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Video

Voiceover:
26-year-old John came to see Dr Pixie at our mobile clinic in Nottingham, for help with an anal abscess that he’d been living with for two years.

John:
In the worst case scenario, I actually can’t move my legs, it’s that painful.

Dr Pixie:
And I mean, you’ve just got, you’ve got a lot of scarring here, haven’t you?

John:
That’s right, yeah.

Voiceover:
She referred John to consultant surgeon Professor Scholefield at The Park Hospital in Nottingham.

Professor Scholefield:
You’ve probably gathered by the fact that this has gone on for two years and you’ve had eleven operations, sometimes these fistulas are, are difficult to deal with. The most likely cause of this is that you have just had a gland that’s just got blocked, an anal mucus gland, and that that’s just formed the abscess, and then it’s burst. Sometimes that’s just a straightforward little tunnel, but because you’ve got a branching tract and it’s gone in several different directions, that’s why we’ve got a difficult problem to deal with.

Professor Scholefield:
Right, John, so I just need to have a little look at this area, so I can see that there’s an area, a red area there, I can see that there’s a tract going back from the base of the scrotum towards the anus, and that there’s a stitch in, um, in the anal canal.

Voiceover:
After examining John, Professor Scholefield explains how he intends to proceed.

Professor Scholefield:
We need to have you in, examine you under the anaesthetic, try and open, try and get down from multiple tracts to one tract, and then to either try to put a plug in that or if I can, and you’re prepared to take the risk, then we might think about whether we could lay that primary tract open as well.

Voiceover:
John has returned to the hospital to be examined under general anaesthetic, so that Professor Scholefield can take a closer look at his abscess and decide how to proceed.

Professor Scholefield:
He’s actually totally fed up with the, with the symptoms from his fistula, because he gets a lot of pus and discharge, and it’s making his life miserable. So he wanted me to do whatever I could to try to and help speed up the resolution of the problem as soon as possible.

Voiceover:
His anal fistula developed after an infection in one of the anal mucus glands led to abscesses, which burst in several directions, onto the skin of the buttock and into the bowel. John’s already had eleven operations to clear out the infected tissue, but none so far have stopped the condition.

Professor Scholefield:
This is all sort of unhealthy granulation tissue here, all of this sort of pink friable stuff is just horrible unhealthy tissue, and it’s probably a tract that comes down here. It’s going to be filled blind with that stuff.

Voiceover:
First, Professor Scholefield inserts a probe into the tract to determine where it leads.

Professor Scholefield:
So that tract really goes down the side here, all the way around, and I suspect that it’s going to join up somewhere around the inside of the anal canal here, to this internal opening. So it’s kind of, it’s effectively sort of like a J shape. So effectively, I’m just trying to cut down onto this probe to see where the tract goes to. Although this is going to look like a huge hole, it’ll actually heal up and shrink down very quickly. There’s no way this is going to heal up without laying it open.

Voiceover:
After cutting from the existing wound, he follows the line of the fistula, gradually opening the tract.

Professor Scholefield:
This tract comes all the way down here, and then terminates in an abscess cavity here. And then from this abscess cavity, I think it’ll go back up into that fistula, which’ll be the next part of the operation. And all this is lined with this horrible sort of pink tissue, that’s just chronic inflammation. That’s just going all the way around the side of his anal canal.

Voiceover:
Like previous surgery, he scrapes out the unhealthy tissue, with the hope that they will heal without more infection. However, Professor Scholefield then takes the more extreme option of cutting into the inner sphincter muscle to open up the second tract and scrape the unhealthy tissue.

Professor Scholefield:
This is the other tract that we’ve put in, that we’ve laid open now and you can see the edges of the muscle here, you can see that sort of horrible sort of unhealthy tissue here, that I scraped out from the other tract. And I suspect that there’s too much muscle involved in this to do it all in one go. I think it’s probably just chancing our, chancing our arms a little bit too much. And hopefully this bit will all just heal up.

Voiceover:
The wound is then left open for the healthy tissue to heal around the previously infected area.

Voiceover:
Six weeks later, and John is back to update Pixie on how he’s been getting on.

Dr Pixie:
So when we met in Nottingham, you were having a terrible problem with your bottom.

John:
I was, yeah.

Dr Pixie:
You had a series of abnormal openings which were really being a complete nightmare, because they would discharge and you were getting abscesses. It was a bit of a mess down there.

John:
That’s right. There were so many tracts going off in different directions that no one could actually work with it, it was described like, uh, the root of a plant. Any one that they managed to close off, another would form.

Dr Pixie:
Right.

John:
And it would start up all over again.

Dr Pixie:
So I guess using your analogy of the tree, instead of just pruning it, the surgeon’s actually gone in on this instance and taken the tree root out.

John:
That’s right. They’ve uprooted the whole thing, they’ve treated the cause rather than the symptoms. Immediately after the operation, it was obviously still very painful, because of the size of the wound, but nowadays, the pain’s gone down below a…kind of a slight sore, more of an irritation than a pain, than anything else, so it’s improved quite a lot. Uh, I am due to go back in for another operation which should hopefully finish it off.

Dr Pixie:
Would you mind showing me how things have improved since we last met?

John:
Of course.

Dr Pixie:
Do you want to pop up on the couch?

John:
Sure.

Dr Pixie:
Wow, you have had a big cut, haven’t you?

John:
Just a bit, yeah.

Dr Pixie:
Funnily enough, it looks a lot cleaner, and you’ve got this nice red granulation tissue, so the healing tissue.

John:
That’s right. There’s not quite as much pus coming out from it now, so apparently that’s obviously helping with the healing, because the actual pus was breaking down a lot of the cells that were forming to heal it up.

Dr Pixie:
Okay. Now let’s have a look on the other side. So, it’s gone right round…obviously there’s a lot more healing to do, but it looks like the healing process is, is headed in the right direction. Hopefully that’ll all go well and you’ll be able to get your life back.

John:
My fingers crossed, I could do with it.

Dr Pixie:
Great to see you again, and I’m really, really delighted for you, because you needed something to be done.

John:
It’s…it’s made a massive difference to my life.

Dr Pixie:
Thank you so much for coming in.

John:
Thank you very much.

Read the video transcript

John came to see Dr Pixie to discuss the abscesses he’s been suffering with for 3 years around the perineum area (the area between his genitals and bottom) which has seem him undergo 11 operations – to no avail. Dr Pixie suspected an anal fistula and sent John to see a specialist. Colo-rectal specialist Professor Schofield suspects a blocked gland that just hasn’t been efficiently sorted out through previous ops and informs John of the need for further surgery. Back under the knife Professor J H Schofield found that the condition is worse than he thought with the infected tract being larger than expected. After completion of the operation John discussed the improvement in symptoms back in the clinic with Dr Pixie and hoped that things would be completely sorted out after one further surgical procedure.

Patient name: John Redman
Condition: Perianal Abscesses
Specialist: Professor Scholefield
Hospital: BMI The Park Hospital, Nottingham

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Comments and Questions

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I was reviewing old ct scans of mine which said I have an enterovaginal fistula and an bladder/vaginal fistula. No one ecertion me it was also noted in a cr scan from 2013. I'm seeing a urogyn for consultation and it was very hard to find a doctor who even knew what a fistula was. All I know is I have had extreme vaginal and vulval pain and infections for years it is so bad they can't get a speculum inside of me. What can I expect?





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This requires a bit of prior history: In 2008 I had a full colectomy due to a severely inflamed colon - this after 20 years of ulcerative colitis &/or Crohn's disease. I'm 66 now. Due to some complications my abdomen was opened up from sternum to crotch for this procedure (instead of the usual arthroscope). Since then food/drink goes through in 1-2 hours looking like it went through a blender. Very little goes to the kidneys. Usually 10+ trips per day. Right after the surgery I developed an infection at the scar and then developed 2 abdominal fistulas, one above and one below my belly button. The whole scar site had to be removed. After months of TPN and going from 185 to 142lb I finally began to recover. It was temporary. 3 years ago I developed 2 anal abscesses which turned out to be fistulas. Several operations later I am now the recipient of a seton which passes in through one of the fistulas and out my anus. It is a mixed blessing. The old abscess sill gets infected and drains monthly but it doesn't "balloon" and cause pain. The seton is a fat rubbery thing which is tied with what appears to be fishing line which can get scratchy as it wends its way around. Since I have many bowel movements per day I can absolutely NOT wipe my behind. It is perpetually raw ans fissured and the gastric acid is intense. Sometimes the seepage of a mere drop or two will cause extreme pain, usually at inopportune times. I don't venture far from home where I have a washlet installed on the toilet. This allows me to wash the area and blow dry it. A real boon. When away from home I must take showers/sitz baths after most movements for relief, so this appliance is very convenient. Life is a bit complicated when every trip has to be planned. I don't eat or drink for hours before any longish trip, esp air travel. The only good news I have to report is that humans can learn to live with almost anything. As Nietzsche said, "what doesn't kill me makes me strong".





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I developed an abscess close to my anus in October 2013, the abscess burst and left a bloody mess on my bed. I went downstairs and passed wind, my boxer shorts filled with puss and blood. Concerned I went to the out of hours doctor and I was told to return home and bathe. Two days later I went to see my GP, who telephoned the hospital and I was admitted. Within two hours I had returned home as no action was taken. After several infections I again went to my GP, who again contacted the hospital. This time my GP said that I had a suspected fistula and it should be investigated further. I was admitted, but no investigation took place. A couple of months passed and after seeing my GP again. I was sent to see a specialist. However, when I arrived nobody knew why I was attending as my medical records had not been updated or sent. So after explaining my condition I was ,investigated for piles. I also had a MRI scan. When I went for my scan results the specialist told me I did not have a fistula as the scan was clear. He then went on to tell me how lucky I was not to have this fistula. I told him that I did not agree with his findings and insisted that I was examined again. They told me that I was correct and there was something near to my anus. My confidence has been destroyed by the non treatment of my condition, and I have no trust in neither the hospital that I have been attending nor the specialist. Can somebody please advise on possible side effects and recovery time? When I first noticed this problem I was out of work so any procedure then would not have been a problem. I am now in full time employment on a six month trial. If I go ahead with surgery I will not have a job to return to.





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Thank you for this informative video. I have a much smaller fistula, that was EXTREMELY painful, and will have it surgically treated in a month. This video was very helpful to me ... thanks to John for sharing his personal case!





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Hello,I was glad to see others dealing with this.I initially had a anal fissure, for amost a year, finally opting for a surgery to help, I had a fissurotomy done. I became constipated after the surgery and could not have a bowl movement for 4 days, finally ending up in the ER. The hospitalist there gave me some pain meds and stuck his fingers up there to "loosen the hard stool. This of course caused immense pain and no immediate relief. the next day with plenty of laxative I was able to have a bowl movement and continue having them, though very painful. Within a week, I noticed a hard lup on the inside right of my butoc and a lot of yellowish fluid and some blood draining. I let it go for a few days because I assumed it was something to do with the surgery I had. A few days later it became so painful tha I could not sit, or even walk without a lot of pain. Back to the ER I went. This doctor was much better, said may have an abscess from he surgery site. A CT scan revealed that to be re, along with a fairly severe case of appendicitis. I was admitted and the next day had the appendectomy and the surgery o clear out the abscess. a few days after that I felt good, pain free bowl movements, and very little drainage, things were improving. Last week that all changed, all of a sudden I as getting quite a bit of drainage, blood and a yellowish foul smelling fluid. This was 5 weeks after the abscess removal etc. I saw the surgeon the other day and he says it appears I have developed a fistula. Now I will be going in for a 5th surgery on my bottom region next week to examine and remove this fistula. Ugh I just want all of this to heal and be better!





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Hell I have had the same done to me it is the first operation I have had it done.it is one week and one day since I had it done but I feel there is a lump under it I am in agony wen I go toilet to the point were it is unbearable just wondering how long it took to heal fully I am bac to see the doctor tomoro so if there any problems he Wil prob tell me tomoro just feels like it getting worse every day not better

I had a perianal abscess drained in February 2009. Was initially excited that the embarrassing condition was over after the procedure to remove the abscess was done and a seemingly good healing afterwards. However, I was very disappointed when a fistula occured after about two months and all I have done in the past five years is suffer the pain and inconvenience, press and drain myself after it gets "ripe", do some sitz bath and have it swell again after about 3 weeks. I have been reluctant to have another procedure to remove the fistula as there are no guarantees that it won't re-occur. Albeit I have now decided to go ahead with the procedure in the first week of February, in view of the convincing talks by my surgeon. I can only just hope now that God heals me once and for all. I'm scared!





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i am 31 yr old female who has had 8 opertions to try and fix my fistula but still no joy on new years day i had to go in for an emergency opp because a bad abbsess came back after having th 7th fistula removed ... my absess was drained and 2nd seaton is now inside my 6inch wond which needs packing daily . last seaton stitch i had wasnt inside a fresh wound so wasnt as bad . i went to the nurse and doc today and they cant help as they have never seen a seaton stitch before . i find that nobody knows what it is apart from my surgeon which isnt much good as i wait weeks to see him and he wants me in and out and never explains much . i really o feel for anyone who.has this problem as i know fine well its a living nightmare and i feel like this is never gonna be fixed .





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I have had a seton stich for eight months now and the area around the stich is raw it hurts to sit for more than a couple of hours, it hurts to walk around also. Is it normal to feel so much pain. What can make the raw areas get better. I'm so depressed that I can't do normal things like working and shopping without being in pain. Does anyone else have this problem? Is it normal to have the stich for so long? or permently? my doctor told me I would have this for life and if taken out my whole anus would fall apart and I would be incognient. Please advice





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I had surgery in May this year to drain and insice my perianal abscess . I am now only 8weeks down the line and have been on antibiotics 3 times for reacurrance of an abscess waiting for my appointment back at the hospital now which is not till the 28th November this year it's a joke I am getting very depressed now it is affecting my relationship and my daily routine I just want to feel normal again in constant pain can not sit or stand for too long keep having dizzy spells temperature up and down all the time I am just scared the antibiotics are masking . A really bad thing is anyone else suffering this really is a nasty thing to have.

i am suffering from uncontrolable passage of motion problem after having anal fistula oparation plese suggedt me how to solve this





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Hello Natalie, I am 2 days post-op, and recovering from anal fistula surgery. I have an open wound, fairly deep, next to the anus, and also have the seton as well. Thursday, surgery day, was not too bad, with all the local anesthesia and general anesthesia given. I went home and pretty much slept the rest of the day. Later that night, it was fairly painful sleeping and trying to roll over in bed. I took a prescribed Vicotin, and was able to get 8 hours of sleep. Yesterday, Friday, I was able to have a bowel movement in the morning, after drinking some coffee, and I was extremely surprised that it was really not painful at all. I took 2 sit-baths during the day, took Vicotin 3 times yesterday, along with a stool softener and the antibiotics prescribed. I did feel a little more pain yesterday, but it was manageable, and I feel it helps to walk around, as opposed to just laying down. Today, just had 2nd bowel movement, no pain at all, typing this while sitting on the sit-bath. Wound doesn't look any better, but I feel really good today. Oh...it helps a lot to take a nice hot shower also. I did that yesterday and will be going into shower after sit-bath this morning. I plan on going to work on Monday....will have to see tomorrow if I am able to sit in the car for a half hour to drive? I am sorry to hear that your mother-in-law is having a worst time. Mine is open also....they generally are left open so the healing starts from the inside out. I would strongly suggest she try to get up and walk around. Take the pain meds...but help her walk around more. Hopefully that will help!

Hi, I would just like to know how long the pain lasts when having a seton stitch? My mother in law had the procedure nearly 3 weeks ago and is in agony, she has been bed ridden ever since, unable to stand for longer than 10 minutes. I have searched the web but cannot find anybody who seems to be in pain with theirs. I also read that everyone else has theirs packed and wound dressing where as hers has just been left bare. Any information about this would be a great help as we are both as clueless.





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Hi Natalie, has your Mum in Law been back to see her surgeon? This doesn't sound right. Seton stiches are relatively non-invasive. The only thing I could think is that the stich is too short, resulting in a small loop. But I am not a Doctor, just a patient who is all too familiar with setons, fistula plugs etc. I hope this has been useful and I wish your M.I.L well.





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It looks like no one else has asked this question, so please fill in the rest of your details below.





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