glad that they don't have to scar me anywhere else besides the open wounds on my butt. I have this friend who wants to get pregnant for a long time and somehow she just can't. She told me that numerous doctors have taken a look inside her virgina. We weren't really sure what was best, haha.. I guess we just deal with it and hope all this hole peaking will help in making us better.

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.

My story: abscess

August 2011

It started with pain in my butt. It was difficult to sit and my bowell started to hurt. It was such a discomfort that eventhough I didn't really want to, I had to go see my doctor. He told me he had to feel on the inside of my butt, exactly the reason I didn't wanted to go to the doctor;) But the pain was so bad, that I thought: well just do it then and make me better. He said I had a fissure that was causing the pain. I had to use a ISDN cream that gave me a terrible headache and in about 3 weeks it should be healed.

After 2 weeks the pain was still the same, so again I went to the doctor's office. This time I had a female doctor who thought it might be hemorrhoids and my IBS (Irritable Bowle Syndrome), so I had to take pills and it would all go away. But again, the pain started to increase.

The third time I went to the doctor I was asked if maybe I was depressed.. (?!!) Yes ofcourse, I'm imagining the pain, just crave for attention and I just love people to stick their finger in my butt.. No, I'm in a lot of pain! She said it maybe was time to make an appointment for me at the hospital to have a better look inside my rectum, I was scheduled for 2 months later! How was I suppose to do that? I couldn't sit, couldn't go to work, had so much pain and was feeling sicker and sicker. I started to have a fever and a couple of days later felt a bumb in my butt, near my rectum. So I called the doctors office again, and the doctor said: 'oh am I glad you're feeling a bumb, because that's how I know what it is now, you have an abscess. Just wait a couple of days because it needs to grow ripe and then I can make a little hole in it and drain it'.

Hmm.. Oké an abscess, that sounds gross. Especially the riping part. Like I have a big pimple in my butt that they have to squeeze out.. But it also meant that I finally knew what was causing all this pain!:)

However, in the following days my fever started to rise and my mom was really worried about me. She went to the doctors office and talked to another doctor about me. That doctor wanted to see me at the doctos office the same day. When she saw me, she told me she could tell I was in a lot of pain for a very long time. And while she said that, I broke down and cried. Finally someone who believed me.. She told me I had to go to the emergency room of the hospital immediately.

So I called my mom and dad and we were in the emergency room about two hours later. A very handsome assistent-surgeon first had to feel on the inside of my butt (ofcourse:-/) and than stuck a needle in the bumb. There was no pus coming out.. He walked out of the room and came back with another surgeon. She also stuck a needle in the bumb and pushed really hard. Oh that hurt so much! She did manage to get pus out of the bumb. So yes this was a fully ripe abscess an they told the nursus to prepare a surgery room, because they were going to operate on me to drain the abscess. Huh? I guess I looked kind of shocked when they told me this.. I only had a surgery ones, and it's not like my favorite thing to do..

After that it all happened so fast. I had to go to anesthetics first. There they told me I was going to have an epidural, which I didn't liked. I wanted to be very much asleep during surgery. But that was not up for discussion. First of all, I ate a cracker 3 hours earlier and secondly the pain reduction after the surgery works much longer because half of my body would be numb for a couple of hours.

I had to check in to the hospital, they showed me my bed, got my nametag bracelet, like I was checking into a resort. And I had absolutely nothing with me. I was still wearing my dress and high heels, haha..

Then they wanted to make an echo to see the exact size and location of the abscess. When they made the echo I was also able to look at the monitor. On the screen I saw a lot of white clouds. The man who was making the echo stopped and seemed very worried. I'm not a doctor, but even I could tell this wasn't just a tiny abscess. The abscess had the size of an orange and the whole area around it, till my bowel was infected. The surgeons didn't want to take any risk and therefor also wanted to make a MRI before operating on me. I was scheduled for the MRI the next morning (I will tell you more about MRI's in another post). A surgeon came to my hospitalbed with the result of the MRI and told me it was going to be a difficult surgery because it was near my sphincters. If they were to make any mistake I could become incontinent. What?! He told me he could try to drain the abscess that day or I could wait a couple of days because there was a female surgeon specialized in this kind of surgeries. She was going to be at the hospital 4 days later. Ofcourse I wanted to wait, I've managed the pain for more than a month so 4 more days shouldn't be that hard. It was like making a decision between diapers and pain. I choose pain. He also told me I could choose to stay in the hospital or wait at home and come back 4 days later. Because of my fever and all the bacteria in a hospital I went home. The appointment with this specialized surgeon was scheduled for the next tuesday.