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.
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
Yes
NoComments and Questions
You can share your experiences and thoughts with other Embarrassing Bodies site-users below. Comments & Questions are reviewed by moderators, but if you see anything on the site that worries you, please report it and one of our moderators will look at it as soon as possible.
Please note: Unfortunately Channel 4 cannot respond to individual inquiries. If you have any concerns, you can check out NHS Choices, but ultimately it is always best to check with a health professional.
in may last year i ended up having an emergency opperation as i had perianal abbcess. after that i was gettin it packed for months after. then once i thought it had gone i had the coil fitted and the doctor told me to go back to the doctors about it as she thought it didnt look right. so i went back and they dun a scan and found that there was two further abcess formed inside of is, so i got the loose seaton fitted. that was removed in may but i had a fisutle and they had cut through part of my sphincter. i have just been back to the hospital and i thought that it would of finally been over and done with, but the consultant has told me that it it still there and booked me in for anouther opperation. i am worried as i dont really seem to know what is going on with it or what they are going to do. i am only 21 and a young mam and am wondering if it going to be worth my while to get the procedure done privately, as it just seems to of taken over my life and i cant get on with normallity
Reply to this comment Report this as offensive
Reading all your comments makes me feel that I am certainly not alone. I also have a fistula which was caused by a perinanal absess. 1st op in Feb 2009 then 2nd in Aug 2009 to insert a seton stich. Still can't understand how in this day and age they just can't close the tract! Living with constant yucky discharge which had lessoned until I thought that I could do something normal like walk for 9 miles, whereupon it flared up again. Best thing I found to help the leakage problem is non-woven swabs (packs from chemist but not the serile ones). Beginning to think that I keep them in buisness though. Can't see an end to it, but tell myself that things can always be a lot worse. Good luck everyone. Would really like to hear a success story... are there any out there??
Reply to this comment Report this as offensive
Hi Sarah, Sorry to hear you have the same prob, 7 ops in as many months seems a lot in a short space of time. After my last op I was getting daily dressings for about 10 weeks till they gave up. It started in my right buttock and has progressed down between the essentail bits :) It has been called an abscess, pilonidal / perianal whatever you call it, it's a pain in the ass. Only joking, as I have no pain at all now I am still keeping the next op on hold, going back to the hospital in June. Hope the next op works for you, keep me posted.
Reply to this comment Report this as offensive
hi my boyfriend also has what looks to be one of these he has been to see his gp but they just keep on pescribing antibiotics saying it a cyst but this problem is getting worse he is finding it hard to sleep sit ,go to the toilet and some times even walk please could you help him in any way
Reply to this comment Report this as offensive
john well done you for highlighting this awful problem and hopefully help people to make more sense of it,i have had my fistula with seton stitch since 2004!after 14 operations ,a stoma bag for twenty months,8 mri scans it has still not cleared up,my fistula is a very high one up in the 3/4 muscle and as yet i do not want to take the option of cutting into my muscle for fear of incontinence!i use daily dressing and get on with my life as best i can though i am in constant pain,i hope yours gets sorted after your next op good luck
Reply to this comment Report this as offensive
i cant believe it woz only last week i woz watchin this program, and thought ooouch that luks so painfull, then as it got 2 the weekend i woz experiencing alot of pain, i first thought id broke my bum bone or something, when the pain got 2 much 2 handle, i went 2 my docs who straight away sent me 2 hospital sayin i had a perineal abscess and 2 get it drained and packed, athough i thought the procedure woz extreamly painfull at the time, it really did ease it afterwards, it was a massive relief, still quite painfull as it is first day and i do have a whole above my bum, but nothing compared 2 the pain i was in, they have said i will have 2 go bk once all healed and have a operation as i have a perineal fistula, i thought mm that rings a bell, sure ive heard that this week on embarrassing bodies, thought god wot r the odds on that, watch it, then days later this happens, anyway i would really like 2 no what is this perineal fisture? how could i have got it, i do suffer fron ibs, i have been tested 4 crones and colitus in past but nothing there,and had a polip removed few years ago in my sigmoid part of bowel, and suffer alot with lumps apearing on inside of my legs round my knicker line, which usualy go purple and skin goes paper thin, and eventually brakes with a little puss and fair bit of blood cuming out, then leaves a horrible purple scaring and feels hollow underneath, like the flesh has been eaten away, i am extreamly self concious bout the scars and refuse 4 my boyfriend 2 luck in that area,as they r constantly apearing i have alot of scaring, could this b related 2 this perineal fisture thing? and also how long do they usually wait b4 doin the operation, and wot can i expect post op?, i also have been experiencing alot of pelvic and lower back ache past 2 days, and still am after this drainage,is this caused by the abscess?
Reply to this comment Report this as offensive
Suffer from the same problem, now had 6 ops over the last 4.5 years, each time it is the same and the wound almost closes, same old story every time, it is a nice clean wound and should heal with the daily dressings but always comes to the last bit and never closes. It would have been good to see an 'end ' result to the problem rather than just finishing saying he would have yet an other op. Life really is a pain but after saying that I have no pain, just continual leakage. Could not afford any more time off sick, so since there is no pain I've just left it for the time being.
Reply to this comment Report this as offensive
Oh my goodness, that is not giving me much hope, as my wound hasn't closed in over 6 months post-op and I am heading for my second op next week (I wrote a long comment below, 38 year old woman). I can't imagine getting a boyfriend and having to explain the whole fistua thing to him, never mind him seeing the state of things down there. The leakage is horrid and really does impact on everyday life. Have other people been tested for crohn's? I've heard there is a drug called Infliximab that blasts the fistulas into oblivion, drying them up complelety. I asked my surgeon about having this drug but she said you could only have it if you have crohn's.
In reply to Tom Report this as offensive
Hi Tom , i have the same problem with the healing and had my 7th operation is as many months 2weeks ago and back to square one but mine is in my left buttock , can i ask what was yours diagnosed as, as finally seeing the cheif consultant on tuesday ....... can't live like this anymore !!! S-j
In reply to Tom Report this as offensive
I totally understand what john is going through. I had perianal abscesses when i was 16 an it was very painful, after a mini operation i felt fine after a week or so i hope everything works out for him
Reply to this comment Report this as offensive
I am a 38 year old woman awaiting second operation to remove fistulas. Thank god for John being so brave, not only going through 11+ operations, but for going onto this programme. I have never actually sat down and watched a whole episode, just randomly caught bits of the programme. Tonight I couldn't believe it when I happened to switch on and John came on - I am going for my second operation in 4 days time and though I got quite hysterical watching the operation the first time round on the tv, I have just watched it clearly again on this website and feel much calmer. I think what triggered me getting so upset was hearing '11 operations' when I was extremely traumatized after my first one, and completely dreading my second. I also have a seton stitch, and my wound either hasn't healed in over 6 months (it was a massive gaping hole) or there are more fistulas causing the constant oozing. Sometimes I can't walk any more because of being in discomfort. I can't call it pain, but the soreness and stinging between my buttocks is really bad sometimes. I wear pads constantly and often have to put a cotton handkerchief inbetween by bum cheeks to ease to pain. I am also grateful to John that I am able to point people towards watching the video to see what it is that I have got / been going through. (Only the one's that are really interested as it's all quite gross!). John never mentioned crohn's disease or rather it was never mentioned on the programme by any doctors and yet I have been told that fistulas are a 'side effect' of crohn's and I have been tested for this, but don't have it. Well, not that I would wish these fistulas on anyone, John has made me realise I am not the only one to be suffering and he looks around my age. It has really affected my life, I was a very active person and a runner, but can't hardly go for a walk these days. Anyway, I must remember what he's been through, and he seemed a very placid guy and not whinging. If you're reading this John, I really hope that your latest op has finally done the trick - 13 operations, it's gotta be lucky for some!! Thanks for going on the show and best wishes, and good health.
Reply to this comment Report this as offensive
John, If you read this then please let us all know the outcome of op13. I was feeling it every time the surgeon was cutting and scraping away. Janet, All the very best for your op this week, sometimes they are solved quickly, and others just seem to go on and on. I only recently found www.pilonidal.org it is quite informative. With mine they have tried every type of dressing, even used manuka honey the last time but no joy. After the last op, I could have stuck a golf ball in the hole. Anyway, fingers crossed for you this time.
In reply to Janet Report this as offensive