The knifeman cometh: My eye-watering pain in the bottom

When a throbbing, eye-watering pain crept its way steadily into my nether regions and had me writhing and twisting and flushing hot and cold, I was anxious and uncomfortable. But when I ended up having to spend the early hours wriggling in a tepid bath like a big red-bottomed larva, I felt I should contradict all previous behaviour. And so I went to the doctor.

The doctor looked at my crimson, ballooning gluteus maximus and sent me straight to A&E with an explanatory letter. “Have a look at this chap’s arse,” I presume it said. Urgency at that point in my treatment appeared to be the name of the game and so when my new medical examiner, a Chinese doctor, declared “We’re going to cut you,” I wondered whether I could go home for a toothbrush and some jim-jams.

“Fraid not. This has to be dealt with immediately. Risk of spreading infection.” Right-oh.

On the operating table they gave me a local anaesthetic and obscured my line of vision with a cloth. I chatted to the anaesthetist and, preoccupied as I was with pleasant chit-chat, I only barely recall that the knifeman seemed puzzled.

He’d found nothing where he was digging, and where he’d been preparing himself for a few quarts of sepsis, there was nothing but a dry well. But he left me with a great gouge, just due east of the natural exit, on my previously peachy flesh.

My naive assumption was that doctors don’t slice you open unless they’ve got something in mind. That was before I knew anything about the notorious fistula-in-ano.

Bertram What is it, my good lord, the king languishes of? Lafeu A fistula, my lord. Bertram I heard not of it before. Lafeu I would it were not notorious. – Alls Well that Ends Well (William Shakespeare, 1605)

Almost as soon as my wound, which required daily packing with dissolving gauze, had healed, the infectious symptoms were back. I hustled my way back to A&E where a Greek doctor mentioned an MRI scan for the first time. This sensible option was dismissed somewhere along the way and I was home a few days later with another matching gouge mark alongside the previous one but a little farther east of the natural aperture.

This time I had a general anaesthetic, so I couldn’t say for sure whether they’d dug anything out or not. Except I knew where my pain was, and I knew where they’d made incisions, and the two places certainly did not correspond.

By this stage an MRI scan had become essential. It revealed that I have a horseshoe-shaped, supralevator abscess located high in the pelvis which is connected by a suprasphincteric fistula – a tunnel, in fact – which is draining at a point inside my back passage. Yummy .

Only 5 per cent of anorectal abscesses are of this kind. Hooray. This would explain all the discharge and the stains in my pants that seep through my trousers, and it accounts for my constant need to waddle around stuffed up the back-end with cotton wool pads. Sigh.

I went in for more surgery, but it didn’t work. They opened up the fistula to encourage draining but the infection just came back. In fact I was in more pain and I was having even more discharge.

After my work health insurance was upgraded, I received private care. Private care meant quicker attention and more consultation. Dr D, my new bottom guy, took me through the options.

He stressed that the main objective was always to avoid cutting muscle and so risking incontinence. He then asked me what I thought. I thought that the best thing would be to involve the Tunnel Tigers of Arranmore Island who have built metro systems all over the world. But I said I didn’t know and suggested that, since he was the colono-rectal surgeon, he might have a better idea. He said, “But it’s your bottom.” I said, “Well, give me a mirror and a scalpel and I’ll have a go.”

No I didn’t. I said, “My bottom is in your hands.” I said, “You know more about my rear-end than I will ever know and I am happy for you to make the decisions.”

So Dr D did his thing. He told me that he got right in there and flushed the whole thing out. He widened the fistula channel to allow gravity to assist with the drainage of pus. But he wasn’t confident.

The problem is that the wound must heal and the abscess must close before the infection returns. And since the infection is in a part of the body that is teeming with germs and bacteria, it is quite a gamble.

He advises the long haul and accentuates the fact that I could well be back again. And again and again until the battle is won.

There are no aftercare suggestions. There is no diet I can adopt, nor are there any special personal hygiene tips. I can’t apply poultices or creams, and the only thing I consider might help is walking since it helps with gravitational drainage. I’ll have to wait and see.

The fact remains that there is still no ideal or definitive way to treat this problem.

Anorectal abscesses and fistulas All you need to know

Causes: Anorectal abscesses and fistulas can be a byproduct of Crohn’s disease or colitis. Otherwise there is no underlying cause. I have always had a tendency for pustules: acne, carbuncles, boils, pimples and cysts. It’s my genetic makeup and it runs in the family. An abscess is a blocked and infected gland and the anorectal area has many such glands.

Symptoms: The symptoms are a pain in the rear-end, often beginning as a slight ache that builds to a full-on, very intense throbbing sensation. Fluctuations in temperature are common, as are constant feelings of nausea, tiredness and weakness.

Treatment : The only option is surgery. Antibiotics are used as part of the healing process but do not work on their own. Various types of surgery may be considered including a drainage method which involves the seton stitch. In extreme instances a colostomy bypass can be considered.