A perianal abscess is an acute, painful infection requiring prompt medical attention. This condition involves the accumulation of pus near the anus and will not resolve on its own. While initial care may occur in a general medical setting, definitive treatment requires a specialized surgical procedure. Understanding the condition and appropriate care helps ensure a swift recovery and minimizes complications.
What is a Perianal Abscess
A perianal abscess is an infected, pus-filled lump located near the anus. It commonly arises from an infection of the small glands lining the anal canal, known as anal glands or crypts. When a gland opening becomes blocked, bacteria and fecal matter get trapped, leading to infection and the collection of pus.
The primary symptom is throbbing, constant pain in the anal area, often worsening when sitting or having a bowel movement. The abscess appears as a red, swollen, and tender lump near the anal opening. Deeper infections may cause systemic symptoms like fever and chills, requiring immediate care. Conditions such as inflammatory bowel disease or diabetes can increase the risk of developing this infection.
Where to Seek Initial Care
Initial care should be sought promptly, often through an Emergency Department or Urgent Care facility, due to the acute nature and potential for systemic infection. These settings provide immediate evaluation, pain management, and determine the necessary next steps. The primary goals are to confirm the diagnosis and assess the infection’s severity.
A provider performs a physical examination, which is usually sufficient to identify the abscess. If the abscess is deeper or not externally visible, imaging tests like a CT scan or MRI may determine the exact location and extent of the pus. Simple abscesses may be drained by an Emergency Department physician, but complex or deeper infections require immediate referral to a surgical specialist. Pain relief, often involving medication and local anesthesia, is a significant part of this initial care.
The Role of the Colorectal Surgeon
The definitive treatment for a perianal abscess is surgical Incision and Drainage (I&D), typically performed by a surgeon. Colorectal surgeons possess the most focused expertise in conditions affecting the colon, rectum, and anus. While general surgeons are qualified to perform I&D, a colorectal surgeon’s specialized knowledge is particularly valuable in complex cases.
The I&D procedure involves making a small cut into the abscess to allow the pus to drain completely, providing immediate relief from pressure and pain. Antibiotics alone are insufficient because they cannot effectively penetrate the pus-filled cavity. The procedure may use local anesthesia for superficial abscesses, but general anesthesia is necessary for larger or deeper ones. The surgeon ensures adequate drainage, sometimes by removing a small piece of skin or placing a drain to prevent the wound from closing too quickly.
Following drainage, the surgeon manages post-procedure care, including instructions for wound cleaning and sitz baths. A primary aspect of the surgeon’s role is monitoring for an anal fistula, an abnormal tunnel connecting the abscess cavity to the anal canal. This complication occurs in 30 to 50 percent of cases and requires specialized surgical planning for resolution. Long-term follow-up is important to manage the wound and address potential fistula formation.