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Why does a fistula hurt?

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Crohn's Disease
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Posted 3/21/2016 9:45 AM (GMT -5)
From what I've read a fistula doesn't normally hurt. My perianal fistula was leaking pus a couple of weeks ago and then it stopped. When it oozes, it doesn't hurt and I'm relieved. Remicade hasn't started working yet. Now, it's hurting again. I keep soaking myself in warm water but it doesn't want to ooze the pus. It seems it's clogged what should I do? Should I see a colorectal surgeon? My GI used in the past whenever I had an anal problem to refer me to the CR surgeon. He didn't recommend this this time.
Posted 3/21/2016 9:50 AM (GMT -5)
Yes if you have a fistula or other rectal issues, you should be consulting with a colorectal surgeon. Do you have a seton in place? If not, the surgeon can place one and that may or may not help. My CRS said until my Crohn's is under control, there's nothing they can do for me.
Posted 3/21/2016 10:44 AM (GMT -5)
Rose*flo, thank you. My GI is against any surgeries. When I got an abscess 3 years ago, he talked to the surgeon and insisted I won't have any surgeries and put me on antibiotics until the abscess was claimed to be clear. He said that since I have Crohn's, any wound and a fistula, in particular, won't heal.
Posted 3/21/2016 1:25 PM (GMT -5)
Placing a seton is not a surgery. It would take the surgeon about 10 min. I had mine replaced durning my last colonoscopy. This will allow the area to drain so it doesn't create another abscess. if you have an active fistula, there should probably be a seton placed

Post Edited (Rose*flo) : 3/21/2016 10:36:39 PM (GMT-6)

Posted 3/21/2016 9:24 PM (GMT -5)
My fistula only hurts when it gets filled up with fluid.
A little pressure discharges the fluid and what little pain there is is gone.
My GIs said the same thing to me as well. No surgery because the risk for incontinence was too great.
Posted 3/22/2016 11:46 AM (GMT -5)
Rose*flo and Gypsyfp, thank you.
@ Rose*flo. I have an honest, skillful crs still he's rough in examining patients. He has to examine everything himself and doesn't accept all what scans show. I can't see him at the time being because my GI is traveling and tbh, I'm dreading having the fistula being examined.
@ Gypsyfp. I'll try to increase the sitz baths and hope the pus leaks out as there is pressure. Bith my GI and crs have warned me against having surgeries because of incontinence, too.
Posted 3/22/2016 1:49 PM (GMT -5)
Why does a fistula hurt...to get to the other side. The old chicken joke really does apply here. Think of the fistula as a bendy straw going between two places. If it fills up, there is pressure on the sides of the straw. That pushes against you internally so you feel the pain. If it does not drain, that pain can increase. Also, keeping all of that pus inside can make you feel lousy as you are basically holding in what I called "toxic sludge" in mine.

Now think of a non-cutting seton as a thread looped through the straw and tied at the end. The liquid in the straw is drawn out via the thread and the thread also keeps the end of the straw from closing ver...eventually the liquid runs out...it helps to have antibiotics along with this.

A non cutting seton is a minimal process. Mine was inserted under general anesthetic, but that was totally unnecessary. They were going to do it under a local??? I went from feeling like I had a bug and worrying about messy underwear...to relief. Over several months, I would visit the CRS occasionally and he would shorten the thread....because the "straw" shrinks as it heals. Mine fell out without my noticing at the end.
Posted 3/22/2016 2:15 PM (GMT -5)
Habs, thank you. I got your point and it is very cleverly portrayed. I like very much the idea of the straw. My GI is now travelling and I might be travelling soon, too. I don't want to do anything w/o his consultation esp. that he has warned me several times of the risk of incontinence. He thought of putting me on antibiotics but both flagyl and cipro cause me problems.
Again, I don't know how much expertise does the CRS have though he is a professor and one of the well-known ones. A friend's husband who lives in Australia warned me too against having any kind of surgery.
I'll try to pluck up courage and go and see my CRS; his digital examination is very painful.
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