Beyond the Butthole: A Perianal Abscess Story

I wish I knew of an engaging intro beyond saying I’m going to take you through an uncomfortable experience in an incredibly embarrassing area of the body. I challenge you to read this one on the toilet and tell me if you don’t experience sympathetic phantom pains in your asshole. This will certainly be one of those “well at least I’m not that guy” stories.

My journey begins on Friday October 7th, 2022. I wake up with a small, painful bump on the rim of my asshole. I think to myself “eh, probably just a hemorrhoid. Better get some Preparation-H”. Holy fuck I wish I knew how wrong I was going to be. I should have realized something was amiss since the hemorrhoid that I had dealt with in 2014 was itchy and bled easily and frequently. This did neither such thing. The pain was pretty low grade throughout this day. I went to 6am BJJ training, saw a full day of 7 patients, and didn’t dwell much on the soon to be growing pain in my butt. Throughout this story, we’ll be using a numeric pain rating scale from 0-10. 0 being no pain at all to 10 being…exactly what I was experiencing in various moments. That 10 will be redefined a few times for me. It should be noted that I’ve had my fair share of acute musculotendinous strains and tears and chronic/non-traumatic pain in just about every region of my body. I really thought I had a handle on what pain can be. I was dead wrong.

Saturday I see two patients in the morning then train BJJ with my bud Brandon. He’s been my favorite training partner, and while he’s finishing up the police academy I have the privilege of being one of the few people he trusts to train with since he knows I won’t accidentally or intentionally ruin his chances of finishing the academy due to injury. While beginning training with Brandon, I note that it’s getting painful to sit on my ass and really painful when trying to transition from sitting to standing. At some point as our flow roll (essentially taking the pace and intensity off a bit so you can explore technique against some resistance) escalated to a real training session, I diverted attention from the growing pain in my ass to the training. The risk of being choked unconscious or losing the function of a joint does wonders for honing your attention to the task at hand. By the time we finish training and Brandon leaves, the pain is picking up. Getting up from a chair is now beginning to feel like a 5-6/10 on that pain score. Worse yet is that while the pain is right on my butthole, it’s now also feeling like my perineum (the taint, the gooch, the fleshy fun bridge for you laypeople) will split in half when I move. My friends Jessica and Alex come over to play board games and have cake since my birthday is tomorrow and Jessica felt bad that I never made any big plans for my 32nd birthday. Despite the pain, we have a good time and the cakes are delicious. We also devour a tray of Greek meats from a restaurant down the road called Souvlaqueria. If the pain weren’t so high, I’d say it was a perfect night. I take an edible so I can sleep deeply and avoid thinking about this pain.

Sunday, my 32nd birthday, I wake up in a fog thanks to the edible. I pet one of the dogs next to me in bed and go to turn over. For a moment I forgot that I had an issue down south, but I was quickly reminded as I swung my leg over the side of the bed. I braced myself to stand up and was surprised this pain was worsening. I figure “eh, at least I can stay home and just keep slathering Preparation-H on this thing. Should turn the corner.” I get a text from Kevin Sheridan, my BJJ professor that on October 23rd I’m testing for my purple belt. He’s been really pleased with my attendance and the reports from other instructors on my performance and says it’s time. He asks me to come to open mat this morning, and ask him any questions I have. This promotion is a big deal to me so I figure I can suck up the pain a bit and move around. He has me do a 10 minute round with him, in which I’m successful at doing 0 things well. Not due to pain, but because he can just completely negate anything I try. I’ve swept, passed the guards of, and submitted a few black belts. Kevin is simply on a different level. I ask him my two questions I had on the test, then he asks me to roll with a white belt who wasn’t doing well at competitions. I keep my usual slow, deliberate pace, land a few sweeps and subs without worsening my pains. My friend Will teases me about beating on a white belt. I tell him I was basically ordered to do so, but I honestly really just wanted out. I say my goodbyes to everyone and go home, shower, and get ready for a double date at KPot for my birthday. Danielle and I sit at the bar while we wait for our friends Mike and Nini to show up and for our table to be ready. I talk to Mike about the growing pain in my ass because it’s getting harder and harder to keep a straight face because the pain is getting intolerable. Despite the good food, good company, I really want to just lay on my side because it’s about the only thing not paining me at this point. Nini suggests I order a sitz bath since it tends to help people with hemorrhoids. She tells me I should eat more fiber. I remind her I work with a dietician and I actually exceed the fiber guidelines for adult men (go me). I place an order on Amazon for the sitz bath, but it won’t show up until Tuesday. More prep-h and edibles I guess.

Monday was a surprising day. The pain in the morning was actually a lot more tolerable than the previous two days. I’d score it a 3-4 at worst for the first few hours. Really thought I was turning the corner. Alas dear reader, like many times in my life, that brief glimmer of “holy fuck we’re getting better” is really just a mirage. We’ll come to another of those when I talk about my dad’s journey with adenocarcinoma in a later post. I had a fairly busy day with 4 patients in a row from 8-12 then two more at 3 and 5 in the evening. My 5pm texted me saying if he could make it in any time sooner than 5, he’d let me know. That brief respite from the intense pain was short lived. I found myself feeling a solid 7-8/10 when trying to stand up from sitting or when trying to even just take a full step. Again, that feeling of “Jesus Christ my taint is going to tear in half” is something else. My patients could clearly tell something was off, so I said “think I have a bad hemorrhoid. I’ll be fine in no time.” During my break, I check on CVS’s website to see if any of the local-ish stores have a sitz bath in stock. I find one that does and head over there as quickly as I can. I scour the store, every aisle. I find that CVS carries sex toys now, including a vibrating anal toy which made me laugh given the pain I’m dealing with. I ask an associate who says they must be out of stock of the sitz bath. I’m pretty non confrontational and didn’t want to scream at her “miss, the website says you have it, don’t lie to me.” Pain nearly got the better of me but I managed a “oh no worries” and limped back to my car. It should be noted that around this point, I’m now developing constipation as it hurts to sit on the toilet and giving a little push to the potential poop spikes the pain a bit. 

After my 3pm patient finished, I really thought about texting my 5pm patient that I had to cancel due to this pain. The moment I finally decide I’m going to do it, he sends a text, “hey, I’ll be there in about 20 minutes.” I decide I’ll tough it out. Throughout the session, he can see, and much to my lament, hear my discomfort. We wrap up, I go home immediately. Danielle, my wife, tells me I should probably go to the doctor. I’ve probably sought medical treatment 4 times in the last 6 years. I think 3 of those were for physicals, one for a skin condition. Despite being in the medical field, I don’t like being a patient. It’s not that I know better, there are a ton of areas of medicine I know little to nothing in. I just don’t want to medicalize something that should be sorting itself out. I tell her I have a sitz bath coming in and it should help me feel better (spoiler, it won’t).

Tuesday morning I try to give myself a pep talk when I wake up. “Come on Soya. Just two patients in the morning, two in the evening. You can do it.” I skip 6am BJJ because the pain is now a 7-8/10 when I’m just standing straight. I confide in my second of my two morning patients that I’m going through this whole ordeal with my butthole. I’m shocked when she says “Soya, I’ve dealt with stuff like this. I’ve had painful hemorrhoids, anal fissures, and more. It’s awful.” We talk about how taboo it is to talk about your asshole and other bodily functions. I feel better knowing that someone I work closely with has gone through similar stuff to me. It doesn’t make the pain better, just reassuring. I come home on my break hoping that the sitz bath is sitting on our doorstep. At this point, you should guess that it definitely wasn’t there. I contemplate canceling my evening patients because I’m really just not myself due to this intense pain, but I have a lovely sense of martyrdom and duty above all else, so I soldier on. I get home from my evening patients and finally, the sitz bath has arrived. The proverbial answer to my prayers. I immediately throw open the toilet, affix this thing around the rim, fill it with hot water, and plop my bottom in there. It’s kind of nice. I watch some videos on youtube and enjoy the personal spa for my ass. I go to get up, stupidly thinking I’d feel better. Oh well, we’ll do another later tonight before bed and see if we eventually get any relief. I have Danielle take a look before I head to sleep. Keep in mind, up to this point in time I’m reasonably certain that the only person to see my asshole was my family physician growing up. No other ex girlfriend or hook up has ever seen this thing. She deserves an award.

D: oh that does not look good.

Me: my actual butthole or…

D: oh your actual butthole is pretty nice, but no that thing does not look good.

Reassuring, right?

Wednesday morning I wake up with a solid 8-9/10 pain. I quickly text all my patients that I need to cancel. I’m going to the ER. Enough is enough. I shower (can’t go in having a smelly body when someone’s going to look at your bootyhole). I tell Danielle, she offers to come with despite being back in school to pursue nursing, I decline. Gathering myself and my belongings I can’t seem to find my wallet. I generally have a very long fuse when it comes to getting angry, but that fuse might as well be god because it no longer exists in this moment. I text Danielle, of course she hasn’t seen it. Normally I love feeling like Sherlock Holmes as I go through a process of deductive reasoning and a journey through the past few days to arrive at the logical conclusion to the location of my wallet. This isn't that kind of day. It’s in the back pocket of the jeans I wore to KPot on Sunday. I nearly tear up getting into my car and have a hell of a time sitting still without gritting my teeth. Driving in Jersey is enough to work anyone into a frenzy. I’m pretty sure we average multiple roadway fatalities per day here. So throw in blinding pain into the mix of the usual frustrations of driving in this hellhole state I’ve called home for the last 7 years. It sucked. I see St Barnabas hospital coming up on my left. I start to feel a little at ease until I notice one awful thing: the parking lot is swamped. I pull up the emergency department lot and see a car waiting for someone to pull out. Every spot taken. I do a lap through the other departments and visitor lots. NOTHING. So dear reader, please imagine the level of agony I’m in now. I drove 20 minutes on Jersey roads to the one place I might finally get help, and I have to do MORE. But like Patton says, “When you’re going through hell, keep going.”

I drive another 20ish minutes to Morristown hospital. Emergency department lot is of course full. The next lot is also full. I pull into the visitor paid parkade and am already filled with anxiety as I’m not seeing an empty spot. I eventually arrive at one and start limping my way over to the emergency room.

Receptionist: what brings you in

Me *sweating, looking around*: uhh, rectal pain.

R: please ensure your name and DOB are correct

I opt not to even take a seat since the thought of my perineum finally having enough and tearing apart as I stand up out of a waiting area chair is just too much. The nurse in the waiting area again asks what I’m in for and begins taking vitals. She grabs the blood pressure cuff and I begin to take my sweater off, she assures me it’s not necessary. She then proceeds to hit the button to start the reading while I’m standing, arm unsupported at my side, and the cuff over my sweater. Reader, this is not how you take blood pressure measurements, even when you’re in a rush. But whatever, bigger fish to fry.

After about 30 minutes I get taken back to a room. A female physician’s assistant comes in and introduces herself to me.

PA: have you had hemorrhoids in the past?

Me: I had one or two, but it’s been since 2014 or 2015

PA: do you eat enough fiber?

Me: I get over 40 grams a day. I started working with a dietician last year because while I can eat for body composition and weight management, I suck at eating for health. I know I get a lot of fiber. Speaking of, I normally have 3-4 bowel movements a day and I honestly haven’t had a good one since Sunday.

PA: mhm.. Well let’s take a look.

I lie on my left side, she has me lift my right ass cheek so she can get a good look.

PA: well, looks like hemorrhoids (yes plural). They don’t appear to be thrombosed so you’re not a candidate for surgery on them. I think we need to give you a stool softener for the constipation and a stronger cortisone cream for the hemorrhoids. You should also be taking sitz baths.

Me: Oh I’ve been taking those. Honestly, they don’t seem to be helping at all right now. I’ve also been using Preparation-H on the area, but my wife said I should have gotten the cream instead of the gel.

PA: Well, this course of treatment should get you feeling better. If not, call an anorectal surgeon.

I leave feeling a little better. Just hemorrhoids. Now I’ve got some medicine that should move things along, literally and metaphorically speaking. I drop the script off at the pharmacy. They tell me it’ll be about an hour and a half. I’ll get a text when it’s ready. I go home and watch the Hellraiser remake (not bad for a B movie). I get a text from the pharmacy saying they’re having an issue verifying my insurance, but no action is needed on my end. I find this weird since they never asked for my insurance info. I figure if the prompt says no action needed, I can wait a little longer. It’s about 3 hours after I dropped off those scripts and the insurance issue doesn’t seem to be solved. I decide to call them up and see what can be done. They take my info over the phone. “Okay all set. Give us another hour.” Ugh. Alright whatever, being mad at stuff outside my control never helps.

I pick up the scripts, pop one of the stool softeners since I was told it should take effect within an hour or two, I take a sitz bath, shower, apply the cortisone cream. Tomorrow we’re really going to turn the corner on this thing. I just fucking know it. Yeah…nope. Also, no poop. Disappointment abounds.

Thursday I feel about the same as I did Tuesday. I get through seeing all but my last two patients, both get stuck at work, it happens. I ask Danielle to grab me an enema on the way home from school. I’m desperate to at least take a shit at this point if nothing else since the constipation pain is now slowly trying to compete with my asshole pain. Danielle comes home with the goods and she’s already talking to my mother-in-law on the phone about my whole ordeal. For context, she’s head nurse in charge on the operating room floor at hospital in NYC. She’s got connections to all sorts of doctors and has seen a ton of shit (literally and figuratively) in her tenure.

MIL: Michael, I’m going to get you connected to some anorectal surgeons. I can probably get you seen tomorrow night or on the weekend, but it’ll likely be in the city.

I groan, I hate going into NYC for anything.

Me: do you think it’s necessary? The PA in the ER thinks it’s hemorrhoids

MIL: do you think it’s hemorrhoids? They don’t hurt this bad. You need a surgeon. This PA wouldn’t know shit if it’s coming out her ass.

She has some valid points.

D: mom, we have shitty NJ marketplace insurance. With everything going on we couldn’t.

MIL: they’d see you for free or I’ll pay for it

It needs to be in writing that my in-laws (all of them) are incredibly gracious people. They’d seriously move mountains for us if they could. I love them to death.

Me: okay, I’ll let you know how I feel in the morning.

MIL: Danielle, you can give him a suppository if he needs to make a BM but can’t.

We opt for the suppository over the enema since it’s a little less drastic. I lie on my side, lift a cheek and Danielle slides that lubed up bullet right into the hole. It falls out because I can’t hold it in.

D: Michael, I have to push it deeper.

M: it wasn’t deep enough?!

It holds this time. 15 minutes later I take the most pathetic little shit of my adult life, and another one a few minutes later. I have these zinc suppositories that my patient recommended to me. She said it’s the only thing that really seemed to help her at her worse. I’m desperate, I’ll take another bullet shaped shot of relief up the bootyhole. A miracle. It actually does feel better. The urge for another bowel movement comes. The medication drips out into my raw ass and it feels awful. I turn the bidet on (I got an attachment in 2018 and never looked back), and rinse my chapped ass for a solid 2 minutes. I go to sleep hoping for something better tomorrow. I’d finally get what I hoped for, but it was going to take lot of torment to get that relief.

I wake up sweaty and in incredible pain at 4:30 in the morning. Up to this point, laying down wasn’t so bad. Danielle wakes up with me, she already knows we’re heading to the ER. Thankfully she’s got Friday’s off from class so she can go on this journey with me. I text my mom and briefly let her know what’s going on and tell her I’ll keep her posted. We end up actually getting a spot in the ER lot this time. For a reference point, it’s about 6:30am. I get checked in, they give me a patient transport chair to sit in. Within 20 minutes I get wheeled into the red zone and get placed in a room. The gentleman who wheeled me over gives me a hospital gown and tells me he’ll grab some blankets after we open the curtain to signal I’m changed and not giving anyone a free show. He never did come back with the blankets so Danielle asks the nurses at the station for some. They’re stored in a warming device, feels great to have a warm blanket.

The attending physician comes in and introduces himself.

P: why didn’t you follow-up with a surgeon?

Me: I needed to be seen this morning. The pain is the worst it’s ever been. I can barely get in a full breath, I can’t find a comfortable position, I need something.

P: alright, well let’s have a look. Lie on your left side for me.

He then proceeds to abruptly use a ton of pressure when pressing on this ass mass. At this point, I thought I was near a 10/10, I just discovered the scale goes higher.

P: yes these are definitely enlarged. I need to do an internal exam.

Before I can get any sort of preparation or mind calming tips from this man, he shoves his barely lubed, gloved finger into my ass. In that moment, I looked upon the face of god, it was laughing.

P: well, you don’t appear to have fissures. I’m going to get a surgical resident to come and take a look.

I begin to cry in front of Danielle for the second time in our six years together, the other being around the time my dad had died. I felt humiliated, degraded, dehumanized and in copious amounts of pain. When I described these feelings later on to someone else. They said “over a finger in the ass?” No. Sure that hurt the worst of everything so far since everything down there was incredibly sensitive. It was the way I was treated. Less than a cog in the wheel. Less than a person.

My nurse comes in to check on me. I can tell from the way she speaks that she’ll be a good fit. I bring up the constipation issue. She says she’ll check with the attending and let me know, asks if I need anything else. I hear the attending physician in the hall with another patient. This patient is an elderly woman who had a fall in her home. Her daughter brought her into the ER. The physician asks questions regarding what was going on at the time of the fall. His next question made Danielle and me both look at each other and laugh. He asks her “so how long have you had dementia?” My dude, do you think she knows? Wooof. Anyways. Nurse comes back in and says she’ll have an enema for me in a bit. Fantastic.

N: so there’s three positions I can administer this to you in. I recommend this one *points to the packaging*. It’ll help gravity do its thing.

Me: if that’s what you think is best, let’s get this show on.

So I position myself doggystyle just like she asked. Bare in mind I’m in a tshirt and a hospital gown so my manhood is just hanging between my legs here.

N: alright here we go

I break into sweat from the pain. I don’t have the adjectives to describe the feeling of that much pressurized liquid being jetted into your colon.

Me *through gritted teeth*: how we doing?

N: halfway there. It also occurred to me that I should have brought a face shield. Did this to an old man last week and I got shot in the face.

She finishes administering the enema, I’m proud to say that the only collateral damage was one of the hospital sheets, and only a small puddle.

Within 5 minutes of the enema I have to kick Danielle out of the room because this liquid is coming out as fast as it came in and I’m desperate to have at least this moment in relative privacy. Some brown fluid jettisons out of me. I’m between the bed and the toilet about 5 times in the next 30 minutes. It’s mostly fluid and hardly even 5% of a week’s worth of back up, but I feel a little relieved. The general surgery resident comes in. He takes a history and then begins an exam.

SR: well, if these are hemorrhoids, they’re not thrombosed. I don’t think you’ll need surgery for anything here. But I need to do a palpation exam, including internal. Also I want to take a picture to see if the colorectal needs to be consulted on this. I promise it just goes in your chart

Me: dude you can send it to whomever. My face isn't in it. Just make money on it at least.

Reader, in the last 16 hours I’ve received two suppositories, an enema, and now two internal digital exams. My asshole has taken a beating worthy of a porn set. At this point, if Johnny Sins came in as my anorectal surgeon, I wouldn’t even be phased.

Surgical resident orders labs because at this stage no one ever drew my blood and he’s thinking I might have an abscess. For my non-medical folk, in some cases of abscesses, particularly in spreading infection you’ll show an elevated white blood cell count on your labs. Time goes by. Surgical resident pops in and out, notes how astonished he is that my blood still hasn’t been drawn. The phlebotomist (wow, I get an actual phlebotomist and not just my nurse to draw my blood. I feel special today). He ties the tourniquet, inserts the needle and begins his draw. I ask him if he can just take it all at this point. I’m done. I’ve lived through enough. He laughs and says feel better. A different nurse stops by and offers to grab Danielle some food from the cafeteria. Glad my queen’s getting some treatment too. Poor woman has had to see so much that no human should bear witness to, the least she deserves is to not go hungry.

Colorectal surgeon comes in. Guess this ordeal with my bottom had to go all the way to the top. I get a good feeling about him. Man’s in a suit vest, dress slacks. Nice and casual, I’m for it. That's cool and confident. We talk, mostly the same conversation. He promises no internal exam, great.

CS: well, this is either a clotted hemorrhoid or an abscess. In either case, we need to cut it open.

Me: okay, so do we go to the OR?

CS: oh no, I’m going to do it in here with you. I’m going to get some supplies and then the resident and I will perform the procedure here.

The supplies show up. Danielle is asked to leave the room for the first time, besides the moments that I had to get on the toilet. Yes, not only has she looked eye to eye with my asshole numerous times these last few days and particularly last few hours, but she’s now seen me at my worst physical health. What a saint. I love her.

CS: I need you to lay face down. We’re going to tape your cheeks open so we have our hands available to make precise incisions.

First attempt at taping my sumptuous ass cheeks open fails miserably. The second time works, barely.

CS: alright, I’m going to shoot the mass directly with lidocaine. This will be the worst of it, but you’re closer to relief. Almost there (I wish).

Me: at this stage, what’s one more bright shot of pain

CS: exactly

We redefined what my 10/10 pain was yet again.

CS: how does this feel *pokes the mass on the rim of my asshole with his finger*

Me: barely feel a thing.

CS: awesome. Nearly there man

He touches the scalpel to the mass. The sound that occurs is somewhere between a crack and a pop

CS: Yup, that’s an abscess. Drains pus like one. Smells like one. I need to make more cuts for a cross incision.

The next two cuts were no longer painless. I’m sweating, teary-eyed, but relief is at the door.

He applies some pressure to squeeze some more ooze out, then hits it with saline and packs it.

CS: you took that better than most!

Me, teary eyed, covered in sweat: you mean it?

CS: oh yeah, one of the most painful things someone could endure.

I could kiss him. Danielle comes back in the room.

D: how’d it feel?

Me: I feel relieved now

D: should have let out a huhhhh yeaaaaahhh when he cut it

CS: good thing you didn’t because I’d legit have cut your asshole open from laughing.

He gives me some discharge instructions and tells me I need to set a follow up appointment. A few minutes later my nurse comes by one last time.

Me: you know, this whole thing made me realize how seldom heterosexual men have their assholes seen by women. Like, we see our partners’ pretty frequently.

N: sir, I am not evening that ratio with you

Me: I feel like we should get drinks because we skipped a few steps.

I stand up to change out of my gown and into my clothes. Holy shit, it didn’t hurt so bad. 

I have to keep toilet paper wedged in between my cheeks for awhile since I’m continuing to drain fluid out of the abscess. Sitz baths need to continue as well just to get some fluid moving. I’m still taking a stool softener, mostly because I’m deathly afraid to give a little push when I shit now. Sneezes also terrify me since they were incredibly painful. I’m slowly unlearning to expect pain with all the things that were hurting me. Hopeful for good news at my follow-up. Reader, I hope you enjoyed the ride, because I did not.