instruction: doctors are switching between whether I have crowns or ulcerative colitis based off response to treatment and medicine started humira last month but it has come in for my and round and it is already a month late wont know if that worked or not since I am off schedule this past week the area around my rectum with is very raw has swelled up its around where I have the sexton in from a fistula past week my bowels have nothing but liquids every time I go to the bathroom is expands that area where the sexton is causing excruciating pain I am currently on imodium and flagil I have taken anvil and tylenol nothing has reduced the pain
output: hello I welcome you to icliniq I know you must be very upset about your ongoing condition you symptoms suggest that you have crowns disease not ulcerative colitis humira and biologic medications like this work for a while before losing effect till the time of next dose so yes if the interval between two doses is extended the patient can develop flare in interval period the symptoms you mention may be of a mild to moderate intensity flare but can be secondary to infections the clostridium difficile infection which is common you did not mention that the pain in area of where you have sexton is new or occurring before as well and when did you have sexton for fistula the swelling you mention can be an evolving perianal abscess due to active lumnial disease the abscess formation is the first step in the formation of fistula which is a end result due to rupture of abscess from both side lumen on one side and skin on other side so I am afraid you me have this flagyl is good if taken for long time to treat perianal disease but you did not mention for how long you been using this for now you can continue this and get yourself examined by your physician to look for evolving abscess adalimumab humira works well for perianal disease but make sure you need to increase the frequency and do not disturb the schedule I hope this will help take care crowns disease with perianl disease stool for difficile antigen and stool for calprotectin stool detail report stool culture