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Embarrassing Bodies, 11:05pm Wednesday 2nd September 2015 on More 4. Catch up for free on 4oD »

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've had a fishula for over 6 years now, it started with an ulcer which burnt through to my vagina and its gone through my muscle which they only found this out 6 months ago with a 3d scan, ive had op which didn't work and a seton fitted 3 years ago and was left in for 18 months, then I had a pig skin plug fitted a year ago which didn't work, I should of had another seton fitted last week but couldn't before of fever and water infections ive had on and off for the last year, then I need to have a big op to repair the muscle which is a worry to me, I feel like I'm back to square one, as any one else gone or going through this? X





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I went to gp thinking I had an abscess in Perianal area , They agreed , I saw 4 different docs and practice nurse each prescribed antibiotics I was referred to crs as after 7 courses of Antibiotics it wasn't shifting . During this time pain was horrific I had fevers almost fortnightly over the six months It took to see crs (YES 6 MONTHS ) MY CRS app was on monday previous Friday and all weekend I had fever which broke su day night , Crs wanted to perform emergency surgery and I was in theatre 2 hours later . Partial fistulotomy , debrided cavity and seton fitted . Home same day with pain meds and antibiotics District nurses packed wound for 4 weeks until seton fell out , I phoned crs dept and got a call back saying it was ok a common occurrence don't worry , I told nurse she said maybe it had done it's job etc . I was almost at end of packing so decided to stop it and just dress wound myself with sterile gauzes , My trust in GPS etc is destroyed I can't bear thought of visiting gp again I could go into more detail but suffice to say last seven months ( now since first started this little adventure ) has been a waste of time the seton did nothing , fistula drained before it was fitted and after (still draining ) it basically caused irritation and pain under under dressing, I have follow up app with crs in few weeks I w old post op thi would be to tighten seton or lay open fistula , I wonder what it will be for now setons gone I am not starting over again with another seton this things destroyed my life I would cycle around 150+ miles a week I haven't been able to sit on a bike since January my muscle in legs has gone my stamina has gone and stress and anxiety are taking a toll . Anyone with a fistula has my utmost sympathy It's a horrible condition and all your told is wait n see or let's see what happens you must basically surrender to a mundane lifestyle Of toilet routines diet restrictions and pads While your next stage of treatment is prepared And Eua means you wake up post surgery to find. Out what's been done it's a total nightmare . I barely sleep I can't think of anything but Hospital or gp times stood still I walk around in switched off mode these days . Best summed up in one word arghhhhh . Who knows what's next my gp doesn't neither did nurse and crs based his reply on seton still being in , wait n see again .





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I been going through this for over a year,it started when I had hemroyds removed I then got a abcest then a fistula a very complex fistula after 7 ops and the seton in for 8 month pluss recurring abcest I now waiting for the advanced flap in a few weeks hopefully to repair all this I have no crones but I woke up today with a sore lump I squeezed it and lots of bloody puss came out iam due to go on holiday in four days and iam hoping I can stay out of hospital till I get home but not sure wats happening can enybody help ???





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Hi iv just had a second seton put in place after 5 years fistula free. 1st time the seton was painless and I didnt even know it was their. Now this time its agony, been 2 weeks and no let up, doctor has checked it and said its doing its job and has no answer for the pain. My life feels on hold, cant work, drive go out I wish id never had it put in and would rather take my chances with the abscess cycle. Is this normal for a draining seton to be so painfull?





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After developing an anal abscess with fistulas I have been through the procedure of having a Seton Stitch inserted and gone through the drainage and packing stages.The wound seems to be healing okay and I have been left with just the Seton to manage. However part of this fell off the other night(just a loop shaped piece). Should I be concerned? The Seton has been in for three months, I was checked about one month ago and am due to see the consultant again in another months time. I have been warned that this condition can return and that there is a real possibility of sphincter muscle damage and incontinence!





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Hi my name is matt I have chrons I have had the problem since I was 16 I'm 25 I've had 13 ops ad have 4 open wounds ad 3 stitches I'm used to the stitches it was pain fall first but pain easyes off ad been on the stoma to give bowls a rest for 2 year then had revised ad no I still have the problem I have a bath 2 times a day I do get fed up after a while and they weap out of the blue. Ad the stitches hurt now as again





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I have a perirectal abscess that I have been dealing with about 6 years. I had around 17 surgeries and countless ER visits. I have multiple fistulas drains and a big and 7 inch deep hole on my right buttock which allows infection to come out of my body. All these pretty much keeping me alive. Specialist took my case all over the world to see if he could find a solution but nobody could come up with different treatment. It all started with some pain around the anus area taking me to ER at a small hospital. ER doctor inserted a giant shovel looking thing in there to take samples which I am pretty sure he didn't know what he was doing. It was extremely painful. Meantime he popped the infection pocket and I felt ok for a few months.then same pain came back but very aggressive. I went to my primary care doctor and he gave me low dose antibiotic without examining. I had high temperature and was in lots of pain so thought that would help. Prior to this I never had any medical problems so I didn't think it was abnormal. He told me it might take a little bit top kick in so don't panic. I had lots of pain and high temperature for about 10 days and finally went to ER because I felt like my body was shutting down and I was scratching the walls due to pain to the same small hospital where I had my first ER visit with the shovel doctor. Luckily they called the Chief of Surgery to take care of me which was a miracle to me because he created a surgery room by collecting tools and machines from around the hospitals to handle the emergency surgery that he had to conduct on me. Later on I was told, if I did not show up to ER for 12 more hours they could not reverse my situation because my blood was full of infection. they couldn't even do a blood transfusion. I stayed in Intensive care for about 10 days then they transferred me to the bi city hospital Swedish Medical Center.I had many more surgeries there. Specialist who is taking care of me at Swedish told me that he wishes they sent me to him at the first ER visit because they turned my situation into this very terrible place. I wish I had more knowledge about medical stuff all the way at the beginning and I would straight up go to the Swedish and maybe I wouldn't go through this crazy pain everyday all day long. I am still trying to live my life and still trying to be strong. This illness is no joke and turns your life upside down.





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I had a seton stitch in July due to be taken out in three weeks possibly new one put in. Very painful the first week but ibroprfen really helped. I have just noticed that the stitch has gone this morning. Not sure what to do symptoms def improved but still some weeping so don't think it's completely healed. Any advice welcomed





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





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