Perianal Abscess

Evaluation and treatment of perianal abscess-fistula disease require a thorough understanding of anal anatomy. Understanding the anatomy helps to determine the origin and the subsequent course of this disease process and also helps both to direct therapeutic interventions and to risk-stratify outcomes.

What Is Perianal Abscess ?

An abscess is a localized collection of pus. In perianal abscess, a localized collection of pus can either occur near the anus under the skin, or deeper, adjacent to the rectum. Perianal abscesses are the most common type of anorectal abscesses 1). Perianal abscesses are more common in patients with diabetes mellitus, Crohn’s disease, and patients who are immunocompromised for any reason. Perianal abscess affects men more than women. Perianal abscess may occur in infants and toddlers who are still in diapers and who have a history of anal fissures. Perianal abscess rarely goes away on its own. Antibiotics alone usually cannot treat an abscess.

The prevalence of perianal abscesses and anorectal abscesses, in general, are underestimated, since most patients do not seek medical attention, or are dismissed as symptomatic hemorrhoids. It is estimated that there are approximately 100,000 cases of the benign anorectal disease in general. The mean age at presentation is 40 years old, and adult males are twice as likely to develop with abscess than females.

Perianal abscesses 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. Perianal abscesses can also cause systemic infection if left untreated.

Perianal abscess treatment

A perianal abscess should be treated in a timely fashion by incision and drainage .

Most perianal abscesses can be treated in the office setting. Some conditions, such as cellulitis without fluctuance, failed drainage in the office, abscesses with associated systemic signs of sepsis, or extensive abscesses, are more appropriately treated in the operating room, where a thorough examination under anesthesia can ensure optimal diagnostic evaluation and drainage.

Treatment involves surgery to open and drain the abscess:

  • Surgery is usually done with local numbing medicine, along with medicine to make you sleepy. Sometimes, spinal or general anesthesia is used.
  • Surgery is most often an outpatient procedure, which means that you go home on the same day. The surgeon cuts open the abscess and drains the pus.
  • Sometimes a drain is put in to keep the incision open and draining, and sometimes the abscess cavity is packed with gauze.
  • If the pus collection is deep, you may need to stay in the hospital longer for pain control and nursing care of the abscess drainage site.
  • After surgery, you may need warm sitz baths (sitting in a tub of warm water). This helps relieve pain and reduce swelling.

Dr. Rahul Yadav is a senior surgeon from India. He has experience of 7 years in the field of medical science and advanced surgery technology. He specializes in all types of general Surgeries, Laser Surgeries, Hernia, and Laparoscopic Surgery.

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