If you follow me on social media, you might know bits and pieces of this story. But I never wrote about it here on the blog and felt like I should. This health experience was something I never heard of until I experienced it, despite the fact that it is pretty common. I am hoping that by writing about it here, more people will be informed in case it happens to them!
In September, I left for Boston on a Tuesday with a small amount of pain in my butt. I thought it was a small hemorrhoid (thanks childbirth) and didn't even bring anything with me to treat it. When I got to Boston that evening I was in a good bit more pain and searched out a Walgreens for some medicine. Over the course of the next two days I did the sightseeing I planned to do and spoke at a conference.
The night before I left town I was in such significant pain I called Matthew. However at this point I still thought it was a crazy hemorrhoid, albeit different than anything I had previously experienced. The pain had turned into a large lump of swollen skin, but it wasn't bulbous and external in the same way a hemorrhoid would be. It was all internal and on the side of my anal area, but I thought maybe the hemorrhoid was thrombosed on the inside. Again, for those of you have had hemorrhoids, you know how crazy painful they can be. This was just as painful… but looking back I can see it was presenting differently. I was in another state though and the thought of going to the ER felt overwhelming and maybe like overkill.
From Boston, I was supposed to be traveling to Toronto to go visit my friend Ann Voskamp. The trip had been planned for months and I decided I wanted to continue on.
Ann and I were staying overnight in Toronto then flying to a speaking engagement for her on Saturday. Saturday night we would fly back to Canada where I would then hang out with her family for two days and work on my book. The night we spent it Toronto was awful from a pain perspective. I tossed and turned and barely got any sleep. I was also having trouble walking I was in so much pain. Yet, I still thought, wow, this is a bad hemorrhoid.
We got to the Toronto airport, went through customs, and I stopped in the bathroom. While in there, I felt lightheaded and almost threw up from the pain. At that point we decided I should fly home to Nashville instead of flying to the speaking engagements. Our only photo we took together was the above shot, taken in the airport. We are both totally faking it in this photo, as we cried immediately after.
I booked a new flight and flew home that afternoon Matthew met me at the airport and we went straight to the ER. These are two photos of the night— one that I posted on Instagram after being admitted and another, taken later on, after I had clearly been crying from the pain.
We had to wait for hours in the ER. It was so full that I was placed on a bed in a hallway. Eventually I had a CT scan and they were able to make a diagnosis.
All the pain I was in had nothing to do with the hemorrhoid it was in fact a perirectal abscess which is something that can be caused from a blocked area in the anal canal. They weren't really sure how I got it and said that sometimes it just happens.
I went into surgery the next morning to have the abscess drained.
The perirectal abscess was so large because I had waited way too long to be seen that the wound with deep enough that it had to be packed for two weeks. Please imagine this — I had a wound, near my anal opening that had to essentially be kept open with packing so it could heal from the inside out, for weeks. If you want to see something horrifying search wound packing on YouTube. It was horrible and mortifying as it sounds. My screaming and the pain with the packing made it too much for Matthew. We ended up hiring a nurse friend to come twice a day to pack the wound for two weeks. I cried almost every single day but after that two weeks when I didn't have to do the packing anymore we thought we were in the clear.
Little did we know this was just the beginning. I developed another perirectal abscess in early November. This time I knew what it was immediately and went straight to the ER because at this point I didn't have a colorectal surgeon of my own (because I had been seen in the ER). In retrospect, I wish I had contacted the colorectal department so I would have had a point of contact and wouldn't have to go back to the ER.
After a long night in the ER they were able to give me antibiotics (because I had caught it soon enough) and I didn't have to go through the draining and packing experience. That said, they said if it happened again though I might need surgery. The abscess ended up bursting after a few days on its own through my original incision. The ER had given me a contact in the colorectal department and I established care right away. I saw a surgeon I and he said if it happens another time I would need to have exploratory surgery (called an exam under anesthesia or EUA).
Of course, the week before Christmas it happened a third time. This time I was in Wisconsin visiting family but was able to call the surgeon and get antibiotics. Once again again the perirectal abscess ruptured, and in January I had that exploratory surgery.
My doctor (Alexander Hawkins at Vanderbilt Health, for anyone in Nashville who needs a colorectal surgeon) found a fistula and put what is called a seton in the fistula. The seton is like a small rubber band that goes from your anal opening through the fistula out your skin to shrink the canal. You see, the body doesn't recognize that the fistula is bad, but by putting the seton in, which the body does recognize as a foreign object, it starts to do the work to shrink the tissue and try to get the seton out, which helps to reduce the size of the fistula.
When I asked Dr. Hawkins why the fistula developed, he said it was dumb luck.
Three months later, I have the seton removed and a fistulotomy to complete eradicate the fistula.
The ER doctors told me that they see perirectal abscess every day in the ER. They are incredibly common but people don't know what they are and they often wait too long to be seen because they are embarrassed or think it is something else like I did. I have shared a lot about this on Instagram and have had dozens of people tell me that they know someone this happened to.
Moral of the story: if you ever experience a small lump in your butt, near your anal opening, do not wait to be seen.
For more about perirectal abscesses, read this Q&A with my Vanderbilt Health surgeon Dr. Alexander Hawkins. For more about how fistulas impact women in the poorest parts of the world, check out the important work that the Fistula Foundation is doing.