What are the symptoms of an anal abscess. How is an anal abscess diagnosed. What causes anal abscesses. What are the treatment options for anal abscesses. How can anal abscesses be prevented. What is the connection between anal abscesses and fistulas. What are the potential complications of anal abscess surgery.

Understanding Anal Abscesses: Definition and Types

An anal abscess is a painful condition characterized by a collection of pus that develops near the anus. These abscesses typically result from infections in small anal glands. The most common type is a perianal abscess, which presents as a painful, boil-like swelling near the anus, often red in color and warm to the touch. Deeper anal abscesses, while less common, can also occur and may be less visible.

Anal abscesses can be classified based on their location:

• Perianal: Located just beneath the skin around the anus
• Ischiorectal: Develops in the deep tissue on either side of the anal canal
• Intersphincteric: Forms between the internal and external anal sphincter muscles
• Supralevator: Occurs above the pelvic floor muscles

Recognizing the Symptoms of Anal Abscesses

Identifying the symptoms of an anal abscess is crucial for early diagnosis and treatment. The manifestations can vary depending on the abscess’s location and severity.

Common Symptoms of Superficial Anal Abscesses

• Constant, throbbing pain, exacerbated when sitting
• Skin irritation around the anus, including swelling, redness, and tenderness
• Discharge of pus
• Constipation or pain associated with bowel movements

Symptoms of Deeper Anal Abscesses

• Fever and chills
• Fatigue
• General malaise

In some cases, fever may be the only symptom of deep anal abscesses, making them more challenging to diagnose without further investigation.

Causes and Risk Factors of Anal Abscesses

Understanding the causes and risk factors of anal abscesses can help in prevention and early intervention. What causes anal abscesses? Several factors can contribute to their development:

• Blocked anal glands
• Anal fissures (tears in the anal canal) that become infected
• Sexually transmitted infections
• Inflammatory bowel diseases like Crohn’s disease
• Compromised immune system
• Diabetes
• Use of medications that suppress the immune system

Risk factors that increase the likelihood of developing anal abscesses include:

• Chronic constipation
• Diarrhea
• Inflammatory bowel diseases
• Sexually transmitted infections
• Anal intercourse
• Use of foreign objects in the anal canal

Diagnostic Procedures for Anal Abscesses

Accurate diagnosis is essential for effective treatment of anal abscesses. How is an anal abscess diagnosed? The process typically involves:

1. Clinical evaluation: A thorough physical examination, including a digital rectal exam
2. Medical history review: Discussion of symptoms, past medical conditions, and lifestyle factors
3. Additional tests: In some cases, further investigations may be necessary to confirm the diagnosis or rule out other conditions

Additional diagnostic procedures may include:

• Anoscopy or proctoscopy: Examination of the anal canal and lower rectum using a small, lighted tube
• Ultrasound: Imaging technique using sound waves to visualize internal structures
• CT scan: Advanced imaging that provides detailed cross-sectional views of the affected area
• MRI: Magnetic resonance imaging for high-resolution images of soft tissues

In rare cases, an examination under anesthesia may be required for a more thorough assessment.

Treatment Options for Anal Abscesses

What are the treatment options for anal abscesses? The primary treatment for anal abscesses is surgical drainage, which is usually successful in resolving the condition. The procedure involves:

1. Making an incision to allow the pus to drain
2. Cleaning the abscess cavity
3. Leaving the wound open to promote healing from the inside out

The type of surgical approach depends on the abscess’s location:

• Superficial abscesses: Can often be drained in a doctor’s office under local anesthesia
• Deeper abscesses: May require hospitalization and general anesthesia

Post-surgical care typically includes:

• Pain medication to manage discomfort
• Sitz baths (warm water soaks) 3-4 times daily to promote healing
• Stool softeners to ease bowel movements
• Gauze pads or mini-pads to manage drainage

Antibiotics are not usually necessary for otherwise healthy individuals but may be prescribed for patients with diabetes, decreased immunity, or extensive cellulitis.

The Connection Between Anal Abscesses and Fistulas

What is the connection between anal abscesses and fistulas? Approximately 50% of patients with an anal abscess will develop a complication known as a fistula. An anal fistula is a small tunnel that creates an abnormal connection between the site of the abscess and the skin.

Fistulas can manifest in two ways:

1. Persistent drainage from the site of the previous abscess
2. Recurrent anal abscesses if the external opening of the tunnel closes

Treatment of anal fistulas:

• Surgery is typically required to cure anal fistulas
• Fistula surgery may be performed simultaneously with abscess drainage or as a separate procedure
• The timing of fistula surgery depends on the individual case, as fistulas can develop weeks, months, or even years after the initial abscess

Prevention Strategies for Anal Abscesses

How can anal abscesses be prevented? While not all cases of anal abscesses can be prevented, certain measures can reduce the risk:

• Practice good anal hygiene
• Treat constipation and diarrhea promptly
• Manage underlying conditions like inflammatory bowel disease or diabetes
• Use condoms during sexual intercourse, including anal intercourse
• Avoid inserting foreign objects into the anal canal

For infants and toddlers, prevention strategies include:

• Frequent diaper changes
• Proper cleaning during diaper changes
• Prompt treatment of diaper rash

Potential Complications and Long-term Outlook

What are the potential complications of anal abscess surgery? While surgical treatment of anal abscesses is generally successful, complications can occur:

• Infection at the surgical site
• Fecal incontinence (rare)
• Recurrence of the abscess
• Development of a fistula

Long-term outlook:

• Most patients recover completely with proper treatment
• The risk of recurrence is low if the abscess is treated promptly and correctly
• Regular follow-up with a healthcare provider is important to monitor for complications or recurrence

To minimize the risk of complications and ensure the best possible outcome, it’s crucial to follow the post-operative care instructions provided by your healthcare provider. This may include maintaining proper hygiene, attending follow-up appointments, and reporting any unusual symptoms promptly.

Advancements in Anal Abscess Management

Research in the field of colorectal surgery continues to improve the management of anal abscesses and fistulas. Some recent advancements include:

• Minimally invasive techniques for drainage and fistula repair
• Use of biological sealants in fistula treatment
• Improved imaging techniques for more accurate diagnosis and treatment planning
• Development of sphincter-sparing procedures to reduce the risk of incontinence

These advancements aim to improve treatment outcomes, reduce recovery time, and minimize the risk of complications. As research progresses, patients can expect even more effective and less invasive treatment options in the future.

Living with and Managing Anal Abscesses

For individuals who have experienced an anal abscess, ongoing management and lifestyle adjustments may be necessary to prevent recurrence and maintain anal health:

• Maintain a high-fiber diet to promote regular bowel movements
• Stay well-hydrated to prevent constipation
• Practice good anal hygiene, including gentle cleaning after bowel movements
• Avoid prolonged sitting, especially on hard surfaces
• Manage stress, as it can exacerbate digestive issues
• Regularly perform Kegel exercises to strengthen pelvic floor muscles

It’s important to maintain open communication with your healthcare provider and report any new or concerning symptoms promptly. Regular check-ups can help detect any potential issues early, allowing for timely intervention and better outcomes.

The Psychological Impact of Anal Abscesses

The experience of an anal abscess can have significant psychological effects on patients. These may include:

• Embarrassment or shame due to the location of the condition
• Anxiety about potential recurrence or complications
• Depression related to chronic pain or lifestyle limitations
• Body image concerns, particularly if surgery results in scarring

Addressing these psychological aspects is crucial for comprehensive care. Healthcare providers should be prepared to offer emotional support and referrals to mental health professionals when necessary. Support groups or online communities for individuals with similar experiences can also be valuable resources for coping and sharing information.

Special Considerations for High-Risk Groups

Certain populations may be at higher risk for developing anal abscesses or experiencing complications:

Patients with Inflammatory Bowel Disease (IBD)

Individuals with Crohn’s disease or ulcerative colitis have an increased risk of developing perianal complications, including abscesses and fistulas. Management of these patients often requires a multidisciplinary approach involving gastroenterologists and colorectal surgeons.

Immunocompromised Patients

Those with weakened immune systems, such as HIV/AIDS patients or individuals undergoing chemotherapy, may be more susceptible to anal abscesses and may require more aggressive treatment and closer monitoring.

Diabetic Patients

Diabetes can impair wound healing and increase the risk of infections. Diabetic patients with anal abscesses may require more intensive care and blood sugar management during treatment.

Pregnant Women

Pregnancy can increase the risk of anal problems due to hormonal changes and increased pressure on the pelvic area. Treatment of anal abscesses during pregnancy requires careful consideration of both maternal and fetal health.

For these high-risk groups, early detection, prompt treatment, and close follow-up are essential to prevent complications and ensure optimal outcomes.

The Role of Nutrition in Anal Health

While nutrition alone cannot prevent anal abscesses, maintaining a healthy diet can contribute to overall anal and digestive health, potentially reducing the risk of complications:

• High-fiber foods: Promote regular bowel movements and prevent constipation
• Adequate hydration: Helps soften stools and prevent straining during defecation
• Probiotic-rich foods: May help maintain a healthy balance of gut bacteria
• Omega-3 fatty acids: Have anti-inflammatory properties that may benefit overall digestive health
• Avoiding irritants: Limiting spicy foods, caffeine, and alcohol can reduce anal irritation in sensitive individuals

It’s important to note that dietary needs can vary among individuals, especially those with underlying conditions like IBD. Consulting with a registered dietitian can help develop a personalized nutrition plan that supports anal and digestive health.

Future Directions in Anal Abscess Research and Treatment

The field of colorectal surgery continues to evolve, with ongoing research aimed at improving the diagnosis, treatment, and prevention of anal abscesses and related conditions:

• Development of novel diagnostic tools for early detection of abscesses and fistulas
• Exploration of regenerative medicine approaches, such as stem cell therapy, for fistula repair
• Investigation of new antimicrobial treatments to prevent abscess formation
• Research into the genetic factors that may predispose individuals to anal abscesses and fistulas
• Advancements in minimally invasive surgical techniques to reduce recovery time and improve outcomes

As research progresses, patients can expect more personalized treatment approaches and potentially new preventive strategies for anal abscesses and related complications. Staying informed about these developments and maintaining open communication with healthcare providers can help individuals make informed decisions about their care and contribute to better long-term outcomes.

Anal Abscess: Symptoms, Causes, and Treatments

An anal abscess is a painful condition in which a collection of pus develops near the anus. Most anal abscesses are a result of infection from small anal glands.

The most common type of abscess is a perianal abscess. This often appears as a painful boil-like swelling near the anus. It may be red in color and warm to the touch. Anal abscesses located in deeper tissue are less common and may be less visible.

Surgical incision and drainage is the most common treatment for all types of anal abscesses and is usually successful.

About 50% of patients with an anal abscess will develop a complication called a fistula. A fistula is a small tunnel that makes an abnormal connection between the site of the abscess and the skin.

In some cases, an anal fistula causes persistent drainage. In other cases, where the outside of the tunnel opening closes, the result may be recurrent anal abscesses. Surgery is needed to cure almost all anal fistulas.

Causes of Anal Abscesses

An anal abscess can have many different causes. These include:

• An anal fissure, a tear in the anal canal, that becomes infected
• Sexually transmitted infections
• Blocked anal glands

Risk factors for anal abscesses include:

For adults, using condoms during sexual intercourse, including anal intercourse, can help prevent anal abscesses. For infants and toddlers, frequent diaper changes and proper cleaning during diaper changes can help prevent anal fistulas and perianal abscesses.

Symptoms of Anal Abscesses

Superficial anal abscesses are often associated with:

• Pain, which is usually constant, throbbing, and worse when sitting down
• Skin irritation around the anus, including swelling, redness, and tenderness
• Discharge of pus
• Constipation or pain associated with bowel movements

Deeper anal abscesses may also be associated with:

Sometimes, fever is the only symptom of deep anal abscesses.

Diagnosis of Anal Abscesses

Usually, a clinical evaluation — including a digital rectal exam — is sufficient to diagnose an anal abscess. But some patients may require additional tests to screen for:

In rare cases, an examination may be done under anesthesia. The doctor may also ask for an ultrasound, a CT scan, or an MRI.

Treatment of Anal Abscesses

Prompt surgical drainage is important, preferably before the abscess erupts. Superficial anal abscesses can be drained in a doctor’s office using a local anesthetic. Large or deeper anal abscesses may require hospitalization and the assistance of an anesthesiologist.

After the procedure, most people are prescribed medications for pain relief. For otherwise healthy people, antibiotics are usually not needed. Antibiotics may be required, though, for some people, including those with diabetes or decreased immunity.

Sometimes, fistula surgery can be performed at the same time as abscess surgery. However, fistulas often develop four to six weeks after an abscess is drained. Sometimes a fistula may not occur until months or even years later. So fistula surgery is usually a separate procedure that can be performed on an outpatient basis or with a short hospital stay.

After abscess or fistula surgery, discomfort is usually mild and can be controlled with pain medications. People can expect to lose only a minimal amount of time from work or school.

People are usually advised to soak the affected area in a warm water (sitz) bath three or four times per day. Stool softeners may be recommended to ease the discomfort of bowel movements. Some people may be advised to wear a gauze pad or mini-pad to prevent the drainage from soiling their clothes.

Complications after surgery can include:

After an anal abscess or fistula has properly healed, it’s unlikely that the problem will come back. To prevent one from doing so, however, it’s important to follow the advice of your doctor or colon and rectal surgeon.

Abscess and Fistula Expanded Information

WHAT IS AN ANAL ABSCESS OR FISTULA?

An anal abscess is an infected cavity filled with pus found near the anus or rectum.  Ninety percent of abscesses are the result of an acute infection in the internal glands of the anus. Occasionally, bacteria, fecal material or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, where it may then collect in a cavity called an abscess.  

An anal fistula (also commonly called fistula-in-ano) is frequently the result of a previous or current anal abscess. This occurs in up to 40% of patients with abscesses. A fistula is an epithelialized tunnel that connects a clogged gland inside the anal canal to the outside skin. 

CLASSIFICATION

Anal abscesses are classified by their location in relation to the structures comprising and surrounding the anus and rectum: perianal, ischioanal, intersphincteric and supralevator. The perianal area is the most common and the supralevator the least common. If any of these particular types of abscess spreads partially circumferentially around the anus or the rectum, it is termed a horseshoe abscess.

Fistulas are classified by their relationship to parts of the anal sphincter complex (the muscles that allow us to control our stool). They are classified as intersphincteric, transsphincteric, suprasphincteric and extrasphincteric. The intersphincteric is the most common and the extrasphincteric is the least common. These classifications are important in helping the surgeon make treatment decisions.

SYMPTOMS

Anorectal pain, swelling, perianal cellulitis (redness of the skin) and fever are the most common symptoms of an abscess. Occasionally, rectal bleeding or urinary symptoms, such as trouble initiating a urinary stream or painful urination, may be present. 

Patients with fistulas commonly have a history of a previously drained anal abscess. Anorectal pain, drainage from the perianal skin, irritation of the perianal skin, and sometimes rectal bleeding, can be presenting symptoms of a fistula-in-ano.

EXAMINATION

A careful history regarding anorectal symptoms and past medical history are necessary, followed by a physical examination. Common findings leading to the diagnosis of a perirectal abscess are fever, redness, swelling and tenderness to palpation. However, while most abscesses are visible on the outside of the skin around the anus, it is important to recognize that there may be no external manifestation of an abscess, other than a complaint of rectal pain or pressure.  A digital rectal exam may cause exquisite pain.  

When diagnosing an anal fistula, an external opening that drains pus, blood or stool is usually seen on examination. Heaped up tissue at the external opening suggests a well-established fistula. A digital rectal exam may produce pus from the external opening. Some fistulas will close spontaneously and the drainage may be intermittent, making them hard to identify at the time of the office visit. A ‘cord’ or tract can be occasionally palpated from the external opening toward the anal canal indicated where an internal opening of the fistula may be.  

USE OF DIAGNOSTIC STUDIES

Most anal abscesses and fistula-in-ano are diagnosed and managed on the basis of clinical findings. Occasionally, additional studies can assist with the diagnosis or delineation of the fistula tract. Today, both traditional two-dimensional and three-dimensional endoanal ultrasound are a very effective manner of diagnosing a deep perirectal abscess, identifying a horseshoe extension of the abscess, and delineating the path of a fistula tract. This may be combined with hydrogen peroxide injection into the fistula tract (via the external opening) to increase accuracy. CT scans can be useful for patients with complicated infections, multiple fistula tracts or with other medical conditions which may present similarly, such as Crohn’s disease.  A pelvic MRI has been shown to have accuracy up to 90% for mapping the fistula tract and identifying internal openings.

TREATMENT OF ANAL ABSCESS

The treatment of an abscess is surgical drainage under most circumstances. An incision is made in the skin near the anus to drain the infection. This can be done in a doctor’s office with local anesthetic or in an operating room under deeper anesthesia. Hospitalization and antibiotics may be required for patients prone to more significant infections, such as diabetics or patients with decreased immunity.

Up to 50% of the time after an abscess has been drained, a tunnel (fistula) may persist, connecting the infected anal gland to the external skin. This typically will involve some type of drainage from the external opening. If the opening on the skin heals when a fistula is present, a recurrent abscess may develop.  Until the fistula is eliminated, many patients will have recurring cycles of pain, swelling and drainage, with intervening periods of apparent healing.

Antibiotics alone are a poor alternative to drainage of the infection. The routine addition of antibiotics to surgical drainage does not improve healing time or reduce the potential for recurrences in uncomplicated abscesses. There are some conditions in which antibiotics are indicated, such as patients with compromised or altered immunity or in the setting of extensive cellulitis (spreading of infection in the skin).  The American Heart Association recommends the use of antibiotics for patients with prosthetic valves, previous bacterial endocarditis, congenital heart disease and heart transplant recipients with valvular pathology.  A comprehensive discussion of your past medical history and a physical exam are important to determine if antibiotics are indicated.

TREATMENT OF ANAL FISTULA

Currently, there is no medical treatment available for this problem and surgery is almost always necessary to cure an anal fistula. If the fistula is straightforward (involving minimal sphincter muscle), a fistulotomy may be performed. This procedure involves unroofing the tract, thereby connecting the internal opening within the anal canal to the external opening and creating a groove that will heal from the inside out.  

The surgery may be performed at the same time as drainage of an abscess, although most commonly the fistula doesn’t become obvious until weeks after the initial drainage. Fistulotomy is a long-standing treatment with a high success rate (92-97%). This high success rate must be balanced, however with risk of incontinence (ability to control stool) that comes with division of the anal sphincter muscle. Small amount of muscle can usually be safely divided to treat the anal fistula without compromising continence. Therefore, the surgeon must assess whether a fistulotomy is appropriate for a given patient. 

In addition to fistulotomy, there are a number of other surgical treatment options for anal fistula which do not involve division of the sphincter muscles.  The two most common procedures utilized in these patients are the endoanal advancement flap and the LIFT procedure.  

An endoanal advancement flap is a procedure usually reserved for complex fistulas or for patients with an increased potential risk for suffering incontinence from a traditional fistulotomy. In this procedure, the internal opening of the fistula is covered over by healthy, native tissue in an attempt to close the point of origin of the fistula. Recurrence rates have been reported to be up to 50% of cases.  Certain conditions, such as Crohn’s disease, malignancy, radiated tissue and previous attempts at repair, and smoking, increase the likelihood of failure. Although the sphincter muscle is not divided in this procedure, mild to moderate incontinence has still been reported. 

Another non-sphincter dividing treatment for anal fistula is the LIFT (ligation of the intersphincteric fistula tract) procedure.  This procedure involves division of the fistula tract in the space between the internal and external sphincter muscles. This procedure avoids division of the sphincter muscle, and has similar success rate of an endoanal advancement flap. 

Most of the operations can be performed on an outpatient basis, but in selected cases, may require hospitalization.  Consider identifying a specialist in colon and rectal surgery who will be familiar with a number of potential operations to treat the fistula. 

WHAT IS A SETON?

As mentioned above, if a significant amount of sphincter musculature is involved in the fistula tract, a fistulotomy may not be recommended as the initial procedure. Your surgeon may recommend the initial placement of a draining seton.  This is often a thin piece of rubber or suture which is placed through the entire fistula tract and the ends of the seton (or drain) are brought together and secured, thereby forming a ring around the anus involving the fistula tract.  The seton may be left in place for 8-12 weeks (or indefinitely in selected cases), with the purpose of providing controlled drainage, thereby allowing all the inflammation to subside and form a solid tract of scar along the fistula tract.  This is associated with minimal pain and you can still have normal bowel function with a seton in place. Once all the inflammation has resolved, and a mature tract has formed, one may consider all the various surgical options detailed above as staged procedures.  

TREATMENT OF FISTULAS IN CROHN’S DISEASE

Fistula-in-ano is very common in Crohn’s disease, which is a chronic inflammatory condition that can affect any part of the gastrointestinal tract. Patients with Crohn’s disease are at increased risk for fecal incontinence because anorectal Crohn’s disease tends to recur and may lead to multiple operations involving the sphincter muscle.  It is important to acknowledge that the primary treatment of Crohn’s perianal fistulas is medical, with surgery reserved for treating infection and, occasionally, as a supplement to medical therapy. The treatment should be individualized to the specific patient and incorporate factors that may decrease the potential for fecal incontinence.  

WHAT IS THE RECOVERY LIKE FROM SURGERY?

Pain after surgery is controlled with pain medication, fiber, and water. Patients should plan for time at home using sitz baths and avoiding the constipation that can be associated with prescription pain medication.  Discuss with your surgeon the specific care and time away from work prior to surgery to prepare yourself for post-operative care. 

CAN THE ABSCESS OR FISTULA RECUR?

As previously mentioned, up to 50% of abscesses may re-present as another abscess or as a frank fistula.  Despite proper treatment and apparent complete healing, fistulas can potentially recur, with recurrence rates dependent upon the particular surgical technique utilized.  Should similar symptoms arise, suggesting recurrence, it is recommended that you find a colon and rectal surgeon to manage your condition.  

WHAT IS A COLON AND RECTAL SURGEON?

Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so. 

DISCLAIMER

The American Society of Colon and Rectal Surgeons is dedicated to ensuring high-quality patient care by advancing the science, prevention and management of disorders and diseases of the colon, rectum and anus. These brochures are inclusive but not prescriptive.  

Their purpose is to provide information on diseases and processes, rather than dictate a specific form of treatment. They are intended for the use of all practitioners, health care workers and patients who desire information about the management of the conditions addressed. It should be recognized that these brochures should not be deemed inclusive of all proper methods of care or exclusive of methods of care reasonably directed to obtain the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of all the circumstances presented by the individual patient.  

Anorectal Abscess | Cedars-Sinai

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What is an anorectal abscess?

An abscess is a pocket of pus from an infection. An anorectal
abscess occurs in the area of the anus or rectum. The anus is the last part of your
digestive tract. It’s at the end of your rectum. It has a ring of muscle (sphincter)
that opens during a bowel movement to allow stool (feces) to pass through. There are
many glands within the anus. If one of these glands gets clogged, it can get
infected. An abscess may then form.

What causes an anorectal abscess?

An abscess in this area is usually caused by a clogged anal gland.
It may be clogged with bacteria or stool.

Who is at risk for an anorectal abscess?

Anorectal abscess occurs more often in men than in women. It
usually happens between ages 20 and 60, with the average age being 40.

A person is more at risk for anorectal abscess if they have any of
the below:

• Inflammatory bowel disease (IBD) such as Crohn’s
  disease
• Certain medicines, such as chemotherapy for cancer
• Objects placed in the rectum, such as during sex
• Medicines that suppress the immune system after an organ
  transplant
• Pregnancy
• Diabetes
• Anal fissure that doesn’t heal, from constipation
• Sexually transmitted infections (STI)

What are the symptoms of an anorectal abscess?

Symptoms can occur a bit differently in each person. They can
include:

• Severe pain or discomfort near the anus. The pain is
  constant. But it may not happen with a bowel movement.
• Tiredness
• Fever
• Night sweats
• Constipation
• Painful bowel movements
• Swelling or redness near the anus
• Lump or painful, hardened tissue near the anus
• Pain in the lower belly (abdomen)
• Fluid or pus leaking from the anus or buttocks

The symptoms of an anorectal abscess may look like other health
conditions. See your healthcare provider for a diagnosis.

How is an anorectal abscess diagnosed?

Your healthcare provider will ask about your symptoms and health
history. They will give you a physical exam. The physical exam will include your
anal area. You may also have:

• Digital rectal exam. The
  healthcare provider may gently put a gloved, lubricated finger into your anus. A
  tool called a speculum may also be used. It is inserted into the anus and gently
  expanded. This lets your provider see more of the anal area.
• Proctosigmoidoscopy
  (sigmoidoscopy).
  A flexible tube with a light and a tiny camera is
  placed in the anus. This lets your healthcare provider look at the area.
• Imaging test. You may also
  have an MRI, CT scan, or ultrasound (sonogram). One of these tests may be done
  to find the exact location of the abscess.

How is an anorectal abscess treated?

Treatment will depend on your symptoms, your age, and your general
health. It will also depend on how severe the condition is. In some cases, you may
need a full anorectal exam under anesthesia. This is to let your healthcare provider
decide the best treatment. Treatment may include:

• Draining the abscess. The
  healthcare provider will make an incision in the skin near the anus so the pus
  can drain. This eases the pressure and lets the tissues heal. This can be done
  in a healthcare provider’s office. If you have a large or deep abscess, you may
  need to be in the hospital and possibly have surgery under general anesthesia.
  You may also need to be in the hospital if your immune system is weak and you
  get infections easily.
• Local anesthesia. This can
  help ease pain.
• Antibiotic medicine. In
  some cases, your healthcare provider may prescribe antibiotics. This medicine
  treats infection. But antibiotics alone are often not helpful. This is why
  drainage is very important.

Talk with your healthcare providers about the risks, benefits, and
possible side effects of all treatments.

What are possible complications of an anorectal
abscess?

Many people with an anorectal abscess develop an anal fistula.
This is a small tunnel that opens up between the inside of the anus and the skin
next to the anus. Pus from the abscess seeps out of this tunnel. A fistula often
needs be fixed with surgery.

Other possible complications include:

• Pain
• Infection
• The abscess comes back

How can I prevent an anorectal abscess?

You can reduce your chances of having this condition by managing
diabetes, STIs, and other risk factors. If you have IBD, you may need medicine to
help prevent anorectal problems such as an abscess.

When should I call my healthcare provider?

Call your healthcare provider if you have pain, discomfort, or
swelling in the anus or rectum.

Key points about anorectal abscesses

• An abscess is a pocket of pus from an infection. There are
  many glands within the anus. If one of these glands gets clogged, it can get
  infected. An abscess may then form.
• Symptoms can include pain and fever.
• You are more at risk for an anorectal abscess if you are
  pregnant, or if you have diabetes or IBD.
• You may have a digital rectal exam and a
  proctosigmoidoscopy.
• The abscess may be drained in a healthcare provider’s office
  or in the hospital.
• Many people with an anorectal abscess develop an anal
  fistula. This is a small tunnel that opens up between the inside of the anus and
  the skin next to the anus. A fistula often needs be repaired with surgery.

Next steps

Tips to help you get the most from a visit to your healthcare
provider:

• Know the reason for your visit and what you want to
  happen.
• Before your visit, write down questions you want
  answered.
• Bring someone with you to help you ask questions and
  remember what your provider tells you.
• At the visit, write down the name of a new diagnosis and any
  new medicines, treatments, or tests. Also write down any new instructions your
  provider gives you.
• Know why a new medicine or treatment is prescribed and how
  it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the
  results could mean.
• Know what to expect if you do not take the medicine or have
  the test or procedure.
• If you have a follow-up appointment, write down the date,
  time, and purpose for that visit.
• Know how you can contact your provider if you have
  questions.

Medical Reviewer: Jen Lehrer MD

Medical Reviewer: Ronald Karlin MD

Medical Reviewer: Raymond Kent Turley BSN MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Department of Surgery – Perianal and Perirectal Abscess/Fistula

What causes perianal abscess?

Perianal abscess is a superficial infection that appears as a tender red lump under the skin near the anus. The infection occurs when bacteria gets trapped in the crypt glands that line the anal canal.  The bacteria and fluid (pus) build up and becomes a lump that is red and painful (like a “pimple”). This type of abscess happens most often in male babies under a year of age. It may drain pus on its own and then heal and disappear.   

What causes perirectal abscess?

Perirectal abscess is different from perianal abscess. Perirectal abscess is an infection that is deep and tracks up along the rectum into the pelvis and are very rare in healthy newborns and children.  These deep abscesses can be found in various locations in the pelvis (see figure) and can be associated with inflammatory bowel disease, such as Crohn’s disease.  

What is a fistula?

Perianal and perirectal abscesses can be associated with fistula development.  Fistula is a tube-like connection between the space inside the anus (anal canal or rectum) and the skin outside the anus.  Once a fistula forms, bacteria from the intestine becomes trapped and causes the infection to return. Fistula that forms from perianal abscess is superficial. Fistula that forms from perirectal abscess is deep and can track through the different layers of the pelvic floor muscle and anal sphincter muscle complex. 

How is perianal or perirectal abscess diagnosed?

Perianal abscess is diagnosed on physical examination.  No other imaging study is necessary. Babies can be irritable and fussy.  The abscess may be firm, red, and tender to the touch.   If left untreated, the infection can spread locally to the buttock area. 

Children with perirectal abscess can appear sicker with fever and pain. The location of the abscess can be not determined by physical examination and requires additional X-ray study, either CT scan or MRI of the pelvis. 

How is perianal abscess/fistula treated?

Perianal abscess can sometimes be treated at home with Sitz baths or warm water soaks with each bowel movement or at least 2-3 times a day. The abscess can drain pus on its own and then heal without needing any other treatment.  When the infection has spread locally to the surrounding buttock area, antibiotics are prescribed to treat the skin infection. In addition, an abscess that does not drain by itself may need to be drained in the office by the pediatric surgeon. This may be all that is needed to treat the abscess and allow the skin to heal permanently. Perianal abscess may return and require repeated warm water soaks or drainage. However, in most healthy babies, the problem will go away completely at one year of age.  

For those babies who have repeat infections, there may be a fistula that has formed and is causing bacteria contamination and abscess development. Your child’s pediatric surgeon will discuss the option of fistulotomy. This an operation that is done in the operating room with your child under general anesthesia.  The operation is an outpatient procedure and your child will go home the same day. During the operation, the pediatric surgeon identifies the opening in the anal canal that connects to the opening in the skin.  The tube-like connection is cut opened.  The incision that is made during the fistulotomy is left open and not closed with stitches. This open wound will heal and close by itself in one to two weeks. While the area is healing, no infection will occur in the wound, even though your child has bowel movements. You can help keep the area clean by giving your child a warm bath after every bowel movement. This will clean and soothe the area while it is healing. Antibiotic is not needed at this time.  Prescription pain medication is not routinely required after this operation. Children usually only need acetaminophen (Tylenol®) or ibuprofen (Motrin®) once they are at home.

How is perirectal abscess/fistula treated?

Location and size of the perirectal abscess determines what needs to be done to the treat the infection. When the abscess is small, antibiotics alone are enough to treat the infection.  However, when the abscess is large, in addition to antibiotics, the infection will need to be drained.  Drainage procedure can be done by radiologist who will place a drain (small plastic tube) into the abscess to drain the pus.  The infection can also be drained by the pediatric surgeon in the operating room. The type of procedure that is done will depend on the location of the abscess.  Both types of procedure are done with your child under general anesthesia.  After the procedure, your child will be admitted to the hospital for a few days until the infection has resolved.  Sometimes, patients are discharged home with drain in the place, which can be removed in the clinic.  

Perirectal abscess can be associated with fistula. The fistula can be identified on the CT or MRI scan that was used to diagnose the perirectal abscess.  If perirectal abscess or fistula is identified, your child will need to be seen by pediatric gastroenterologist to be evaluated for inflammatory bowel disease. If your child is diagnosed with inflammatory bowel disease, medications will be prescribed to treat the inflammation and allow the fistula to heal.  In some occasions, the fistula stays open and continues to cause abscess formation.  To prevent future abscess, your child’s pediatric surgeon may recommend an operation to place a Seton (thin rubber band) through the fistula to prevent bacteria and pus from building up.  After this operation, your child can go home the same day or may need to be admitted in the hospital for a few days depending on the extent and how deep the fistula is located.  The Seton can remain in place for few months. The decision to remove the Seton is determined by your child’s pediatric gastroenterologist and pediatric surgeon.  When the Seton needs to be removed, removal can be done in clinic.  

What are the signs and symptoms of anorectal abscess?

Author

Andre Hebra, MD Chief Medical Officer, Nemours Children’s Hospital; Professor of Surgery, University of Central Florida College of Medicine

Andre Hebra, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Pediatric Surgical Association, Children’s Oncology Group, Florida Medical Association, International Pediatric Endosurgery Group, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoendoscopic Surgeons, South Carolina Medical Association, Southeastern Surgical Congress, Southern Medical Association

Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, MSc, DSc, AGAF Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, Professor, Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow; Fellow of the Royal Society of Medicine

John Geibel, MD, MSc, DSc, AGAF is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Nothing to disclose.

Acknowledgements

Marc D Basson, MD, PhD, MBA, FACS Professor, Chair, Department of Surgery, Assistant Dean for Faculty Development in Research, Michigan State University College of Human Medicine

Marc D Basson, MD, PhD, MBA, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Gastroenterological Association, Phi Beta Kappa, and Sigma Xi

Disclosure: Nothing to disclose.

Michael S Beeson, MD, MBA, FACEP Professor of Emergency Medicine, Northeastern Ohio Universities College of Medicine and Pharmacy; Attending Faculty, Akron General Medical Center

Michael S Beeson, MD, MBA, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Association of EMS Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Steven C Dronen, MD, FAAEM Chair, Department of Emergency Medicine, LeConte Medical Center

Steven C Dronen, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Eugene Hardin, MD, FAAEM, FACEP Former Chair and Associate Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science; Former Chair, Department of Emergency Medicine, Martin Luther King Jr/Drew Medical Center

Disclosure: Nothing to disclose.

Nizar Kifaieh, MD, FACEP Assistant Professor, Medical Director, Department Of Emergency Medicine, State University of New York Downstate Medical Center

Nizar Kifaieh, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, New York County Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Patrick B Thomas, MD Fellow, Department of Pediatric Surgery, Texas Children’s Hospital

Disclosure: Nothing to disclose.

Walter W Valesky Jr, MD Clinical Assistant Instructor, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center

Disclosure: Nothing to disclose.

Anal fistula – NHS

An anal fistula is a small tunnel that develops between the end of the bowel and the skin near the anus (where poo leaves the body).

They’re usually the result of an infection near the anus causing a collection of pus (abscess) in the nearby tissue.

When the pus drains away, it can leave a small channel behind.

Anal fistulas can cause unpleasant symptoms, such as discomfort and skin irritation, and will not usually get better on their own.

Surgery is recommended in most cases.

Symptoms of an anal fistula

Symptoms of an anal fistula can include:

• skin irritation around the anus
• a constant, throbbing pain that may be worse when you sit down, move around, poo or cough
• smelly discharge from near your anus 
• passing pus or blood when you poo
• swelling and redness around your anus and a high temperature (fever) if you also have an abscess
• difficulty controlling bowel movements (bowel incontinence) in some cases

The end of the fistula might be visible as a hole in the skin near your anus, although this may be difficult for you to see yourself.

When to get medical advice

See a GP if you have persistent symptoms of an anal fistula. They’ll ask about your symptoms and whether you have any bowel conditions.

They may also ask to examine your anus and gently insert a finger inside it (rectal examination) to check for signs of a fistula.

If the GP thinks you might have a fistula, they can refer you to a specialist called a colorectal surgeon for further tests to confirm the diagnosis and determine the most suitable treatment.

These may include:

• a further physical and rectal examination
• a proctoscopy, where a special telescope with a light on the end is used to look inside your anus
• an ultrasound scan, MRI scan or CT scan

Causes of anal fistulas

Most anal fistulas develop after an anal abscess. You can get one if the abscess does not heal properly after the pus has drained away.

Less common causes of anal fistulas include:

• Crohn’s disease – a long-term condition in which the digestive system becomes inflamed
• diverticulitis – infection of the small pouches that can stick out of the side of the large intestine (colon)
• hidradenitis suppurativa – a long-term skin condition that causes abscesses and scarring
• infection with tuberculosis (TB) or HIV
• a complication of surgery near the anus

Treatments for an anal fistula

Anal fistulas usually require surgery as they rarely heal if left untreated.

The main options include:

• a fistulotomy – a procedure that involves cutting open the whole length of the fistula so it heals into a flat scar
• seton procedures – where a piece of surgical thread called a seton is placed in the fistula and left there for several weeks to help it heal before a further procedure is carried out to treat it

All the procedures have different benefits and risks. You can discuss this with the surgeon.

Many people do not need to stay in hospital overnight after surgery, although some may need to stay in hospital for a few days.

Find out more about treating an anal fistula

Page last reviewed: 18 June 2019
Next review due: 18 June 2022

Perianal Abscess – StatPearls – NCBI Bookshelf

Continuing Education Activity

Perianal abscesses are the most common type of anorectal abscesses. These abscesses can cause significant discomfort for patients. They are located at the anal verge and if left untreated, can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space. They can also cause systemic infection if left untreated. This activity reviews the pathophysiology of perianal abscess and highlights the role of the interprofessional team in its management.

Objectives:

• Describe the pathophysiology of perianal abscess.

• Review the presentation of perianal abscess.

• Outline the treatment and management options available for perianal abscess.

• Describe interprofessional team strategies for improving care coordination and outcomes in patients with perianal abscess.

Access free multiple choice questions on this topic.

Introduction

Perianal abscesses are the most common type of anorectal abscesses. These abscesses can cause significant discomfort for patients. They are located at the anal verge and, if left untreated, can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space. They can also cause systemic infection if left untreated.[1][2]

Etiology

Ninety percent of all anorectal abscesses are caused by non-specific obstruction and subsequent infection of the glandular crypts of the rectum or anus. A perianal abscess is a type of anorectal abscess that is confined to the perianal space. Other causes can include inflammatory bowel diseases such as Crohn’s disease, as well as trauma, or cancerous origins. Patients with recurrent or complex abscesses should be evaluated for Crohn’s disease.[1][3][4][3]

Epidemiology

The prevalence of perianal abscesses and anorectal abscesses, in general, are underestimated, since most patients do not seek medical attention, or are dismissed as having symptomatic hemorrhoids.  The mean age at presentation is 40 years old, and adult males are twice as likely as females to develop an abscess.[5][6] Risk factors include anything that causes immunosuppression or poor wound healing such as smoking, HIV, immunosuppressive drugs, and diabetes. Crohn’s disease is also a known risk factor for developing a perirectal abscess.[7]

Pathophysiology

On presentation, patients will typically complain of severe pain in the anal area, which has generally been present for several days. This is due to an infection of the anal glands, which are not adequately draining through the anal crypts. The anal glands empty into ducts that traverse the internal sphincter and drain into the anal crypts at the level of the dentate line. If not adequately draining, infection of these glands will form an abscess that can spread along several planes, such as the perianal or perirectal spaces. The perianal space surrounds the anus and is continuous with the fat of the buttock. Once a fluid collection forms, it can spread along the path of least resistance, which is typically into the intersphincteric space and other potential spaces such as the supralevator space or ischiorectal space.[8][9]

Aerobic and anaerobic organisms are responsible for these abscesses, including Bacteroides fragilis, Peptostreptococcus, Prevotella, Fusobacterium, Porphyromonas, Clostridium species, Staphylococcus aureus, Streptococcus, and Escherichia coli.[10]

History and Physical

A detailed history and physical examination are pertinent to every patient and maybe all that is necessary to make a diagnosis. Patients will complain of anal pain, which may be dull, sharp, aching, or throbbing. This may be accompanied by fever, chills, constipation, or diarrhea. Patients with perianal abscess typically present with pain around the anus, which may or may not be associated with bowel movements, but is usually constant. Purulent discharge may be reported if the abscess is spontaneously draining, and blood per rectum may also be reported in a spontaneously draining abscess.

A physical exam can typically rule out other causes of anal pain, such as hemorrhoids. It will yield an area of fluctuance or an area of erythema and induration in the skin around the perianal area. Cellulitis should be noted and marked if extending beyond the fluctuant area. For follow-up purposes, it should be noted whether the patient has diabetes, and their blood sugar on routine fingerstick should also be noted.

Evaluation

A physical exam is typically the only requirement for diagnosis. The digital rectal exam should be performed and may yield a fluctuant mass. Cellulitis may extend beyond the fluctuant area and should be marked. Computed tomography or MRI may be used in the setting of clinical suspicion without signs discussed above, especially in the setting of unexplained significant anorectal pain, and in the immunocompromised patient who may not mount an immune response. MRI is the preferred method of imaging as a CT scan may miss small abscesses in the immunocompromised patients. Anorectal ultrasound may be used however it is not tolerated well secondary to pain.[11][12][13]

Laboratory testing will usually reveal an elevated white blood cell count. However, the absence of a leukocytosis should not deter the physician from the appropriate treatment of an abscess, namely surgical drainage.

Treatment / Management

Perianal abscesses are an indication for timely incision and drainage. Antibiotic administration alone is inadequate and inappropriate. Once incision and drainage are performed, there is no need for antibiotic administration unless certain medical issues necessitate the use. Such conditions include valvular heart disease, immunocompromised patients, diabetic patients, or in the setting of sepsis. Antibiotics are also considered in these patients or cases with signs of systemic infection or significant surrounding cellulitis.[1][14]

Incision and drainage are typically performed in the clinic setting or immediately in the emergency department. Local anesthesia with 1% lidocaine may be administered to the surrounding tissues. A cruciate incision is made as close to the anal verge as possible to shorten any potential fistula formation. Blunt palpation is used to ensure no other septation or abscess pocket is missed. Before completing the procedure, it is useful to excise a skin flap of the cruciate incision or the tips of the four skin flaps to ensure adequate drainage and prevent premature healing of the skin over the abscess pocket. Packing may be placed initially for hemostasis. Continual packing may be further utilized for healing by secondary intention. Patients are encouraged to keep the incision and drainage site clean. Sitz baths may assist in pain relief.

More extensive abscesses may require the operating room for the adequate exam under anesthesia to ensure adequate drainage and inspect for other diseases such as fistula in ano.[1]

Differential Diagnosis

The differential diagnosis for a perianal abscess includes anal trauma, anal fissure, anal fistula, thrombosed external hemorrhoid, pilonidal cyst, buttocks abscess, cellulitis, Crohn’s disease, ulcerative colitis, malignancy, proctitis, HIV/ AIDS, other sexually transmitted diseases, Bartholin’s abscess, and hidradenitis suppurativa.

Prognosis

With appropriate and prompt drainage mortality from a perirectal abscess is very low. However, in immunocompromised patients, those with Crohn’s, or those where the abscess is detected late and has progressed to a potentially deadly condition such as Fournier’s gangrene mortality and morbidity can be significant[15][16]. Additionally, the morbidity even in healthy patients can be significant with approximately one-third of patients developing a fistula secondary either to the disease process itself or the surgical drainage.[17]

Postoperative and Rehabilitation Care

After treatment, the patient needs pain control, laxatives or fiber supplements to avoid constipation, and instructions on properly performing sitz baths.

Outpatient antibiotics are rarely indicated but should be considered if the patient demonstrates signs of systemic infection such as fevers or high leukocytosis. Cultures and sensitivities of the causative organism are rarely helpful.[19]

Because of a high recurrence rate, all patients need to be followed up until there is complete healing, which may take up to 8 weeks. Additionally, up to one-third of patients may either already have a fistula in ano or develop one after their abscess, which is another reason to have a close follow-up. If there is a recurrent abscess, further evaluation is needed for potential Crohn’s HIV, neoplasm, or other underlying etiology.

Consultations

Perirectal abscesses often require surgical drainage even if they have ruptured or are already training. Therefore a general or colorectal surgeon should be consulted to evaluate the patient. Alternatively, an ED physician may perform the drainage procedure themselves.

If the abscess is recurrent or complicated, then a work-up for Crohn’s disease or HIV should be performed with appropriate consultations to gastroenterology or an HIV management team as needed.

Deterrence and Patient Education

There are few effective strategies to prevent perianal abscess in an otherwise healthy patient. Keeping the perianal area clean and dry to avoid skin breakdown can be helpful. High fiber diets may theoretically reduce the chance of anal gland blockage, but there is no real evidence to confirm that as an effective treatment. If the patient has an underlying etiology such as Crohn’s or HIV, then treatment of that condition can help reduce the risk of developing a perianal abscess.

Pearls and Other Issues

Horseshoe perianal abscesses are uncommon. They are abscesses that surround the entire anus. These abscesses are typically drained through an incision, and drainage is performed posterior to the anus. It is helpful to place counter incisions at the anterior extent of the abscess to ensure adequate drainage. Penrose may be placed through these incisions to aid in continued drainage and prevent premature closure. These drains are left in place for 2 to 3 weeks and then removed in the post-operative office visit.

Prompt follow-up with surgical services is advisable to monitor wound healing. Inadequate drainage may result in the reformation of an abscess, which may require repeat incision and drainage. If not promptly diagnosed and treated, perianal abscesses may lead to several other sequelae, including fistula in ano, perianal sepsis, or necrotizing soft tissue infection of the anus and surrounding buttock. If a fistula in ano is detected, patients will need operative drainage, fistulotomy, or seton placement, which may have a risk of incontinence. Necrotizing soft tissue infection treatment goals are debridement of all non-viable tissue and may require colostomy for diversion of stool during healing. If not adequately treated, necrotizing soft tissue infection may have mortality as high as 50%.

Enhancing Healthcare Team Outcomes

Dealing with Perianal Complications in Crohn’s Disease: A Need for an Interprofessional Approach

Lack of Medical Evidence

Perianal abscess in patients with Crohn disease causes significant morbidity. Even though there are several treatments for perianal abscess, very few are based on evidence.[1] Some treatments include drainage of the abscess, assessment of Crohn’s disease status, determining sinus tracts, medical treatment, and surgery. With the availability of new biological therapies, the outcomes are even more conflicting. Once the abscess has been drained, attempts may be made to eradicate the fistula and control Crohn disease. The definitive treatment for perianal complications of Crohn disease is very challenging and rarely leads to complete healing. No matter what treatment is selected, one must weigh the risk of ana sphincter injury, which can be devastating. Given these facts, expert opinion suggests that an interprofessional approach to the management of perianal disease in these patients is crucial to improving outcomes.[20] Because Crohn disease is a systemic disorder, the health care team should consist of the following:

• Colorectal surgeon

• Dietitian to determine the need for nutrition

• Gastroenterologist to monitor for Crohn’s disease

• Nurses to educate the patient on perianal complications

• Pharmacists to follow the prescribed drugs and ensure that the patient is not developing adverse drug reactions

Outcomes

The outcomes of perianal abscess treatment depend on the timing of the surgery. Patients with early diagnosis and treatment tend to have good outcomes, but those who have a delay in treatment usually have prolonged hospital course, need for repeated surgical treatments at higher risk of recurrence. The key to improving outcomes is to follow the patient and monitor for any perianal symptoms closely.[21] [Level V]

References

1.

Choi YS, Kim DS, Lee DH, Lee JB, Lee EJ, Lee SD, Song KH, Jung HJ. Clinical Characteristics and Incidence of Perianal Diseases in Patients With Ulcerative Colitis. Ann Coloproctol. 2018 Jun;34(3):138-143. [PMC free article: PMC6046543] [PubMed: 29991202]

2.

Sahnan K, Adegbola SO, Tozer PJ, Watfah J, Phillips RK. Perianal abscess. BMJ. 2017 Feb 21;356:j475. [PubMed: 28223268]

3.

Mahmoud NN, Halwani Y, Montbrun S, Shah PM, Hedrick TL, Rashid F, Schwartz DA, Dalal RL, Kamiński JP, Zaghiyan K, Fleshner PR, Weissler JM, Fischer JP. Current management of perianal Crohn’s disease. Curr Probl Surg. 2017 May;54(5):262-298. [PubMed: 28583256]

4.

Ikeda T, Konaka R, Adachi Y, Matsumoto A, Harada N, Wada T, Mitsutsuji M, Samizo M. Perianal abscess due to a long fish bone: a case report. J Surg Case Rep. 2021 Mar;2021(3):rjab084. [PMC free article: PMC7984843] [PubMed: 33777354]

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Adamo K, Sandblom G, Brännström F, Strigård K. Prevalence and recurrence rate of perianal abscess–a population-based study, Sweden 1997-2009. Int J Colorectal Dis. 2016 Mar;31(3):669-73. [PubMed: 26768004]

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Read DR, Abcarian H. A prospective survey of 474 patients with anorectal abscess. Dis Colon Rectum. 1979 Nov-Dec;22(8):566-8. [PubMed: 527452]

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Gajendran M, Loganathan P, Catinella AP, Hashash JG. A comprehensive review and update on Crohn’s disease. Dis Mon. 2018 Feb;64(2):20-57. [PubMed: 28826742]

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Deen-Molenaar CH, Jordanov T, Felt-Bersma RJ. Intersphincteric infection due to an anal fissure. Int J Colorectal Dis. 2016 Mar;31(3):727-8. [PubMed: 25935451]

9.

Ommer A, Herold A, Berg E, Fürst A, Sailer M, Schiedeck T. German S3 guideline: anal abscess. Int J Colorectal Dis. 2012 Jun;27(6):831-7. [PubMed: 22362468]

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Brook I. The role of anaerobic bacteria in cutaneous and soft tissue abscesses and infected cysts. Anaerobe. 2007 Oct-Dec;13(5-6):171-7. [PubMed: 17923425]

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Chandwani D, Shih R, Cochrane D. Bedside emergency ultrasonography in the evaluation of a perirectal abscess. Am J Emerg Med. 2004 Jul;22(4):315. [PubMed: 15258876]

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Sofic A, Beslic S, Sehovic N, Caluk J, Sofic D. MRI in evaluation of perianal fistulae. Radiol Oncol. 2010 Dec;44(4):220-7. [PMC free article: PMC3423712] [PubMed: 22933919]

13.

Khati NJ, Sondel Lewis N, Frazier AA, Obias V, Zeman RK, Hill MC. CT of acute perianal abscesses and infected fistulae: a pictorial essay. Emerg Radiol. 2015 Jun;22(3):329-35. [PubMed: 25421387]

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Wright WF. Infectious Diseases Perspective of Anorectal Abscess and Fistula-in-ano Disease. Am J Med Sci. 2016 Apr;351(4):427-34. [PubMed: 27079352]

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Mak WY, Mak OS, Lee CK, Tang W, Leung WK, Wong MTL, Sze ASF, Li M, Leung CM, Lo FH, Lam BCY, Chan KH, Shan EHS, Tsang SWC, Hui AJ, Chow WH, Chan FKL, Sung JJY, Ng SC. Significant Medical and Surgical Morbidity in Perianal Crohn’s Disease: Results from a Territory-Wide Study. J Crohns Colitis. 2018 Nov 28;12(12):1392-1398. [PubMed: 30165543]

16.

Chen Y, Wang X, Lin G, Xiao R. Successful treatment following early recognition of a case of Fournier’s scrotal gangrene after a perianal abscess debridement: a case report. J Med Case Rep. 2018 Jun 27;12(1):193. [PMC free article: PMC6020361] [PubMed: 29945675]

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Khalid A, Faisal MF. Endoscopic Ultrasound-Guided Transrectal Drainage of Perirectal Abscess in a Patient with Crohn Disease. Am J Case Rep. 2021 Jun 08;22:e930698. [PMC free article: PMC8202418] [PubMed: 34099613]

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Rho M, Guida AM, Materazzo M, Don CP, Gazia C, Ivanikhin AM, Tognoni V, Venditti D. Ligasure Hemorrhoidectomy: Updates on Complications After an 18-Year Experience. Rev Recent Clin Trials. 2021;16(1):101-108. [PubMed: 33023436]

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Xu RW, Tan KK, Chong CS. Bacteriological study in perianal abscess is not useful and not cost-effective. ANZ J Surg. 2016 Oct;86(10):782-784. [PubMed: 27226422]

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Amato A, Bottini C, De Nardi P, Giamundo P, Lauretta A, Realis Luc A, Tegon G, Nicholls RJ., Italian society of colorectal surgery. Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR). Tech Coloproctol. 2015 Oct;19(10):595-606. [PubMed: 26377581]

21.

Nguyen VQ, Jiang D, Hoffman SN, Guntaka S, Mays JL, Wang A, Gomes J, Sorrentino D. Impact of Diagnostic Delay and Associated Factors on Clinical Outcomes in a U.S. Inflammatory Bowel Disease Cohort. Inflamm Bowel Dis. 2017 Oct;23(10):1825-1831. [PubMed: 28885229]

90,000 Rectal abscesses (paraproctitis) – symptoms and treatment

Author: doctor, scientific director of JSC Vidal Rus, Zhuchkova T.V., [email protected]

Table of contents:

What are rectal abscesses (paraproctitis)?

Paraproctitis – purulent inflammation of the tissues surrounding the rectum.

Acute (for the first time) and chronic paraproctitis (develops as a result of spontaneous or incorrect opening (treatment) of acute paraproctitis) are distinguished.

Rectal abscesses are often found in patients with previous anorectal diseases, diabetes, alcoholism and neurological diseases; infections in this area most often develop in patients with acute leukemia, especially in the presence of neutropenia. Since the clinical picture can for a long period be regarded as a fever of unknown origin, it is important that patients with unexplained fever must undergo a thorough digital and endoscopic examination of the rectum.

Causes of rectal abscess (paraproctitis)

There are a lot of reasons for the occurrence of paraproctitis:

• non-compliance with personal hygiene rules,
• traumatic anal manipulation,
• the presence of diseases of the anus (hemorrhoids, anal fissures, cryptitis, etc.)

Through special glands located in the anus, the infection from the lumen of the rectum penetrates into the surrounding tissues.Inflammation develops, an abscess forms. Therefore, a simple opening of abscesses from the outside, without sanitation of the internal inflamed area, does not lead to a lasting recovery.

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal (peri-rectal) cellular space. Depending on the person’s immunity, the size and location of the abscess may be different. An abscess can be located both directly under the skin of the perineum (subcutaneous – most often), and deeply between the muscles of the perineum and buttocks (ischiorectal – sciatic-rectal, pelviorectal – pelvic-rectal, and as one of the types of pelvic-rectal – posterior rectal (retrorectal)) …

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

Acute paraproctitis

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal cell space – subcutaneous (most often), ischiorectal, pelviorectal, retrorectal (very rare). Depending on the affected space, paraproctitis is distinguished by localization – subcutaneous, etc. The internal opening of the abscess is almost always one, there may be two or more external abscesses.In more than half of the patients, the abscess is located on the border of the mucous membrane and the skin.

Symptoms of acute paraproctitis are, first of all, sharp pains that increase when walking, coughing, etc. The general condition worsens, especially with deep (ishiorectal, pelvic-rectal) abscesses, while there are practically no external signs – skin redness, fluctuations.

With deep (high) ishiorectal and other acute paraproctitis, the patient’s condition can be severe – high temperature, signs of intoxication, pain in the depth of the pelvis.

Symptoms of acute paraproctitis

The disease usually begins acutely. Following a short prodromal period with malaise, weakness, headache, there is an increasing pain in the rectum, perineum or pelvis, accompanied by an increase in body temperature and chills. The severity of the symptoms of acute paraproctitis depends on the localization of the inflammatory process, its prevalence, the nature of the pathogen, and the reactivity of the body. When the abscess is localized in the subcutaneous tissue, the clinical manifestations are more pronounced and definite: painful infiltration in the anus, skin hyperemia, increased body temperature usually force us to consult a doctor in the first days after the onset of the disease.

Ishiorectal abscess in the first days of the disease is manifested by general symptoms: chills, poor health, dull pain in the pelvis and rectum, aggravated by bowel movements; local changes – asymmetry of the buttocks, infiltration, flushing of the skin – appear in a late stage (5-6th day).

The most difficult is pelviorectal paraproctitis, in which the abscess is located deep in the pelvis. In the first days of the disease, general symptoms of inflammation predominate: fever, chills, headache, pain in the joints, in the pelvis, and in the lower abdomen.Often the patient turns to a surgeon, urologist, women – to a gynecologist. Often they are treated for acute respiratory illness, influenza. The duration of this period sometimes reaches 10-12 days. In the future, there is an increase in pain in the pelvis and rectum, retention of stool, urine and severe intoxication.

Chronic paraproctitis

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

The internal opening of an abscess in the anal canal does not heal and a fistula remains.Healing can occur with a fragile scar, which with minor injury – cycling, constipation, etc. – an abscess reappears, inflammation in the wrong place of the anal canal, while the localization of the abscess may be in a different place of the perineum. After improper opening and treatment, the wound on the perineum does not overgrow – the rectal fistula remains, while re-infection of the intestinal flora occurs through the internal opening of the fistula.

In the majority of patients, the cause of the infection cannot be identified.Rectal abscesses are usually very painful, easily detectable on palpation, and often visible on examination. Treatment consists of an incision and drainage.

Diagnostics

The first and main task of diagnosing acute paraproctitis is to recognize the presence and localization of an abscess in the cellular space surrounding the rectum on the basis of the patient’s complaints, clinic and examination.

Reveal the disease by examination and digital examination of the rectum.

To exclude complications of acute paraproctitis, women also need to consult a gynecologist, and men – from a urologist.

Treatment of acute paraproctitis is only surgical. The operation must be performed immediately after the diagnosis is made. The operation is performed under general anesthesia.

The purpose of the operation is to open the abscess (abscess) and remove the pus. After the operation, dressings are performed, antibiotics, vitamins, and immunity-enhancing drugs are prescribed. Such an operation can be performed in any surgical hospital.

However, opening the abscess is not a radical operation: after it, as a rule, repeated suppurations occur (chronic paraproctitis is formed).The reason for this phenomenon is the preservation of the inflammatory canal (fistula) between the rectum and the surrounding tissues.

For a complete cure, a second operation is required, performed in a specialized proctological hospital. As a result of such an operation, the connection between the intestinal cavity and the abscess is eliminated. It is called radical because leads to a complete cure.

Complications

In case of untimely surgical treatment of acute paraproctitis, complications may develop: purulent destruction of the rectal wall and / or the wall of the urethra in men, breakthrough of pus into the vagina in women.The most formidable complication is the breakthrough of pus into the pelvic cavity, which, if diagnosed late, can lead to death.

After opening the abscess spontaneously or surgically without eliminating the purulent passage and the affected crypt in the future, as a rule, a rectal fistula is formed. If the fistula has not formed, but the focus of inflammation remains in the area of ​​the anal glands and intersphincteric space, then after a while there is a relapse of acute paraproctitis.

90,000 Rectal abscesses (paraproctitis) – symptoms and treatment

Author: doctor, scientific director of Vidal Rus JSC, T. ZhuchkovaV., [email protected]

Table of contents:

What are rectal abscesses (paraproctitis)?

Paraproctitis – purulent inflammation of the tissues surrounding the rectum.

Acute (for the first time) and chronic paraproctitis (develops as a result of spontaneous or incorrect opening (treatment) of acute paraproctitis) are distinguished.

Rectal abscesses are often found in patients with previous anorectal diseases, diabetes, alcoholism and neurological diseases; infections in this area most often develop in patients with acute leukemia, especially in the presence of neutropenia.Since the clinical picture can for a long period be regarded as a fever of unknown origin, it is important that patients with unexplained fever must undergo a thorough digital and endoscopic examination of the rectum.

Causes of rectal abscess (paraproctitis)

There are a lot of reasons for the occurrence of paraproctitis:

• non-compliance with personal hygiene rules,
• traumatic anal manipulation,
• the presence of diseases of the anus (hemorrhoids, anal fissures, cryptitis, etc.))

Through special glands located in the anus, the infection from the lumen of the rectum penetrates into the surrounding tissues. Inflammation develops, an abscess forms. Therefore, a simple opening of abscesses from the outside, without sanitation of the internal inflamed area, does not lead to a lasting recovery.

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal (peri-rectal) cellular space. Depending on the person’s immunity, the size and location of the abscess may be different.An abscess can be located both directly under the skin of the perineum (subcutaneous – most often), and deeply between the muscles of the perineum and buttocks (ischiorectal – sciatic-rectal, pelviorectal – pelvic-rectal, and as one of the types of pelvic-rectal – posterior rectal (retrorectal)) …

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

Acute paraproctitis

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal cell space – subcutaneous (most often), ischiorectal, pelviorectal, retrorectal (very rare).Depending on the affected space, paraproctitis is distinguished by localization – subcutaneous, etc. The internal opening of the abscess is almost always one, there may be two or more external abscesses. In more than half of the patients, the abscess is located on the border of the mucous membrane and the skin.

Symptoms of acute paraproctitis are, first of all, sharp pains that increase when walking, coughing, etc. The general condition worsens, especially with deep (ishiorectal, pelvic-rectal) abscesses, while there are practically no external signs – skin redness, fluctuations.

With deep (high) ishiorectal and other acute paraproctitis, the patient’s condition can be severe – high temperature, signs of intoxication, pain in the depth of the pelvis.

Symptoms of acute paraproctitis

The disease usually begins acutely. Following a short prodromal period with malaise, weakness, headache, there is an increasing pain in the rectum, perineum or pelvis, accompanied by an increase in body temperature and chills. The severity of the symptoms of acute paraproctitis depends on the localization of the inflammatory process, its prevalence, the nature of the pathogen, and the reactivity of the body.When the abscess is localized in the subcutaneous tissue, the clinical manifestations are more pronounced and definite: painful infiltration in the anus, skin hyperemia, increased body temperature usually force us to consult a doctor in the first days after the onset of the disease.

Ishiorectal abscess in the first days of the disease is manifested by general symptoms: chills, poor health, dull pain in the pelvis and rectum, aggravated by bowel movements; local changes – asymmetry of the buttocks, infiltration, flushing of the skin – appear in a late stage (5-6th day).

The most difficult is pelviorectal paraproctitis, in which the abscess is located deep in the pelvis. In the first days of the disease, general symptoms of inflammation predominate: fever, chills, headache, pain in the joints, in the pelvis, and in the lower abdomen. Often the patient turns to a surgeon, urologist, women – to a gynecologist. Often they are treated for acute respiratory illness, influenza. The duration of this period sometimes reaches 10-12 days. In the future, there is an increase in pain in the pelvis and rectum, retention of stool, urine and severe intoxication.

Chronic paraproctitis

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

The internal opening of an abscess in the anal canal does not heal and a fistula remains. Healing can occur with a fragile scar, which with minor injury – cycling, constipation, etc. – an abscess reappears, inflammation in the wrong place of the anal canal, while the localization of the abscess may be in a different place of the perineum.After improper opening and treatment, the wound on the perineum does not overgrow – the rectal fistula remains, while re-infection of the intestinal flora occurs through the internal opening of the fistula.

In the majority of patients, the cause of the infection cannot be identified. Rectal abscesses are usually very painful, easily detectable on palpation, and often visible on examination. Treatment consists of an incision and drainage.

Diagnostics

The first and main task of diagnosing acute paraproctitis is to recognize the presence and localization of an abscess in the cellular space surrounding the rectum on the basis of the patient’s complaints, clinic and examination.

Reveal the disease by examination and digital examination of the rectum.

To exclude complications of acute paraproctitis, women also need to consult a gynecologist, and men – from a urologist.

Treatment of acute paraproctitis is only surgical. The operation must be performed immediately after the diagnosis is made. The operation is performed under general anesthesia.

The purpose of the operation is to open the abscess (abscess) and remove the pus. After the operation, dressings are performed, antibiotics, vitamins, and immunity-enhancing drugs are prescribed.Such an operation can be performed in any surgical hospital.

However, opening the abscess is not a radical operation: after it, as a rule, repeated suppurations occur (chronic paraproctitis is formed). The reason for this phenomenon is the preservation of the inflammatory canal (fistula) between the rectum and the surrounding tissues.

For a complete cure, a second operation is required, performed in a specialized proctological hospital. As a result of such an operation, the connection between the intestinal cavity and the abscess is eliminated.It is called radical because leads to a complete cure.

Complications

In case of untimely surgical treatment of acute paraproctitis, complications may develop: purulent destruction of the rectal wall and / or the wall of the urethra in men, breakthrough of pus into the vagina in women. The most formidable complication is the breakthrough of pus into the pelvic cavity, which, if diagnosed late, can lead to death.

After opening the abscess spontaneously or surgically without eliminating the purulent passage and the affected crypt in the future, as a rule, a rectal fistula is formed.If the fistula has not formed, but the focus of inflammation remains in the area of ​​the anal glands and intersphincteric space, then after a while there is a relapse of acute paraproctitis.

90,000 Rectal abscesses (paraproctitis) – symptoms and treatment

Author: doctor, scientific director of JSC Vidal Rus, Zhuchkova T.V., [email protected]

Table of contents:

What are rectal abscesses (paraproctitis)?

Paraproctitis – purulent inflammation of the tissues surrounding the rectum.

Acute (for the first time) and chronic paraproctitis (develops as a result of spontaneous or incorrect opening (treatment) of acute paraproctitis) are distinguished.

Rectal abscesses are often found in patients with previous anorectal diseases, diabetes, alcoholism and neurological diseases; infections in this area most often develop in patients with acute leukemia, especially in the presence of neutropenia. Since the clinical picture can for a long period be regarded as a fever of unknown origin, it is important that patients with unexplained fever must undergo a thorough digital and endoscopic examination of the rectum.

Causes of rectal abscess (paraproctitis)

There are a lot of reasons for the occurrence of paraproctitis:

• non-compliance with personal hygiene rules,
• traumatic anal manipulation,
• the presence of diseases of the anus (hemorrhoids, anal fissures, cryptitis, etc.)

Through special glands located in the anus, the infection from the lumen of the rectum penetrates into the surrounding tissues.Inflammation develops, an abscess forms. Therefore, a simple opening of abscesses from the outside, without sanitation of the internal inflamed area, does not lead to a lasting recovery.

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal (peri-rectal) cellular space. Depending on the person’s immunity, the size and location of the abscess may be different. An abscess can be located both directly under the skin of the perineum (subcutaneous – most often), and deeply between the muscles of the perineum and buttocks (ischiorectal – sciatic-rectal, pelviorectal – pelvic-rectal, and as one of the types of pelvic-rectal – posterior rectal (retrorectal)) …

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

Acute paraproctitis

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal cell space – subcutaneous (most often), ischiorectal, pelviorectal, retrorectal (very rare). Depending on the affected space, paraproctitis is distinguished by localization – subcutaneous, etc. The internal opening of the abscess is almost always one, there may be two or more external abscesses.In more than half of the patients, the abscess is located on the border of the mucous membrane and the skin.

Symptoms of acute paraproctitis are, first of all, sharp pains that increase when walking, coughing, etc. The general condition worsens, especially with deep (ishiorectal, pelvic-rectal) abscesses, while there are practically no external signs – skin redness, fluctuations.

With deep (high) ishiorectal and other acute paraproctitis, the patient’s condition can be severe – high temperature, signs of intoxication, pain in the depth of the pelvis.

Symptoms of acute paraproctitis

The disease usually begins acutely. Following a short prodromal period with malaise, weakness, headache, there is an increasing pain in the rectum, perineum or pelvis, accompanied by an increase in body temperature and chills. The severity of the symptoms of acute paraproctitis depends on the localization of the inflammatory process, its prevalence, the nature of the pathogen, and the reactivity of the body. When the abscess is localized in the subcutaneous tissue, the clinical manifestations are more pronounced and definite: painful infiltration in the anus, skin hyperemia, increased body temperature usually force us to consult a doctor in the first days after the onset of the disease.

Ishiorectal abscess in the first days of the disease is manifested by general symptoms: chills, poor health, dull pain in the pelvis and rectum, aggravated by bowel movements; local changes – asymmetry of the buttocks, infiltration, flushing of the skin – appear in a late stage (5-6th day).

The most difficult is pelviorectal paraproctitis, in which the abscess is located deep in the pelvis. In the first days of the disease, general symptoms of inflammation predominate: fever, chills, headache, pain in the joints, in the pelvis, and in the lower abdomen.Often the patient turns to a surgeon, urologist, women – to a gynecologist. Often they are treated for acute respiratory illness, influenza. The duration of this period sometimes reaches 10-12 days. In the future, there is an increase in pain in the pelvis and rectum, retention of stool, urine and severe intoxication.

Chronic paraproctitis

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

The internal opening of an abscess in the anal canal does not heal and a fistula remains.Healing can occur with a fragile scar, which with minor injury – cycling, constipation, etc. – an abscess reappears, inflammation in the wrong place of the anal canal, while the localization of the abscess may be in a different place of the perineum. After improper opening and treatment, the wound on the perineum does not overgrow – the rectal fistula remains, while re-infection of the intestinal flora occurs through the internal opening of the fistula.

In the majority of patients, the cause of the infection cannot be identified.Rectal abscesses are usually very painful, easily detectable on palpation, and often visible on examination. Treatment consists of an incision and drainage.

Diagnostics

The first and main task of diagnosing acute paraproctitis is to recognize the presence and localization of an abscess in the cellular space surrounding the rectum on the basis of the patient’s complaints, clinic and examination.

Reveal the disease by examination and digital examination of the rectum.

To exclude complications of acute paraproctitis, women also need to consult a gynecologist, and men – from a urologist.

Treatment of acute paraproctitis is only surgical. The operation must be performed immediately after the diagnosis is made. The operation is performed under general anesthesia.

The purpose of the operation is to open the abscess (abscess) and remove the pus. After the operation, dressings are performed, antibiotics, vitamins, and immunity-enhancing drugs are prescribed. Such an operation can be performed in any surgical hospital.

However, opening the abscess is not a radical operation: after it, as a rule, repeated suppurations occur (chronic paraproctitis is formed).The reason for this phenomenon is the preservation of the inflammatory canal (fistula) between the rectum and the surrounding tissues.

For a complete cure, a second operation is required, performed in a specialized proctological hospital. As a result of such an operation, the connection between the intestinal cavity and the abscess is eliminated. It is called radical because leads to a complete cure.

Complications

In case of untimely surgical treatment of acute paraproctitis, complications may develop: purulent destruction of the rectal wall and / or the wall of the urethra in men, breakthrough of pus into the vagina in women.The most formidable complication is the breakthrough of pus into the pelvic cavity, which, if diagnosed late, can lead to death.

After opening the abscess spontaneously or surgically without eliminating the purulent passage and the affected crypt in the future, as a rule, a rectal fistula is formed. If the fistula has not formed, but the focus of inflammation remains in the area of ​​the anal glands and intersphincteric space, then after a while there is a relapse of acute paraproctitis.

90,000 Rectal abscesses (paraproctitis) – symptoms and treatment

Author: doctor, scientific director of Vidal Rus JSC, T. ZhuchkovaV., [email protected]

Table of contents:

What are rectal abscesses (paraproctitis)?

Paraproctitis – purulent inflammation of the tissues surrounding the rectum.

Acute (for the first time) and chronic paraproctitis (develops as a result of spontaneous or incorrect opening (treatment) of acute paraproctitis) are distinguished.

Rectal abscesses are often found in patients with previous anorectal diseases, diabetes, alcoholism and neurological diseases; infections in this area most often develop in patients with acute leukemia, especially in the presence of neutropenia.Since the clinical picture can for a long period be regarded as a fever of unknown origin, it is important that patients with unexplained fever must undergo a thorough digital and endoscopic examination of the rectum.

Causes of rectal abscess (paraproctitis)

There are a lot of reasons for the occurrence of paraproctitis:

• non-compliance with personal hygiene rules,
• traumatic anal manipulation,
• the presence of diseases of the anus (hemorrhoids, anal fissures, cryptitis, etc.))

Through special glands located in the anus, the infection from the lumen of the rectum penetrates into the surrounding tissues. Inflammation develops, an abscess forms. Therefore, a simple opening of abscesses from the outside, without sanitation of the internal inflamed area, does not lead to a lasting recovery.

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal (peri-rectal) cellular space. Depending on the person’s immunity, the size and location of the abscess may be different.An abscess can be located both directly under the skin of the perineum (subcutaneous – most often), and deeply between the muscles of the perineum and buttocks (ischiorectal – sciatic-rectal, pelviorectal – pelvic-rectal, and as one of the types of pelvic-rectal – posterior rectal (retrorectal)) …

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

Acute paraproctitis

Acute paraproctitis occurs with the rapid penetration of infection into the pararectal cell space – subcutaneous (most often), ischiorectal, pelviorectal, retrorectal (very rare).Depending on the affected space, paraproctitis is distinguished by localization – subcutaneous, etc. The internal opening of the abscess is almost always one, there may be two or more external abscesses. In more than half of the patients, the abscess is located on the border of the mucous membrane and the skin.

Symptoms of acute paraproctitis are, first of all, sharp pains that increase when walking, coughing, etc. The general condition worsens, especially with deep (ishiorectal, pelvic-rectal) abscesses, while there are practically no external signs – skin redness, fluctuations.

With deep (high) ishiorectal and other acute paraproctitis, the patient’s condition can be severe – high temperature, signs of intoxication, pain in the depth of the pelvis.

Symptoms of acute paraproctitis

The disease usually begins acutely. Following a short prodromal period with malaise, weakness, headache, there is an increasing pain in the rectum, perineum or pelvis, accompanied by an increase in body temperature and chills. The severity of the symptoms of acute paraproctitis depends on the localization of the inflammatory process, its prevalence, the nature of the pathogen, and the reactivity of the body.When the abscess is localized in the subcutaneous tissue, the clinical manifestations are more pronounced and definite: painful infiltration in the anus, skin hyperemia, increased body temperature usually force us to consult a doctor in the first days after the onset of the disease.

Ishiorectal abscess in the first days of the disease is manifested by general symptoms: chills, poor health, dull pain in the pelvis and rectum, aggravated by bowel movements; local changes – asymmetry of the buttocks, infiltration, flushing of the skin – appear in a late stage (5-6th day).

The most difficult is pelviorectal paraproctitis, in which the abscess is located deep in the pelvis. In the first days of the disease, general symptoms of inflammation predominate: fever, chills, headache, pain in the joints, in the pelvis, and in the lower abdomen. Often the patient turns to a surgeon, urologist, women – to a gynecologist. Often they are treated for acute respiratory illness, influenza. The duration of this period sometimes reaches 10-12 days. In the future, there is an increase in pain in the pelvis and rectum, retention of stool, urine and severe intoxication.

Chronic paraproctitis

Chronic paraproctitis often occurs with spontaneous or incorrect opening (treatment) of acute paraproctitis.

The internal opening of an abscess in the anal canal does not heal and a fistula remains. Healing can occur with a fragile scar, which with minor injury – cycling, constipation, etc. – an abscess reappears, inflammation in the wrong place of the anal canal, while the localization of the abscess may be in a different place of the perineum.After improper opening and treatment, the wound on the perineum does not overgrow – the rectal fistula remains, while re-infection of the intestinal flora occurs through the internal opening of the fistula.

In the majority of patients, the cause of the infection cannot be identified. Rectal abscesses are usually very painful, easily detectable on palpation, and often visible on examination. Treatment consists of an incision and drainage.

Diagnostics

The first and main task of diagnosing acute paraproctitis is to recognize the presence and localization of an abscess in the cellular space surrounding the rectum on the basis of the patient’s complaints, clinic and examination.

Reveal the disease by examination and digital examination of the rectum.

To exclude complications of acute paraproctitis, women also need to consult a gynecologist, and men – from a urologist.

Treatment of acute paraproctitis is only surgical. The operation must be performed immediately after the diagnosis is made. The operation is performed under general anesthesia.

The purpose of the operation is to open the abscess (abscess) and remove the pus. After the operation, dressings are performed, antibiotics, vitamins, and immunity-enhancing drugs are prescribed.Such an operation can be performed in any surgical hospital.

However, opening the abscess is not a radical operation: after it, as a rule, repeated suppurations occur (chronic paraproctitis is formed). The reason for this phenomenon is the preservation of the inflammatory canal (fistula) between the rectum and the surrounding tissues.

For a complete cure, a second operation is required, performed in a specialized proctological hospital. As a result of such an operation, the connection between the intestinal cavity and the abscess is eliminated.It is called radical because leads to a complete cure.

Complications

In case of untimely surgical treatment of acute paraproctitis, complications may develop: purulent destruction of the rectal wall and / or the wall of the urethra in men, breakthrough of pus into the vagina in women. The most formidable complication is the breakthrough of pus into the pelvic cavity, which, if diagnosed late, can lead to death.

After opening the abscess spontaneously or surgically without eliminating the purulent passage and the affected crypt in the future, as a rule, a rectal fistula is formed.If the fistula has not formed, but the focus of inflammation remains in the area of ​​the anal glands and intersphincteric space, then after a while there is a relapse of acute paraproctitis.

Treatment of rectal abscess – all doctors treating the disease

Coloproctologists of Moscow – latest reviews

Polite doctor.The reception went well on time. Igor Valerievich conducted an examination, said that he had not found anything particularly on my problem and sent me for an MRI. I would contact this specialist again, if necessary.

Anastasia,

November 13, 2021

Professional doctor.The reception went well. Everything was quick and convenient. The doctor examined, gave recommendations, prescribed medication that helps me. I was satisfied. I would contact this specialist again, if necessary.

Nikita,

12 November 2021

All was good.The only thing I absolutely didn’t like was that the doctor suggested doing a certain manipulation, but she didn’t warn me about its price. And after that I don’t want to go to see her again. The doctor is polite, attentive. I chose a specialist based on reviews.

Lyudmila,

03 November 2021

The doctor is positive, communication is easy enough, the specialist is good.I liked everything. It was not the first time. Everything is pretty good. If necessary, I will come again. I recommend this specialist. There was enough time for the consultation.

Paul,

October 19, 2021

Everything went well.The doctor is kind, helpful and attentive. All good qualities are present in him. I also received answers to all my questions.

Tatiana,

October 15, 2021

The doctor is the most delicate, just wonderful.I was so nervous, but everything was as comfortable as possible. The manipulations began immediately. The clinic is certainly not cheap, but everything is transparent and the service is consistent. In another more popular clinic, it was cheaper, but the treatment was more painful and conservative, and a lot of time and money still had to be spent on top of tests and, for sure, subsequent appointments. And then the course.

Anonymous,

06 October 2021

I was prescribed an operation, and then it turned out that they were wrong and I did not need the operation.At the reception, the doctor formed a conservative method of treatment for me. So far, I cannot say anything concrete, since the treatment has not yet begun. The doctor is very well-read, educated, qualified, calm, reasonable, experienced, attentive, he explains everything clearly and easily. I can recommend this specialist to my friends, if necessary. I was pleased with the quality of the reception.

Sergey,

August 22, 2021

Dmitry Gennadievich is a good and friendly doctor.We found a common language. The doctor explained everything to me and gave me recommendations. I’m happy!

Alexey,

April 22, 2021

The doctor disposes to himself, relieves stress, sociable.In general, the reception went well. All on time. Fizuli Abumuslimovich conducted an examination and provided medical intervention. Then he appointed observation. I am happy with the service. As a result, he prescribed dressings.

Moderation,

November 16, 2021

The reception went well.Timur Feliksovich is polite and professional. At the reception there was an examination and consultation. They received me on time. He explained everything in an accessible language. As a result of the consultation, the solution to their problem

Moderation,

November 16, 2021

Show 10 reviews of 8395 90,000

Paraproctitis is an inflammation of the tissues near the rectum (pararectal tissue) due to the penetration of infection into them.Often abscess (limited space with purulent contents) is formed, this is called acute paraproctitis . An abscess of pararectal tissue can break through on its own, but the process often becomes chronic, forming rectal fistulas (chronic paraproctitis) .

Paraproctitis is one of the most common proctological diseases, most often only hemorrhoids, anal fissure and colitis are found. The most common causes of paraproctitis are infection of pararectal tissue, most often through the mucous membrane of the rectum (microtrauma and cracks in the mucous membrane due to constipation, hemorrhoids, etc.).etc.).

Reasons for development

There are many factors that can contribute to the development of pathology. Among them:

• Frequent bowel disorders or constipation
• Intestinal infections, Escherichia coli
• STD
• Hemorrhoids
• Rectum trauma
• Untreated anal fissures
• Colitis
• Crohn’s disease
• Decreased immunity
• Improper nutrition – the prevalence of fatty and spicy foods in the menu
• Alcohol abuse
• Specific physical activity, lifting heavy objects
• Non-compliance with hygiene standards

The combination of reasons determines the main category of patients of a proctologist – most often men aged 25-50 go to the doctor with paraproctitis.

Diagnosis of paraproctitis:

A coloproctologist performs a rectal examination to detect the internal opening of the abscess.

Symptoms of acute paraproctitis:

Symptoms of acute paraproctitis depend on the location of the focus of inflammation and other factors. The most typical symptoms are:

• Pain in the anal area; pain may worsen during bowel movements, physical exertion, long sitting, etc.etc .; pain sensations can be localized not only in the rectum, but also in the lower abdomen
• Deterioration of the general condition – low-grade fever (37-38), weakness, loss of appetite
• Skin redness, swelling and thickening of tissues in the anus, sharp pain on pressure (when located in the subcutaneous tissue space)

In acute paraproctitis, symptoms may increase (pain intensifies, general health continues to deteriorate).In some cases, the condition improves dramatically, with pus and blood appearing in the stool. This means that the abscess has burst into the rectum. With a breakthrough or improper treatment of acute paraproctitis, the risk of the disease becoming chronic is high. In addition, paraproctitis is dangerous by the spread of purulent inflammation to the pelvic organs, abdominal cavity, and other serious complications.

Chronic paraproctitis (rectal fistulas)

With improper treatment of acute paraproctitis, independent breakthrough of the abscess, or under the influence of other factors, the internal opening of the abscess forms a fistula.A perianal fistula is a thin canal that connects the anus to an opening in the skin near the anus. Chronic paraproctitis is characterized by stages of remission and exacerbation.

Pus can accumulate in the fistula opening, causing swelling and pain. The fistula can drain itself (break through), in which case the symptoms disappear for a while, and return when the fistula lumen becomes clogged again. Periodic exacerbations occur due to constant infection of the fistula by the pathogenic flora of the rectum.

Symptoms of rectal fistulas (manifested mainly in the acute phase)

• recurrent itching in the anal region
• pain during bowel movements
• Blood and pus in stool, discharge of blood and pus
• Moisturizing the skin in the perineal region During remission, a person is most often worried about the discharge of pus from the external opening of the fistula.

Treatment of paraproctitis

The most effective method of treatment for both acute paraproctitis and rectal fistula is surgical.

The operation is performed under general anesthesia. In this case, local anesthesia is not used, since it is extremely important to completely anesthetize the operating field and relax the muscles. During the operation, the abscess is opened, the patient is drained of pus. However, the surgical treatment does not end there, if we are talking about the chronic form of the disease – it is important to eliminate not only the abscess, but also the fistula itself. This cannot always be done at the time of active inflammation. Therefore, in some cases, two operations are performed – one to open the abscess, the second to excision the fistula.Sometimes, as part of preoperative preparation, the patient is prescribed a course of anti-inflammatory and antibacterial therapy, and physiotherapy methods have also proven themselves well.

In the Diagnostic and Treatment Center of the Central Clinical Hospital of the Russian Academy of Sciences, operations for acute paraproctitis and excision of the fistula are carried out in the operating unit of the day hospital. The use of modern anesthetics negates the discomfort during the operation. After the intervention, the person is under the supervision of a doctor for several hours, after which he can go home on his own, having received the necessary recommendations for postoperative treatment.

Proctologist consultation

Any suspicion of paraproctitis is a reason for an immediate appeal to a proctologist and an urgent operation if the diagnosis is confirmed. If the treatment is not carried out or does not get rid of the source of the infection, the paraproctitis becomes chronic, over time a fistulous tract is formed. At the consultation, the proctologist will diagnose by palpation and visual examination. Determine the severity of the condition and recommend the most effective way to combat the disease.

90,000 Treatment of rectal fistulas

Rectal fistula treatment

One of the most common diseases is rectal fistula. According to statistical data, approximately 95% of patients with rectal fistulas associate the onset of the disease with acute paraproctitis. In 30-50% of cases, after acute paraproctitis, a rectal fistula is formed in patients. A simple opening and drainage of the abscess without eliminating the entrance gate of the infection predisposes to the formation of a fistula of the rectum.Through the area of ​​the affected anal crypt or through the entrance gate of a different etiology (trauma), there is a constant infection of the pararectal tissues from the intestinal lumen. In the course of the fistula in the tissue with insufficiently good drainage, infiltrates and purulent cavities can form. Currently, we have developed and introduced into clinical practice various methods to avoid trauma to the muscular structures of the sphincter and the development of anal incontinence. Our specialists are proficient in all possible sphincter-preserving operations for rectal fistulas.

Fibrin glue

This technique is used in patients with rectal fistulas that involve less than 30% of the anal sphincter, a simple intervention technique, makes it possible to repeat the procedure, as well as the absence of a damaging effect on the muscle structures of the perineum. The technique has an advantage in patients with a high risk of developing anal sphincter insufficiency or with pre-existing anal incontinence.

Sealing pads (PLUG)

This method is used in patients with rectal fistulas.The biological material from which the tampon is made serves as the basis for obliteration of the fistulous tract. The low-traumatic nature of the operation, the lack of influence on the sphincter apparatus of the rectum gives an advantage over other techniques.

LIFT technique

(ligation and intersection of the fistulous tract in the intersphincteric space) .

The main purpose of the operation is to ligate and cross the part of the fistulous tract passing in the intersphincteric space. This method is used in patients with seizure of more than 1/3 of the sphincter.

VAAFT Technique

(Video-assisted rectal fistula treatment) .

The main feature of this technique is the absence of damage to the anal sphincter. The main stages of this technique are: visualization of the fistula using a fistuloscope, correct and accurate determination of the internal opening of the fistulous passage, detection of additional fistulous passages and leakage cavities under direct visual control, endoscopic treatment of the fistula and closure of the internal opening using a stapler or mucous flap.

This method is superior:

• Lack of damaging effect on the sphincter;
• Absence of large wounds, scar tissue deformation as a result of the operation;
• Rapid recovery of working capacity;

Method of moving / transferring “high” fistulous tract into the submucosal layer or intersphincteric space.

Elimination of the fistulous tract in the intersphincteric space is a fairly simple and effective sphincter-preserving method of treating rectal fistulas.This technique is used in patients with transsphincteric and extrasphincteric fistulas.

Elimination of fistula using bioplastic material.

The advantages of using bioplastic material are to preserve the structures of the anal sphincters, by reducing the volume of surgical intervention in the area of ​​the internal and external anal sphincter. At the same time, the stage of isolation and transposition of a full-wall flap of the rectal wall is excluded, which reduces the operation time, and the use of a special guide allows for convenient and quick delivery of bioplastic material.