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
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hi, about a week ago i started to get pain around my anus area, it got worse and i noticed a lump/bump on the edge of my anus/perenuim, so i visited my GP who recommended i go straight to the hospital as she said it was a abcess...the doctor on duty at the hopital also said it was a abcess and i waited for my op...when the surgeon came round after the op he said he couldnt find an abcess just a little clot of blood which he drained off(using a syringe i assume i got no wound?, now ime home im still in pain and whilst showering i can still feel the original lump that I went with...is it possible the surgeon(who I never even met before) missed the abcess and found a clot and thought it was "job done" or will the lump take time to go? HELP!!!!!
Hello, I'm a 15 year old female and I am worried about that "area" of my body, too. I've noticed it's gotten slightly tighter and the muscles tense more. Also, when I go no.2 it is in very large amounts and sometimes there is a small amount of blood on the tissue. Could it be it just keeps tearing skin as I go because of the large amounts? I have been constipated for a while and I am doing things to resolve it, so when I go and it goes a bit softer and in smaller amounts when I'm more regular, will I bleed less (it's not every time) and seem less tight down there?
Huge thanks to John and the programme. I found this site while looking for info on my symptoms. I'm a 47yo male and in the autumn of 2009 I was aware of a small lump on the edge of my anus. It eventually burst and I didn't think any more of it. I'm not sure if this was a coincidence, but a few weeks later I got the mother of all piles, I had infrequent mild bouts of them a decade before but nothing compared to this. When the pile eventually went, I noticed the lump was back (and back to stay). There wasn't any pain, just a feeling of pressure and brief itching when it was due to burst. Then it would fill again, at first it discharged every few days, then eventually, constantly. I finally went to the doctor 5 months later, after seeing this site. I was referred to a specialist, then had a colonoscopy with seems to be the routine, nothing serious showed up. I got my operation 10 months after my initial doctor's appointment. The fistula tract was tiny, and was opened up to heal, I had little pain from the wound, but I also had a skin tag removed from the other side of the anus at the same time and the healing of that was very painful. I was back at work the following week, with plenty of padding in my undies. Four months on, I've not had any more problems. My advise to anyone with fistula symptoms, don't delay, go and get it checked out as it's unlikely to go away on it's own, no matter how much TCP you dab on it.
I too have suffered for many years with perianal abcesses. On numerous occasions to hospital I have had gyne doctors prodding and poking me saying its not them I need to be refered to G.S, then the G.S COME AND SAY ITS A GYNE!!!! I have now seen a rectal surgeon, after numerous gyne appointments and 2 failed procedures, who seems "hopeful" he can solve my problem??!! However I have also now got a rebel tract that has burrowed through into my vagina!! I am now confused as to whether I will have a seton stitch hanging out of my bottom and one hanging out of my front!!!! Do any of you people regret having the surgery? I am now bleeding daily after toilet visits, this includes just having a wee.It seems to free flow when I am hot. Is/has this happening to any of you? Also if I get hot or sweaty I seem to generate pus! I know this problem needs to be sorted before I develop any more rebel tracts but am also very apprehensive of the negativity regarding the stories I have read after surgery?? Please help?
Hi michaela ive suffered with perianal abcesses for over 11 years now..its really getting me down because they haven't found a diagnosis to what is causing them ive had all test done ie..barium enema/meal,scans and tested for crohns but still got no futher with it..the pain with abcesses is horrendus but I have all the symptoms for crohns..but after changing hospitals they have know put me a seton stitch in to try and drain all the puss..i will admit it does hurt to start with but it eases after a few days alot of hot baths eases it..the stitch does hang out of your bottom but it's not a problem..it sounds daft but I use baby wipes when been to toilet its easier n there is no pain..i have had it in 2 mths now and I have to go back in soon and have this out and another one in but the doc's have said they cant guarantee me not getting anymore so it's all just a waiting game.!!
Hi..ive suffered with perianal abcesses for over 11 years now and in that time I have numerous tests to try and find out what the problem is to what is causing them, I would have them drained and packed and that would be that. And I would dread when the next one would arise as the pain is horrendous..i was getting fed up as I was getting no better so I change hospitals last october 2010 to see a different surgeon which has made me a little happier. On my first visit I had the camera to which ive had quite a few of these at the other hospital..they found a bag of puss on my bowel which I clearly saw myself on screen..so up to press this year I have had 3 operations to try and get around it but my 3rd one on the 1st of april 2011 I had a seton stitch put in to make my sphyncter muscle stronger because of the place where it is and the worst thing that could happen is I could lose all control of my bowels..but having seton stitch in is the worst pain ive had in my life but its slightly under control its hard to walk far and sit but I have to go back to hospital for a EAU in 6 wks..but im happy im getting somewhere now I just hope it dont take years as I would like rid of the pain for good..!!
Hi I had my stitch placed on August 16th, anally and vaginally!! I have to say I was so apprehensive about the surgery and what state I would be in afterwards but fortunately everything has been great! I had to have the wound packed for maybe 3 weeks and then dressed but it healed really well considering it is in such an area. I am extremely grateful for such a good healing experience as I have to have further surgery soon and now am not as nervous because this has been such a positive experience. I had quite abit of muscle removed when I had my stitches placed but next time I have to have 2 anal plugs fitted?! Do any of you guys have experience of this kind of surgery and recovery?
I came across this video when I was researching fistulas as I have just found out I have one (same old story - history of perianal abscess) and am scheduled for an op in 2 weeks. It was a very informative video and I am very grateful to both John and Channel 4 for telling the story. However, I am horrified at how long both John and some of the posters on here have been undergoing treatment. My surgeon seemed pretty confident that the fistulotomy would sort me out - but now I am not sure sure!
I'm reading these posts with complete horror. Last year in may I started to suffer from piles...... That's what the gp said I used a 100 different creams with avail... Then in september I started to suffer with more and more pain. After visiting my gp 4 times in one week along with out of hours gp's I took myself to a&e the doctor there admitted me says I had a massive perianal abscess which required surgery straight away. I sent the the 36hrs in the most horrendous pain waiting for the op. After surgery 6 weeks of recovery and having the dressing packed daily I returned to work. Still in pain 4 months later. End of jan I went back for a hospital check up, doc said another op is required to find the cause of the pain, I went for the Pre assessment of this op today they told me the op would be to investigate and do whatever surgery is required to put right ...... I'm left completely unsure what the future holds as they said this second op could mean months of recovery ahead again. I don't know how to cope with the daily and nightly pain. I have a young son, and I work, both of which are under pressure from this 'pain in my bottom' . I can't do the activities I would normally do cycling swimming etc all because of the 'pus' . I just want this to be over and done with and get my life back. Would be great to hear someones story that has turned out well?
Hi, I just thought I would follow up on my situation. Since I had the seton placed in Sepetember I have gradually become incontinent. I don't know why this is but it's very distressing. They also probed my vaginal wall (by accident, even though they won't admit it) when they placed the seton, I had an MRI scan ( I made a formal complaint so the original doctor was removed and I demanded a scan as soon as I met the new doctor) The fistula has branched off and now one branch is in my coccyx. I feel that a lack of information is prevalent with this type of thing yet I've read all the guidelines in medical journals and none of these guideline seem to be followed by the doctors. It will be a year soon and I'm still housebound, the pain in my back is unbearable and the fistula still leaks as much as it did in September, it's very painful. The doctor has casually suggested I can go back to work!! I honestly think some of them are on a different planet, have they ever experienced this personally themselves? I have an examination under anaesthetic on the 4th of March and I have decided that I am going to request a colostomy. I can't live like this anymore, it's less than a half life.I don't go out as I'm frightened of having an accident and the leaking fistula smells like cadaverine. It's just awful.
I know exactly what your going through. I'be had fifteen perianal abcesses in the space. of 2 years. but don't give up hope I'be not had one for over a year was refered to a brilliant sympathetic consultant. the treatment was long and at times very hard going and I still see him every three months. I really look after myself have a high fibre diet and drink heaps of water. there is light at the end of the tunnel
hi all ive had two anual abcesses in the same place both had to be drained and packed but the packing always fell out just before it completely healed thus leaving a skin tag, which i lived with for 4 years,i was getting flare ups of irritation all this time so went back and had the skin tag removed this i am regretting as this was nearly 4 months ago the operation left me really sore and in alot of pain they put stitches in and they was really tight they eventually popped open which eased the pain untill it got infected, ever since ive had 5 lots of antibiotics and the puss just keeps on coming, im now waiting for a date for another op and they say yet again it could be a fistula but ive had 2 mmr scans to check for this and been put to sleep twice, cant see this ever being sorted.
Hi everyone. I had a perianal abscess which turned into a fistula (apparently most do). Had my abscess incised and then it was all opened up again last year. The surgeon beamed when he said it was just a sinus not a fistula. The aftercare in both cases was practically non-existent and negligent. The wound must be kept open so that it heals from the bottom up (no pun intended). But in my case it closed up in three weeks because the nurses don't know how to pack a wound correctly and so, guess what? Saw a different surgeon in June who had not even read my case notes and did not believe me when I told him it was a fistula not a sinus (pus comes out of the external opening and my back passage). Asked the surgeon what treatment he would choose if he were me and he said he would go to St Marks in London (at last, some honesty about a surgeon's competence). Now have been waiting 3 months because my referral was lost, mislaid, not sent... My overall impression of the NHS is that A&E is great but the rest needs some serious changes. Wish I was in Spain, where medical treatment is so much better. All the best to everyone.
hi everyone dont mean to sound insensitive but its quite comforting to hear of others with same problems.i' ve had my latest fistula problem for 8 years now laid open and packed by district nurses more times than i can remember with every time seeming to go well only to fail in the end.got some relief after receiving a stoma but as soon as it was reversed problems returned doctors now stumped saying that they cant do anymore however dont all get disheartened because my condition is complicated due to crohns disease hope you all get sorted soon and if anyone has any info on healing fistulating crohns please drop a line cheers mike, good luck and take care x
Can i just ask how your reversal went? i am terrified after googling it and reading some horror stories, i have had my storma for only 3month or so and should be getting it reversed in the next month or so after awful fistulas. fingers crossed mine done come back. Any info would be fab. Thank you