Introduction:
An anorectal abscess describes the pus-filled cavity in the anal canal. Based on the location, these can be referred to as:
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Perianal abscess
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Perirectal abscess
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Perineal abscess
It occurs when the anal glands or sacs become clogged and infected. The gland at the anal canal becomes infected and is lined with bacteria. The infection causes the development of a lump that is red and uncomfortable (like a "pimple"). These deep abscesses are sometimes associated with inflammatory bowel conditions like Crohn's disease (an inflammatory disease of the intestines mainly affecting the colon and ileum and associated with ulcers and fistula). The pus may drain on its own, heal, and go away. These abscesses sometimes require medical attention for drainage, adequate treatment, and complete relief.
What Is a Fistula?
Fistula formation can occur with perianal and perirectal abscesses. A fistula is a tube-like connection between the skin area outside and inside the anus (rectum or anal canal). When a fistula forms, bacteria from the gut become trapped, causing the infection to reoccur. A superficial fistula results from the perianal abscess. A perirectal abscess-related fistula can penetrate the layers of the pelvic floor muscle and the anal sphincter muscle complex because it is deep.
What Are the Signs and Symptoms of a Perineal Abscess?
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The most typical sign of a perianal abscess is soreness and swelling around the edge of the anus that looks like a huge pimple.
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It is red, excruciatingly painful, or always throbbing.
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Coughing, pooping and sitting down make the pain worse.
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Anal abscesses include anus discharge that resembles pus.
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Discomfort in the anus or rectum.
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A painful bowel movement or constipation.
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The tissue surrounding the anus is irritated.
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Abdominal bleeding.
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Lower abdominal pain.
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Fever, chills, and other flu-like symptoms can result from abscesses.
Why Do Perianal Abscesses Develop?
The anus contains a lot of glands. Most perianal abscesses develop when a gland in the anus becomes obstructed or clogged. An abscess occurs when bacteria or stools (poop) get caught inside one of these glands and become inflamed. The following additional factors can result in a perianal abscess:
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A tear in the lining of the anus.
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Injury to the anus (like during anal sex).
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Bowel and intestine-related medical problems.
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A sebaceous cyst on the epidermis of the anus that is infected. An infected cyst is typically less painful and less likely to result in fever and other general symptoms than a normal perianal abscess.
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Special skin glands can be found in specific locations, including armpits, groin, perianal, perineal, and under breasts. The abscesses develop from these glands located in the anus, which is known as perianal hidradenitis.
How Are Perirectal or Perianal Abscesses Identified?
A proper medical history and physical examination are required to diagnose a perianal abscess. The abscess may be firm, red, and sensitive to the touch. A healthcare practitioner will perform an endoscopy with a flexible, illuminated endoscope to determine whether the abscess is internal or external (within the anal canal). When an abscess is deep, imaging tests such as computed tomography (CT) scans or transrectal ultrasonography (TRUS) are used less frequently. Because they cannot pinpoint the exact location of the abscess. Additional imaging, such as a pelvic CT scan or MRI (magnetic resonance imaging), will be required.
How Is a Perianal Abscess or Fistula Treated?
A perianal abscess can occasionally be treated at home with sitz baths (shallow baths used to cleanse the perineum), or warm water soaks after every bowel movement, at least twice or three times daily. Abscesses may sometimes self-drain with the sitz bath without further medical attention. Antibiotics are prescribed to treat skin infections if there is a local spread to a nearby region, like the buttocks. Painkillers are given to relieve pain. Additionally, a surgeon may need to perform abscess drainage if it does not drain independently. Drainage rids the abscess of infective material and promotes long-term skin healing. When the abscess is not deep, medical professionals drain the abscess using a local anesthetic, a scalpel, and a set of forceps. Surgery must be carried out in the hospital under general anesthesia if the abscess is deep. Typically, the procedure lasts for around thirty minutes. The pus sample is sent to the lab for culturing and to find the causative organism. Antibiotics are recommended for about a week after the procedure to help cure and stop the spread of the infection.
However, in individuals who experience recurrent infections, a fistula may have developed, contaminating the bloodstream with bacteria and leading to repeat abscess formation. For the fistula, a surgical treatment called a fistulotomy is carried out. A CT or MRI scan is used to diagnose the fistula and also used to diagnose a perirectal abscess. A patient also needs to consult a gastroenterologist to be assessed for inflammatory bowel disease if a perirectal abscess or fistula is found. Medicines for inflammatory bowel disease are provided to treat the inflammation and facilitate fistula healing.
The fistulotomy is performed by a surgeon under general anesthesia and will take place in the operating room. Because it is an outpatient treatment, the patient will return home on the same day of the surgery. First, the surgeon locates the anal canal hole that connects to the skin opening during the procedure. Next, a cut is made to the tube-like connector. The fistulotomy incision is not sutured after it is created; it is left open. The open wound naturally seals and heals itself within one to two weeks. Even during bowel motions, the wound will not get infected while the region heals. After every bowel movement, the area should be bathed with warm water to keep the anal region clean. Sometimes doctors recommend using over-the-counter topical creams and gels to help soothe anal tissues. After the procedure, pain medication is not frequently needed.
Conclusion:
Abscesses can develop much higher in the rectum or close to the anus. While an abscess can develop suddenly and for no apparent reason, it is frequently linked to gastrointestinal disorders, bowel abnormalities, immune system suppression, and even specific drugs. A gastroenterologist and a surgical team should promptly perform an examination and proceed toward management. Diagnosis requires a physical examination, a careful medical history, and certain imaging tests. Rarely can anorectal abscesses disappear on their own or entirely after receiving antibiotic treatment. A medical professional will typically need to drain the abscess. Treatment involves a surgical procedure that requires an anesthetic, a scalpel, and a set of forceps.
