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Perianal Abscess

Dr Ganesh Ramalingam

Specialist in General Surgery

Condition

What Is A Perianal Abscess?

“An anal abscess is a painful condition, involving a collection of pus that develops near the anus.”

Dr Ganesh Ramalingam

A perianal abscess may appear red in colour and feels warm when you touch it. Infections of the small anal glands usually cause it. In some instances, the abscess is unable to heal, and tears open on the skin’s surface, which results in a painful anal fistula. The most common and effective way to remove perianal abscess is via surgical incision and drainage.

Table of Contents

Perianal Abscess

What Causes Perianal Abscess?

Some causes of perianal abscess include infection of an anal fistula, blocked anal glands and sexually transmitted infections, which compromises your immune system and makes you more prone to having it. You may have a higher risk of perianal abscess if you have Inflammatory Bowel Disease (IBD) such as Crohn’s disease or ulcerative colitis, constipation and/or diarrhoea, have anal sex, use of steroids such as prednisone or have diabetes.

Most anal abscesses result from an infection of the small anal glands. A perianal abscess is typically a painful boil-like swelling near the anus, and it is the most common type of abscess.

Sharing her experience about managing her perianal abscess, Brittany, a mother to a one-year-old daughter, explains the struggles she faced while managing her condition.

In this particular case, her abscess was left undiagnosed on various occasions by five different physicians. The lack of treatment left the patient in pain for a prolonged period.

“The perianal abscess I had was very painful,” says Brittany. “I couldn’t move or barely walk.” Her condition was not helped as she struggled to find a doctor who would take her symptoms seriously.

What Are The Risk Factors Of A Perianal Abscess?

Certain risk factors increase your chances of developing a perianal abscess.

These factors are:

  • Crohn’s disease or ulcerative colitis (inflammatory bowel diseases)
  • Diabetes
  • A weakened immune system attributed to illnesses such as HIV or AIDS
  • Anal sex
  • Usage of certain medications such as prednisone or other steroids
  • Chemotherapy or history of chemotherapy
  • Constipation
  • Diarrhoea

A perianal abscess is not limited to only adults. They can also affect children and toddlers. This is usually observed in children with a history of anal fissures caused by constipation.

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What Are The Symptoms Or Warning Signs If I Have A Perianal Abscess?

One of the most common symptoms of an anal abscess is the constant pain and throbbing in the anal region. This pain is usually accompanied by swelling in the anal area and may cause greater pain during bowel movements.

Other symptoms may include:

  • Anal discharge or bleeding
  • Fever and chills

Some patients may experience a red, swollen lump that is tender to the touch at the rim of the anus. The infection can result in fever and chills.

You may also experience rectal bleeding or urinary difficulties.

Anal abscesses may also occur deeper and further in the rectum. They are more commonly observed in patients who have inflammatory bowel diseases, which may result in pain or discomfort of the abdominal area as well.

How Can Perianal Abscesses Be Prevented?

While there may be no definite ways to prevent an anal abscess, there are some measures that you can take, which includes:

  • Protection against sexually transmitted diseases (STDs) and seeking prompt treatment if any abnormalities are observed are essential for managing any form of infection.
  • Usage of condom, especially during anal sex, is critical in preventing STDs that may lead anal abscesses.
  • Practising good hygiene and cleanliness in the anal area

While anal abscesses can lead to complications, most conditions are treatable. By understanding the risk factors and managing any health conditions that may increase the risk of developing a perianal abscess, you can seek medical advice from a doctor should you require early intervention and prevent them from worsening.

How Is A Perianal Abscess Diagnosed?

A perianal abscess is most often diagnosed by a physical examination of the affected area. Your doctor may check for pain, redness and swelling in the anal region while observing if further investigations are required.

In some instances of deeper perianal abscesses, where the signs are not immediately visible, an instrument called the endoscope might be used to look inside the anal canal and lower rectum.

Your doctor may also arrange for an imaging test such as a CT scan, ultrasound or MRI. This is such that a more accurate diagnosis can be made.

Further tests such as a blood test, imaging, and a colonoscopy may be required to rule out the possibility of Crohn’s disease. Additionally, your doctor will use a lighted, flexible scope to examine your colon for other signs of growth or infection during a colonoscopy.

What Are The Potential Complications Of A Perianal Abscess?

Complications of a perianal abscess may include:

  • Fever and chills
  • Anal fistula, an abnormal connection between the anus and another structure
  • Sepsis, infection of the blood
  • Persistent pain
  • Recurring abscess in the anal region

In a lawsuit filed by a patient at Thomson Snell & Passmore, it was reported that the patient had to undergo nine surgeries after a hospital failed on two occasions to treat her perianal abscess with antibiotics. Instead, they discharged her without treatment, leading to cellulitis (infection of the skin) and worsening the abscess.

While the patient was treated for her condition by the end of the ordeal, the experience left her scarred.

“A medical specialist should exercise fair judgement when treating a patient’s condition. As with the patient’s case in the case above, careful investigations have to be made when treating an abscess. Doctors may sometimes recommend several examinations to identify and diagnose a condition better.”

Dr Ganesh Ramalingam

How Are Perianal Abscesses Treated?

An anal abscess rarely goes away without proper medical treatment. As with most abscesses, your doctor’s most common approach is to drain the pus from within the infected area. Drainage can usually be done in the doctor’s clinic without the need for surgery. The affected region will be numbed before treatment, and any uncomfortable pressure should be relieved, allowing the tissue to begin to heal properly.

A perianal abscess that is left untreated can lead to severe complications such as the development of anal fistulas which will require more surgical treatment. An anal fistula is an abnormal opening in the skin near the anus, and it is a condition that requires surgery.

For cases where an extensive anal abscess is observed, your doctor may recommend surgery as a treatment option. In some cases, a catheter may also be utilised to make sure the abscess drains completely. Abscesses that have been drained are typically left open to heal and do not require stitches.

After surgery, your doctor may recommend some additional self-care advice to ease the pain, such as taking warm baths. Sitting in warm water will aid in reducing the swelling and allow for more drainage of the abscess.

Antibiotics may also be prescribed if you have a compromised immune system or if the infection has spread.

Recounting his experience with what he calls an enormously painful perianal abscess, Brandon shares his story with Crohn’s & Colitis Foundation.

“In November of 2014, an enormously painful half-dollar sized perianal abscess took me by surprise. At the time, I had no idea what an abscess was,” Brandon recounts.

He was directed to a colorectal surgeon who attempted to cut and drain the abscess.

Following two different surgical attempts, Brandon consulted another surgeon. By then, his condition had worsened, the abscess had manifested into an intersphincteric fistula.

When Should Surgery For Perianal Abscess Be Considered?

Perianal abscesses do not often go away without treatment. If left untreated, it may develop into more severe conditions such as anal fistulas which are painful and require more extensive surgical treatment. It is estimated that 50 per cent of these abscesses develop into anal fistulas.

Perianal abscess surgery is the most common and effective method to drain abscesses completely to prevent discomfort for the patient. This is why it is essential to undergo prompt surgical drainage before the abscess erupts.

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