Perianal Abscess

What is Perianal Abscess?

This is a common cause of perianal pain. It usually starts with a small swelling around the anus and quickly becomes painful over a few days. Patients who have diabetes mellitus are predisposed to getting this condition. Another condition that predisposes to an abscess formation is anal fistula (see under anal fistula).

There are several different locations of the abscess but the treatment is usually surgical drainage. Infrequently, when the abscess is very small, antibiotics alone can suffice. After drainage, the wound would be left exposed to heal by secondary intention. 

This process can take a variable amount of time depending on the size/depth of the incision and also longer for immunocompromised patients such as poorly controlled diabetes. Due to the profound influence of diabetes, most will have to be screened for diabetes and for diabetics, their treatment may need to be altered to optimize their healing.

What Causes Perianal Abscess?

The primary cause of perianal abscess is infection. This can be caused by a variety of bacteria, including E. coli, Staphylococcus aureus, and Klebsiella pneumoniae. The infection can enter the tissue around the anus and cause an abscess. 

It can be difficult to determine which type of bacteria is responsible for the infection, but it can be identified by culture. Another cause of perianal abscess is blockage or tear in the area. This can be caused by constipation, hemorrhoids, or conditions like Crohn’s disease. If the blockage is severe, it can cause an abscess to form.

Finally, perianal abscess can also be caused by a sexually transmitted infection (STI). STIs that cause this type of abscess include gonorrhea, chlamydia, and herpes. It’s important to practice safe sex and get tested regularly to help prevent these infections and the formation of an abscess.

By understanding what causes perianal abscess, you can take steps to prevent it and recognize the warning signs. If you do develop an abscess, your doctor can provide the necessary treatment.

Who is at Risk for Perianal Abscess?

Anyone can get perianal abscess, but there are certain groups of people who are more likely to develop them. People who have weakened immune systems, such as those living with HIV or AIDS, are at a higher risk for developing perianal abscesses, as are those on immunosuppressant medications or who have recently undergone chemotherapy. 

People with inflammatory bowel diseases, like Crohn’s disease or ulcerative colitis, and diabetics are also at an increased risk. Toddlers or children that have a history of anal fissures (tears in the anal sphincter) are also at a higher risk for developing anal abscesses later on. Patients with anal fistulas are also predisposed to developing perianal abscess. 

If you think you or your child might be at risk for developing an anal abscess, it is important to speak to your healthcare provider. They will be able to assess your risk factors and provide advice on how to reduce your risk. Your healthcare provider may also be able to recommend treatments for an existing abscess, if one is present. 

If you are experiencing any type of pain or discomfort in the area around your anus and rectum, it is important to speak to your healthcare provider as soon as possible to determine the cause and to receive the appropriate treatment.

What are the Symptoms of Perianal Abscess?

The most common symptom of an anal abscess is a throbbing or constant pain in the anal area, accompanied by swelling and tenderness. Other signs of an abscess include constipation, rectal discharge or bleeding, swelling or tenderness of the skin surrounding the anus, fatigue, fever and chills. 

In some cases, a person may feel a nodule or lump in the anal area, accompanied by redness and tenderness. If the abscess is severe, it can cause fever and chills. It is important to seek medical attention immediately if you experience any of these symptoms. 

How is Perianal Abscess Diagnosed?

The first step of diagnosing perianal abscess is a physical exam. During this exam, the doctor looks for any nodules or lumps in the area. They may also check for pain, redness, and swelling in the anal area and rule out other potential causes for the discomfort. In some cases, the area may not be visibly swollen and the doctor may use an anoscope to look inside the anal canal and lower rectum.

In some cases, the abscess may be deeper and require imaging tests, such as a CT scan, MRI, or ultrasound, to get a better look. If the doctor suspects that Crohn’s disease may be a contributing factor, they may also order blood and stool tests, imaging, and a colonoscopy. A colonoscopy is an outpatient procedure in which a doctor uses a flexible scope with a light to examine the colon and large intestine.

What are Ways to Prevent Perianal Abscess?

Perianal abscesses are painful and can be difficult to treat, so it’s important to take steps to prevent them. Perianal abscesses are caused by bacteria, which can be transmitted through unprotected sex.

It is also important to practice good hygiene in the anal area, as poor hygiene can make it easier for bacteria to enter the body. Keeping the anal area clean and dry can help reduce the risk of an abscess forming.

People who are prone to anal abscesses should also be aware of any underlying conditions that may increase their risk. Those with Crohn’s disease, for example, are more likely to develop an abscess. It’s important to manage Crohn’s disease and other underlying conditions by taking medications as prescribed and making lifestyle changes.

What are the Treatment Options for Perianal Abscess?

The most common treatment for perianal abscess is for a doctor to drain the pus from the infected area. This can usually be done in the doctor’s office with medication to numb the area. Any uncomfortable pressure should be relieved, allowing the tissue to begin healing properly.

If the abscess is too large, surgery with anesthesia may be required to make sure the abscess is completely drained. This type of surgery is usually performed in a hospital and may require a catheter to keep the abscess drained. After the abscess is drained, it is typically left open and doesn’t require stitches.

If you have diabetes or a weakened immune system, your doctor may suggest that you stay in the hospital for a few days to monitor any infection. This is because diabetes and weakened immune systems can make it more difficult for the body to heal after surgery.

No matter what treatment you receive for an anal abscess, it is important to ensure proper hygiene and to follow your doctor’s advice for aftercare. This may include a sitz bath, which is a bath of warm water with a mild antiseptic soap to help reduce swelling and pain.

It is also important to take any medication as prescribed and to keep the area clean and dry. This will help to prevent any infection from recurring. It is important to follow your doctor’s advice and to take any medication as prescribed. With proper care and treatment, an anal abscess can be treated successfully and the discomfort relieved.

Frequently Asked Questions

  • What is the perianal area?

    This refers to the skin and soft tissue around the anus. It consists of the subcutaneous tissue, anal glands and the anal complex. There are many conditions that can occur in this area namely abscess,eczema, fistula, fissure, fungal infection, hemorrhoids and even tumors.

  • Is perianal abscess serious or life threatening?

    Abscess in this area is usually very painful. Many patients usually seek medical attention due to pain or swelling. The use of antibiotics is effective in small abscesses. There are some serious possibilities if left untreated like fournier’s gangrene and septicemia. 

    Most abscesses resolve with a simple incision and drainage of the abscess. When treated, most abscesses are not life threatening. Some patients may be more predisposed to a severe infection like poorly controlled diabetes or immunocompromised.

  • How long does perianal abscess last?

    While on antibiotics, it may take 3 days to 1 week to resolve. Otherwise, without incision and drainage, the tendency is for this abscess to grow in size or spontaneously rupture.

  • Can perianal abscess heal on its own?

    Generally no. Most abscesses will require some form of treatment whether it is antibiotics or operative drainage. However, if it spontaneously rupture, it may not require further drainage and will then likely heal and scar down. 

  • Do I need to visit the ER for a perianal abscess?

    Most patients will go to see a GP or ER as it is very painful. The treatment really depends on the size and location of the perianal abscess. Most GPs would be able to prescribe antibiotics and certain GPs may be able to aspirate an abscess at bedside. However, if the patient is unwell, has poorly controlled diabetes or large abscess, he/she should go to the ER.