Perianal Abscess Still Leaking

My father had Perianal abscess drained through surgery about 2.5 months ago. His wound is stil leaking clear water with no foul smell. He has been in constant touch with the doctor. Recently, the doctor had put him on one week medication (antibiotic) which stopped the leaking and he was sitting on a ring cushion. But on his last visit to the doc, he advised to start sitting on all surfaces without the cushion and also stopped the medication. The wound has now again started leaking clear fluid, the doctor says it's fine and suggested do all the normal activities for a month or two. It's not fistula as per the doctor and he doesn't have any symptoms of fistula as well. 

Q: 

1. Since the wound is still discharging liquid therefore he's feeling very upset and wondering what should he do as the doctor has stopped the medication/sitz baths/ etc? 

2. Also, when the liquid touches his body he feels inflammation like feeling even though there is no inflammation. What is this? 

3. Can he use water to wash it everytime he changes the gauze? 

4. Is the clear liquid dangerous? 

5. When will the leaking stop? 

6. Can he still sit on the ring cushion even though the doc advised not to? It pains a bit when he sits without it and liquid comes out. 

Thanks in advance!

Original Post

Keeping up sitz baths will not hurt anything, so if they make him more comfortable, why not continue them? Drainage is a good thing, when an abscess is the diagnosis.

Clear drainage is a good sign (no ongoing infection). Perianal abscesses can take a very long time to heal, as they heal gradually from the inside out. He can wash it with water as needed. The drainage is not dangerous, but if irritating, he should use a barrier cream on the external skin.

The leaking will stop when it is healed. Sometimes they never fully heal.

Sitting on a donut cushion for a prolonged time puts too much pressure in a concentrated area. It can promote swelling, reduce blood flow, and potentially cause pressure sores. When he gets uncomfortable, it is best to shift his weight or get up and walk around.

Be sure to ask these questions of his provider. He should explain to your satisfaction. Hope this helps.

Jan

This sounds like the abscess drained to the skin in two places, creating a tunnel connecting the openings. The good news is that it doesn’t appear to be connected to the GI tract at all, so it won’t be resupplied/contaminated with stool. I’m guessing that it might possibly clear up on its own, though it could take a while. A gastroenterologist (or perhaps even a dermatologist) could examine it to judge whether it’s better to do something or leave it alone.

This is a great question for the doctor. People can (and often do) live with fistulas for a very long time.They can certainly become painful when pressure builds up, and they can branch out into more complicated trees that are much harder to treat. On the other hand, surgical treatment of fistulas is far from a guaranteed success, so you may not want to be the one to push it if he’s not ready.

I read that fistulotomy has a success rate of over 90% if the person is healthy and has no Crohn's or AIDS. In my dad's case given he has none of those, do you think surgical treatment can remedy his fistula?

Thanks again Scott! You've been very helpful.

Surgeon said it will be fine after surgery but he's not saying that with assurance. He said he'll cut the fistula open to the skin and leave the wound open so that it can heal with healthy tissue on its own. Basically, he'll be performing fistulotomy with lay open technique.

Well, my dad went to a colorectal surgeon yesterday and he has suggested an MRI as he thinks that the fistula might be communicating with the anal canal and only an MRI can confirm that. Also, he said that in case with a surgery he'll go with seton stitch instead of fistulotomy  with lay open  technique.

So a seton isn’t really a surgery, even if it’s placed under anesthesia. It’s just a loop of thread or elastic that passes through the fistula and runs along the outside. It keeps the fistula open, which can help prevent pressure from building up and hurting or developing an abscess. They’re not definitive cures, but they can reduce the problems caused by a fistula. The surgeon is wise not to suggest cutting the sphincter.

Fistulas can make you miserable in various ways, but it would be very unusual for it to be life-threatening. Folks here who’ve actually had setons could do a better job than I describing the experience. Nobody seems to like them very much, but they are often better than nothing.

Thanks Scott! You've been really helpful. Here'a MRI report of my dad, it has too many medical jargon and we can't make anything of it (sorry about the image quality, that's how my dad sent me).

The doc has said he'll go with seton stitch and keep it there for 6 months then will see what to do next based on the response.

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