See Colorectal Surgeon urgently – get MRI fistulogram or endo-anal ultrasound to confirm fistula. If fistula present – fistulotomy or seton/Ksharsutra is permanent cure (80–90% success). Don’t delay – repeated abscesses can worsen.
Internal Medicines 1 Triphala Guggulu – 2 tablets morning + night after food 2 Bolbaddha Rasa – 2 tablets morning + night after food 3 Gandhak Rasayan – 250 mg morning + night with water (purifies & heals abscess) 4 Abhayarishta – 20 ml + 40 ml warm water after dinner (prevents constipation & strain).
Local Care (daily – key for drainage) Warm sitz bath (hot water + 1 tsp Triphala powder + pinch rock salt) for 15–20 min twice daily (reduces pain & swelling fast) After bath: apply Jatyadi Ghrita on draining area
Diet Give daily: moong khichdi + ghee, pomegranate, papaya, thin buttermilk + roasted jeera Avoid completely: spicy/sour, fasting, heavy pulses, cold drinks (triggers recurrence)
Regards Dr Gursimran Jeet Singh MD Panchakarma
Thank you for explaining the full sequence so clearly ,as history is very important.
what you are describing fits strongly with a recurrent perianal abscess ,with a likely underlying fistula tract ,rather than a simple skin infection .The clues are recurrence from the same site drainage from the old incision point ,temporary relief with antibiotics and surgery and flare ups after fasting or diarrhea.
Antibiotics and neem may reduce surface infection and inflammation but they do not eliminate an internal tract ,if one is present .That is why the abscess subsided initially ,but returned later and why it came back aggressively after fasting .The periods of prolonged fasting and sudden diarrhea can alter gut motility immune response and local bacterial balance increasing pressure and infection in the anal glands ,which can trigger abscess formation again.
The fact that it is now swelling and draining for more than a week from the same incision point strongly suggests that there is a persistent internal connection ,that has not closed .A draining abscess after I&Dfor weeks is not normal healing and should be evaluated further.
At this stage the most important step is proper evaluation by a colorectal surgeon ,preferably with MRI pelvis or endoanal imaging to look for a fistula tract. Repeated antibiotics or fasting will not resolve this and may actually worsen recurrence .Surgery if needed should be targeted to the tract not just drainage.
Until evaluated ,avoid fasting ,avoid diarrhea ,avoid constipation maintain soft regular stools ,good hydration and local hygiene Warm sitz baths can help. If there is fever ,increasing pain ,foul smelling discharge or spreading redness seek care urgently
This is a condition where early correct diagnosis prevents years of recurrence so please do not delay definitive evaluation
Hello, I understand how distressing and frustrating recurrent perianal abscess can be—especially when it keeps returning despite antibiotics and even after incision & drainage (I&D). Repeated flares after fasting, diarrhea, and diet changes strongly suggest that this is not just a simple abscess, but likely has an underlying cause that needs targeted treatment. Based on your history, this pattern is highly suggestive of a perianal fistula or chronic crypt infection, where infection reactivates whenever digestion, bowel movements, or immunity is disturbed.
🩺 Clinical Understanding (What is likely happening) Initial abscess drained → temporary relief Recurrent swelling + discharge from the same incision site → persistent internal tract (fistula-in-ano) Fasting → altered gut flora, dehydration, loose stools → triggers inflammation Diarrhea → increased anal gland irritation → reactivation
⚠️ Antibiotics alone cannot cure a fistula, which is why neem/antibiotics stopped working later.
🔎 Recommended Investigations (Very Important) (If not done already) MRI Pelvis (Fistulogram protocol) – gold standard to detect fistula tract Proctoscopy / Examination by Colorectal Surgeon CBC, ESR, CRP – ongoing infection/inflammation Stool exam – rule out chronic infection or dysbiosis 👉 These will decide whether definitive surgical or medical management is required.
💊 Internal Medicines (Supportive – Not a substitute for surgical care) Phase 1 – 21 days (Reduce infection, support healing, prevent spread) 1.Triphala Guggulu – 2 tablets twice daily after meals 2.Gandhak Rasayan – 1 tablet twice daily after meals 3.Guduchi Ghana Vati – 1 tablet twice daily after meals ⚠️ These help control discharge and inflammation but will not close a fistula tract if present.
Phase 2 – After acute infection settles (Tissue healing + recurrence prevention) 1.Kaishora Guggulu – 2 tablets twice daily 2.Haritaki Churna – ½ tsp at bedtime with warm water (Very important to keep stools soft)
🌿 Local / External Care Sitz Bath – twice daily Warm water + Triphala decoction OR plain warm water 10–15 minutes Local dressing Keep area dry Do not apply random oils/pastes inside the wound Avoid forceful squeezing or probing the area
🥗 Diet & Lifestyle (Key to Prevent Recurrence) ❌ Strictly Avoid Prolonged fasting Sudden diet changes Spicy, oily, fermented foods Diarrhea-triggering foods Dehydration ✅ Include Regular meals (do not skip) High-fiber diet (vegetables, soaked seeds) Plenty of warm water Buttermilk (if tolerated) Soft stools—no straining 👉 Constipation and diarrhea both worsen fistula/abscess.
🧘🏻♂️ Supportive Measures Avoid long sitting Gentle walking Stress management (stress alters gut immunity)
🚨 When Surgery Is Likely Needed You should consult a colorectal surgeon urgently if: Discharge persists beyond 1–2 weeks Swelling keeps recurring MRI confirms fistula
👉 Definitive treatments may include: Fistulotomy Seton placement Advanced procedures (depending on tract type)
Your history strongly points to a chronic fistula-related abscess, triggered by fasting and bowel disturbances. Medicines can control infection, but imaging and specialist evaluation are essential to stop recurrence permanently.
With warm regards, Dr.Sumi MS(Ayu)
Consult with a nearby MS Shalya doctor. Best Treatment option is Kshara sutra ( a para surgical procedure).
Warm Regards Dr.Anjali Sehrawat
It is better you have personal consultation wherein ayurvedic doctor can examine, to see if there is fistula, where there is a cannal, and only opening of the cannal can cure your problem. Meanwhile you can start with Triphala guggul 1-0-1 will help reduce inflammation. Kishore guggul 1-0-1 will help heal . Mahamanjistadi kadha 15 ml twice daily after food with water, as blood purifier, will help prevent infection. Do sitz bath twice daily with betadine drops in the water. Pat dry and apply Kasisadi oil 2-3 times daily. Avoid spicy , fried, foods, sour, fermented foods Avoid nonveg food if non-vegetarian.
You need to get a detailed check up of the abscess. Also you need to keep a watch on what you are consuming that is causing the abscess to reappear.
Make the following changes in your routine and food till than to prevent further deterioration of the condition.
✔️Do’s✔️ Drink buttermilk daily. Eat freshly cooked food. Drink warm water. Lunch and dinner on fixed timings. 100 steps after every meal. If possible dinner as early as 7-8 pm.
🧘♀️ Yogasan : 🧘♀️ 1. Pawanmuktasana 2. Bhujangasana 3. Dhanurasana 4. Paschimottanasana 5. Ardha Matsyendrasana 6. Vajrasana 7. Supta Matsyendrasana
🧘♀️ Pranayam: 🧘♀️ 1. Bhramari 2.Bhasrika 3.Kapalbhati 4.Jyoti Tratak 5. Anulom Vilom
❌Don’ts:❌ Packed and processed food. Ready to eat items. Oily and spicy food. Sour and fermented products. Dals (only moong dal can be eaten) Besan Raw vegetables and sprouts Curd Reduce dairy intake
