An abscess is a common medical condition characterized by pus collection within a confined area. Pus is an inflammatory fluid consisting of white blood cells (WBCs), microorganisms, and dead tissue, which is formed when your body's natural immune system fights off any infection.
An abscess near your anus or rectum is known as a perianal abscess, also called an anal or rectal abscess. It is a painful lump or a boil that most often occurs due to clogging of the anal glands; however, there could be other possible reasons for its formation.
This article will brief you about the perianal abscess, its causes, symptoms, and management. So read on!
Perianal abscess is a painful, pus-filled boil or lump found near your anus (an opening in the body where the gastrointestinal tract ends and waste exits the body), rectum (a chamber that begins at the end of the large intestine and ends at the anus), or perineal area (the space between your anus and genitals). The anus consists of several mucus-secreting glands, and when one of these glands gets blocked or clogged, it can lead to infection and the formation of an abscess.
A perianal abscess is most often caused due to any infection in the body in conditions like:
- Blocked anal glands
- An anal fissure (a tear or injury in the anal canal)
- Sexually transmitted infections (Gonorrhea, Herpes, Chlamydia, etc.)
However, there could be several risk factors that increase your probability of developing a perianal abscess:
- Inflammatory bowel diseases such as Crohn's disease
- Pelvic inflammatory disease (PID) (bacterial infection in the female genital tract caused by Chlamydia, Gonorrhea, and Mycoplasma)
- Diverticulitis (infection or inflammation of the pouches that can form in your intestines).
- Diabetes (a debilitating disease characterized by increased blood sugar levels)
- Prolonged use of steroids
- A compromised immune system as seen in AIDS (Acquired Immunodeficiency Syndrome)
- Chronic (long-lasting) smoking habit
- Persistent constipation or diarrhea
- Trauma to the anus and the perianal area, especially during anal sex
The most common and immediate symptom of a perianal abscess is constant throbbing pain and swelling in the anal area. Other signs and symptoms include:
- Extreme pain that can worsen while sitting down, coughing, or during bowel movements
- A prominent boil or lump in the anal area that is red, tender, and swollen
- Pus discharge from the anus if the abscess bursts
- Painful bowel movements due to constipation
- Lower abdominal pain and discomfort
- Rectal bleeding
- Irritation of the tissues surrounding your anus
- Difficulty in urination
- Other signs of infection include high-grade fever (> 104 ?), chills, body aches, and weakness.
A perianal abscess can be easily diagnosed through a physical examination of the lump to check for pain, redness, and swelling in the anal area.
- For abscesses not visible under the skin or without visible signs, your surgeon will conduct a test using a diagnostic tool known as a "proctoscope." This is a tube-like instrument to look inside the anal canal and lower rectum (proctosigmoidoscopy).
- For deep-seated abscesses, you may require an ultrasound, MRI (Magnetic Resonance Imaging), or CT (Computed Tomography) scan to get a better look for evaluation.
Additional tests may also be required:
- Blood tests
- Stool tests
- Colonoscopy-A colonoscopy is performed as an outpatient procedure (no hospitalization required) where a flexible scope with a light source will be used to examine your colon and large intestine.
Prompt treatment of a perianal abscess is important since it does not go away on its own. There are two types of treatments:
Incision and Drainage (I and D)
- It is a simple outpatient procedure (does not require hospitalization) done under local or general anesthesia by a surgeon to cut open the abscess and drain the infected pus.
- This procedure usually takes 15 to 20 minutes, depending on the surgeon's expertise.
- The abscess will be left open without stitches to drain further and heal completely.
- You may require surgery with anesthesia for large abscesses, and a catheter (tube-like drain) may be inserted for further drainage.
Fistula treatment
- Fistula (an abnormal connection between two body parts or organs) is a common complication of a perianal abscess seen as a tunnel connecting the anal gland and the skin surface.
- Almost half the patients with an anal abscess will eventually develop a fistula.
- Fistula treatment is an outpatient procedure where the internal and external openings are surgically joined.
- It is important to surgically treat a fistula to prevent the recurrence of a perianal abscess.
Post-op Care
Medications
- Your surgeon will prescribe antibiotics to treat the infection post-drainage. This is also helpful if you have a weakened immune system. Your surgeon will prescribe painkillers to reduce pain and soreness.
Laxatives or fiber supplements
- Laxatives will be prescribed to prevent constipation because straining during painful bowel movements may delay healing.
- You will be advised to consume a fiber-rich diet like fresh fruits and green leafy vegetables.
Sitz bath
- Your surgeon will instruct you about sitz baths to promote healing.
- A Sitz bath is a method of submerging your anus and genitals region in warm water.
- This also helps soothe pain and reduces swelling.
Follow-up appointments
- You must attend all the follow-up appointments to prevent abscess recurrence or fistula formation.
Healing of a perianal abscess usually takes around 3 to 4 weeks.
Treatment for perianal abscesses is usually successful with proper post-op care and follow-ups. However, if complications occur, they include:
- Recurrence of abscess- an abscess may again be formed at the same place.
- Anal fistula- a small tunnel or passage which connects an infected anal gland to an opening on the skin surrounding the anus.
- Fournier's gangrene- It is a serious, life-threatening infection of the perineum caused by bacteria.
- Infection- around the anal area, with symptoms like fever, chills, and body aches.
- Sepsis- a life-threatening complication of untreated infection may develop
- Delayed healing- can occur, especially if you have weakened immunity.
Usually, there are not many preventive measures for perianal abscess, but you may reduce your chances of recurrence by
- Managing those medical conditions like diabetes, etc. that can put you at an increased risk.
- Maintaining good anal and genital hygiene.
- Using condoms and other barrier methods during anal sex prevents STIs (sexually transmitted infections) and the spread of other bacterial infections.
- Avoiding prolonged use of steroids.
- Limiting or quitting smoking.
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