Editor’s note: This is the fourth in a series of columns by Mary Horsley about IBD-related procedures. Part one, part two and part three also are available.

Continuing my “Scope Series” theme, this column recalls my experience with emergency surgery for a perianal abscess.

A perianal abscess, as you can imagine, deals with the anal region of your body, an abscess near or on your rectum.

An abscess — an area filled with pus and infection — can appear, sometimes creating a visible lump due to the swelling. The abscess is usually tender to touch, red-hot and extremely sore.

In my case, my abscess was around 11 o’clock on my rectum, respectively, and the area grew overnight. I woke with pain in my bottom. And I mean, it was pain IN MY BOTTOM.

I could barely walk for fear of tightening muscles down there. When I looked in a mirror, I saw swelling and bruising of the skin. My perianal abscess had gotten so swollen that it was the size of a golf ball. Pressed between my butt cheeks, it was putting me in constant pain. I needed a doctor. If you have pains like this, I suggest an emergency visit.

Your doctor will examine the swelling to determine it’s an abscess, and whether it needs to be cut open and drained, or if medication can handle the situation.

Mine was first diagnosed as hemorrhoids, even though I knew this was wrong. In order to be certain, my doctor went to the emergency department and got the surgeon in charge to “come have a look.” Sometimes, a second opinion is needed. With Crohn’s, you may get comfortable showing the usually hidden body parts.

In my case, the second doctor grabbed my butt cheeks and spread them apart, his goal to insert a finger for inspection.  Anyone down the hall could have heard me screaming. To this day, it was the worst pain I have ever experienced. I truly hope your doctor is gentler with you. I pushed the doctor away and smacked at his hands to remove his grip from me. I was uncontrollable.

The doctor knew immediately that my perianal abscess needed surgery, or else the swelling was going to cause the skin to rupture on its own.  His exact words “We have to give you anesthesia; to do this without would be considered cruel.” On to emergency surgery I went.

Once I received morphine, my mood changed significantly, as shown in the photo.

After the surgery, I was given pain medication and instructions to go home and take it easy for the six-week recovery. I was given a sitz bath — a small tub to sit in with warm water to help clean my wound — and told how to remove the gauze still tucked in my bottom. They gave me a plastic pillow to sit on, as hard surfaces would hurt, and tons of gauze for me to wear for drainage.

After a few weeks, I returned for a follow-up and was told to prepare for a second surgery, where a fissure was present. A fissure, a tunnel that starts inside the anus and works its way to the outside of the skin, can lead to infection and requires being cut out – a fistulotomy.