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anal fistula
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anal fistula

Well where do i start.
I was diagnosed with crohn's disease when i was about 6, i had my first operation to remove pollips from my colon.This continued twice a year till i was about 17.
Some pollips were removed and found to be malignant.
My doctor recomended that my entire colon be removed, they would connect the smaller intestine straight to my anal pouch.This would have had to be reconstructed.
I went through the whole ordeal,(colectomy) they constructed what i think is called an "H" pouch at the anal area, i also had an external bag that would have to be drained regularly but it was removed about 3 months after the main operation.
I have recovered fully but on the flip side now go to the toilet about 6 times a day (basically 1 to 2 hours after every meal).

However i developed a peri-anal-fistula about 2 years ago.I had gone to doctors and they assured me (THEN) that it would go away after a while, ive been back numerous times - all they do is put their finger up my rectum fiddle around - and thats it !!!! - It's been more than 2 years now.

I dont know what to do any more - i walk around 27 / 7 with a pad as the fistula constantly drains fluid. Sometimes it is difficult to walk or even sit down because of the inflamed scar that is constantly wet.

I think it affecting my sexual drive aswell as i find it painfull sometimes to have sex or when i ejaculate.

Please help SOMEONE ......... ANYONE - any thing will be helpfull
Thank You
Related Discussions
303398_tn?1193102884
These are difficult problems. The plug with fibrin glue is a great treatment because it is reasonably inexpensive and noninvasive.   But as detailed in the thread above, recurrence is a big problem.  I agree with Stan--- to say the plug is 80% effective is a tremendous over statement.  

This is a surgical problem and requires input from a surgeon.  Any surgeon worth his weight has experience with this problem-- though most will try to avoid these problem because of the recurrence issues.  

The other key point made above is that you need to make sure that there is not a diagnosis of IBD or cancer.  
10 Comments
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Avatar_n_tn
No good news, I'm afraid.  Basically, a perianal fistula represents anorectal disorders that arise from obstruction of anal crypts (keep the anus lubricated).  Normally each person has 4-10 crypts (glands) in the anus and any number of them can become obstructed.  The obstruction commonly results in an abscess containing bacteria.  These are usually spontaneous events rather than caused due to a long-term buildup or growth of an obstruction.  The treatment is to drain them.  A rectal finger exam tests to see if there are any "hard"  spots in the anus that may represent an obstruction that may need to be drained.  Since treatment for this condition is drainage, and you are draining, there is nothing that can be done except to watch for any glands that may become blocked while the draining ones are healing.  Sometimes an antibiotic is given to kill off any bacteria but otherwise one must just wait until the body heals itself.  You can get an ultrasound of the anus done to check out the condition (and number) of the anal glands that are draining, or you can take a sample of the drainage and have the lab see if it can identify the bacteria for the correct antibacterial.  Healing time is hard to measure since it depends on how many crypts are draining or blocked and what your overall health condition is.  With Crohns, it is most difficult to determine. Eventually the glands will heal and the problem will go away on it's own.  That's the bad news, the really bad news is that it can re-occur.  sorry
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Avatar_n_tn
No good news, I'm afraid.  Basically, a perianal fistula represents anorectal disorders that arise from obstruction of anal crypts (keep the anus lubricated).  Normally each person has 4-10 crypts (glands) in the anus and any number of them can become obstructed.  The obstruction commonly results in an abscess containing bacteria.  These are usually spontaneous events rather than caused due to a long-term buildup or growth of an obstruction.  The treatment is to drain them.  A rectal finger exam tests to see if there are any "hard"  spots in the anus that may represent an obstruction that may need to be drained.  Since treatment for this condition is drainage, and you are draining, there is nothing that can be done except to watch for any glands that may become blocked while the draining ones are healing.  Sometimes an antibiotic is given to kill off any bacteria but otherwise one must just wait until the body heals itself.  You can get an ultrasound of the anus done to check out the condition (and number) of the anal glands that are draining, or you can take a sample of the drainage and have the lab see if it can identify the bacteria for the correct antibacterial.  Healing time is hard to measure since it depends on how many crypts are draining or blocked and what your overall health condition is.  With Crohns, it is most difficult to determine. Eventually the glands will heal and the problem will go away on it's own.  That's the bad news, the really bad news is that it can re-occur.  sorry
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Avatar_m_tn
Thanks, well for the bad news ! But isn't two years a long time ...... damn ! Can there be permanent damage ?

Is there not an anteseptic cream or something that i can use to take it away ? If i need to shove something up - well ill be willing - just to stop it - it really is becoming a nuisance !!! I think, but am not sure, but it seems as if fiscure might be coming out aswell.

It also seems that i have a fever all the time ...... its like i burn up most of the time ...... even when its cold i get hot ....... that can't be right .......

Again thanks for the help !!!
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Avatar_n_tn
The cure is call Surgisis fistula plug. is has 80 to 90% success rate
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Avatar_n_tn
I've been dealing with an anal fistula for two years, the first year at the hands of well-meaning but misinformed doctors.  The result was eight surgeries and numerous doctor and emergency room visits.  In year two I was finally referred to a very fine colo-rectal specialist.  Even with his help, getting well is going to be a long process.  

And yes, I've had the Cook Surgisis Plug.  It didn't work the first time, but my surgeon may try it again.  It can be inserted in minutes, with very little trauma, and as an out-patient procedure.  The alternative for me was a long and difficult surgery, several days in the hospital, and the possibility of becoming incontinent.  

Because very few surgeons or doctors of any specialty seem to know much about the proper treatment of anal fistulas, my advice is to seek out the best colo-rectal specialist you can afford as quickly as possible.  

Don't prolong the agony by following advice that is based on a poor understanding of how to deal with the problem.  Only simple fistulas may eventually heal themselves.  From what I've learned, Crohn's is a complicating factor that makes a fistula anything but simple.
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Avatar_n_tn
I'm not sure what kind of hell hole you live in, but what you describe is a bad fistula, if you're getting a fever and stuff it needs to be taken care of.  Fistulas CANNOT be drained, they simply DO drain, only an abscess can be drained, and roughly 50% of anal abscesses turn into a fistula.  The only treatment is surgery or the plug method mentioned (there are a few other, rarely useful techniques).  The plug method, however, is NOT 80% effective, this is a bit of misinformation that's going around the net, probably originating from the company who started them.  It has, at best, a 45% success rate until they figure out how to make them better, but it does have the benefit that it won't harm your body to try it in 98% of cases.  If it doesn't work, that's it and you can try surgery, which DOES have a high success rate, roughly around 90%.  It can be quite uncomfortable depending on how deep the fistula is and how it has tracted through your muscle, but usually they tend to be fairly shallow and require roughly 4-6 months to fully heal.  Most people report feeling little to no pain after surgery, and I mean RIGHT after surgery.  But you need to go somewhere else, this REQUIRES surgical intervention, there is no way to stop it and it could get cancerous if you let it go too long.
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Avatar_m_tn
Well thanks guys ....... for all the input ......
I've AGAIN been back to our lovely state hospital ....... and again i got the same ....... "it will go away, give it time" "here are some antibiotics"

When i was younger my whole procedure was done by a 'dr Cook' - and the problem is it cost medical aid ........

I can't say these doctors know nothing at all ...... because they have been studying for ages .... but - when i tel them of what i know and what i've read about my situation - and ofcourse what could  be some of the sollutions - they seem totally stunned that a "non professional" can tell them on what it might be, i just think they are to uninformed on the crohns condition  .... they might be scared to make the wrong 'call' ........

I do try and keep it clean - and change the gause as often as what i can - just not to get it even more infected ......

until my government hospital is willing to experiment on me ...... ill have to wait ........

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Avatar_n_tn
I TWO SUFFER FROM ANAL FISTULAS AND  SOMETIMES AN
ABCESS (abscess).  I HAVE HAD SEVERAL SURGERY'S.  THEY HAVE SUGGESTED REMICADE POSSIBLY.  HAS THIS EVER BEEN SUGGESTED TO YOU?  
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303398_tn?1193102884
The literature would suggest that remicade helps with fistulas from Crohns disease when those fistulas are limited to the perirectal area.  However, when patients who have the fistula undergo an MRI, there is still evidence of the fistula internally.  
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