Procedure

Anal Abscess Drainage- Colorectal Medicine

Anal Abscess

An anal abscess, also called anorectal abscesses or perianal abscesses, is a painful, pus-filled bulge next to your anus, rectum, or perineal area (the space between your genitals and anus). It occurs when one of your anal glands becomes clogged and infected. Your risk of developing these abscesses may increase due to certain medical conditions or other factors. Your doctor can drain an anal abscess.

Who Are At Risk?

Men are most likely to develop a perianal abscess. It is also more common between the ages of 20 and 60. In addition, you may be more susceptible to developing an anal abscess if you suffer from any of the following conditions:

  • Diabetes.
  • Inflammatory bowel diseases (IBD), such as Crohn’s disease or ulcerative colitis, which cause the body to attack healthy tissues.
  • Diverticulitis.
  • Sexually transmitted infections (STIs).
  • A compromised immune system (for instance, in HIV/AIDS).

Additional risk factors include:

  • Pregnancy
  • Cigarette smoking
  • Use of prednisone, cancer-treating medications, or immune-suppressing medications
  • Frequent diarrhea or constipation
  • Anal sex or foreign objects placed in the rectum during sex

Children and toddlers who have previously experienced tears in the anal sphincter (anal fissures) are also more likely to experience anal abscesses eventually. In addition, these anal fissures could develop in kids with a history of constipation.

Causes Of Anal Abscess

The majority of perianal abscesses develop when a gland in your anus becomes obstructed or clogged. Your anus contains a lot of glands. An abscess occurs when germs or stool (poop) become caught inside one of these glands and become inflamed.

A perianal abscess can also result from:

  • Injury to the region (like during anal sex)
  • STIs
  • An infected anal fissure
  • Bowel and intestine-related medical problems
  • A sebaceous cyst on the skin of your perianal area that is infected. An infected cyst is typically less painful and less likely to result in fever and other general symptoms than a traditional perianal abscess.
  • Hidradenitis suppurativa: This is a chronic condition affecting special skin glands in the groin, armpits, perianal and perineal regions, as well as under the breasts. Perianal hidradenitis can cause an anal abscess.

Symptoms Of Anal Abscess

The most typical symptom of a perianal abscess is a sore, swollen boil around the edge of your anus that looks like a huge pimple. It could be red, painful, or constantly throbbing.

The pain may be dull, sharp, or throbbing and aching. Coughing, going to the bathroom, and sitting down could make the pain worse. Other symptoms of an anal abscess include:

  • Fever, chills, and other flu-like symptoms
  • Pain in your anus or rectum
  • Fatigue
  • Pus-like discharge from the anus
  • Painful bowel movements or constipation
  • Lump or nodule that’s swollen, red, and painful
  • Irritation of the tissue around your anus
  • Pain in the lower part of your belly
  • Rectal bleeding

Some may be able to feel a red, swollen, and tender nodule or bump at the rim of the anus. The infection may cause fever and chills. You can also experience rectal bleeding or urinary symptoms like difficulty urinating.

Deeper rectum anal abscesses can also develop, most frequently in people with inflammatory bowel disorders. As a result, you may experience pain or discomfort around the stomach.

Other than signs of pain or discomfort, which may make a child cranky, toddlers usually don't exhibit many symptoms. A lump or nodule may also be felt or visible around the anal region.

An anal abscess is frequently confused with hemorrhoids which are hard bumps that develop inside or outside your anus or rectum. They might be uncomfortable and might cause bleeding. However, hemorrhoids are not an infection, unlike abscesses.

Hemorrhoids are swollen veins that frequently disappear on their own with over-the-counter medications. Abscesses feel warm and delicate to the touch, whereas hemorrhoids are firmer.

Diagnosing Anal Abscess

Most often, anal abscesses are discovered during a physical examination, where a doctor looks for distinctive nodules in the area. During a rectal exam, the doctor inserts a gloved, lubricated finger to check for irregularities in your rectum. Your doctor might use a speculum that opens hollow body parts to see your whole rectum.

Exterior abscesses can be seen Without the use of any tools. Other abscesses, meanwhile, are deeper in your skin or don't appear on the surface. The doctor may also look for pain, redness, and edema in the anal area to rule out other problems.

The abscess may occasionally be deeper than what a physical examination can detect. Therefore, the doctor could request imaging tests like a CT scan, MRI, or ultrasound, to obtain a better look,

Additional tests might be required to ensure Crohn's disease isn't a contributory factor. Blood and stool testing, imaging, and a colonoscopy may be needed. A doctor uses a flexible scope with light during an outpatient procedure called a colonoscopy to examine the colon and large intestine.

Treatment

Anal abscesses rarely disappear on their own without medical intervention. Surgery or drainage may be required.

The most simple and common treatment is the drainage of the pus from the infected area. The doctor's office is usually an excellent place to do this. To make the area numb, your doctor will give you drugs. It is important to release any uncomfortable pressure so that the tissue can start healing correctly.

Surgery under anesthesia can be necessary if the anal abscess is very large. A catheter may occasionally be used to ensure that the abscess drains entirely. Post drainage, drained abscesses are often left open and don't need stitches.

Your physician might recommend that you spend a few days in the hospital to monitor for infections if you have diabetes or a compromised immune system.

Following drainage, treatment options include:

Medication

Antibiotics

In cases where the infection has spread or your immune system is compromised, the doctor may recommend antibiotics. They may be administered after draining the abscess, but antibiotics are not considered adequate to treat the infection on their own.

Fiber supplements or laxatives

After draining the abscess, your doctor could advise laxatives or fiber supplements to prevent constipation.

Warm baths

The doctor may offer guidance on how to keep the area clean and can suggest a sitz bath. In addition, you are advised to take warm baths rather than hot ones. A warm bath could help decrease swelling.

Follow-up appointments

Attending all follow-up sessions is crucial since there is a possibility that anal abscesses could recur or fistulas will develop. According to a 2019 study, a higher body mass index (BMI) may be linked to the recurrence of abscesses.

It takes 3 to 4 weeks to recover from a drained anal abscess. These can develop into painful anal fistulas that may need additional surgical intervention if left untreated.

Complications

Anal abscesses are typically successfully treated. However, according to the American Society of Colon and Rectal Surgeons, about 50% of persons with an anal abscess will eventually develop an anal fistula. And surgery is typically needed to treat a fistula.

Other complications include

  • Infection or sepsis (a life-threatening complication of infection)
  • Recurring abscesses
  • Fournier’s gangrene (a serious bacterial infection of the perineum)

When To See A Doctor?

If left untreated, an anal abscess can cause complications. You should call your doctor if you experience any of the following:

  • Severe pain and discomfort
  • Fever and chills
  • Rectal bleeding
  • Swelling in your rectal area

References:

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