Can an anal abscess cause a swollen lymph node in the groin?

Hi,

Welcome to icliniq.com.

I understand your concern.

Please provide me with further details about your case.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Yes, an anal abscess can cause lymph node enlargement in the groin. Well, that is very heroic of you. It requires a lot of courage to drain an abscess without local anesthesia. I hope it went smoothly. I suggest you take an antibiotic course to prevent its recurrence.

Plus, please take a picture and send it to me. I want to see it as an external anal abscess or something that has communication inside. In the latter case, surgery is the treatment whereby the surgeon obliterates the tract, which keeps forming the abscess again.

The antibiotic course is:

• Tablet Ciproxin (Ciprofloxacin) 500 mg twice daily for five days.
• Tablet Flagyl (Metronidazole) 400 mg thrice daily for five days.
• Additionally, do a sitz bath with any available antiseptic.

I hope you find this helpful.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Well, as a rule of thumb, that abscess needs drainage and antibiotics (attachment removed to protect the patient's identity). If it has been more than two weeks since drainage and you did not have constitutional symptoms such as fever, then you can avoid taking antibiotics.

Lymph nodes can enlarge in infections. The perianal area drains into the perineal lymph nodes and groin lymph nodes.

I hope this information will help you.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Yes, they can hurt if pressed. The lymph nodes in the groin of that size are frequently found in humans. That does not mean that they are infected or cancerous (tumor).

The lymph nodes can reach a tennis ball size, smaller than that in infectious and cancerous conditions. A node may get smaller with antibiotics. But that small lymph node does not change much in size with anything.

As said above, it is common to have groin lymph nodes in humans without infection or cancer. Yes, the antibiotics will heal the abscess you have now, which seems to be just a tiny, hard lump. They will always work to clear the remnant infection and thus decrease the abscess size.

No, I do not think that mildly swollen lymph nodes cause the type of testicle pain I described. You describe the testicular pain as being due to tight undergarments or maybe because of overthinking (this happens).

If the pain intensity is one to two on a scale of one to 10, I suggest ignoring it. It is a bad idea for you to cut open the hard bump. It is not wise to perform this kind of thing yourself. It is not necessary. Surgeries are never required for such a small abscess.

Pinching with extravasation of the pus, followed by antibiotics, is all that is needed. And you see, you have done it this way.

The size of your lymph nodes is nearly ignorable. Believe me. However, your testicular cancer history concerns me, but I want to know if you have an undescended testis.

1. How did the surgeon remove that tumor via laparoscopy or laparotomy (completely opened-up abdomen)?
2. Did you receive chemo or radiotherapy?
3. Did the cancer spread to other parts of the abdomen, like abdominal lymph nodes?
4. Did they do follow-up surveillance with CT (computed tomography) or MRI (magnetic resonance imaging) of the abdomen?
5. What were the findings in the last CT or MRI report?

These questions are necessary to establish whether it was completely cured or not.

I hope this information will help you.

Thank you.

Hi,

Welcome back to icliniq.com.

Good to hear from you. I must tell you that it is my pleasure to have provided some advice that may help. I can understand your concerns. However, CT (computed tomography) or MRI (magnetic resonance imaging) scans are required in the initial post-operative period and during chemotherapy to assess treatment response. They are not required at the moment.

Thankfully, it has been 15 years since your diagnosis and treatment, and it is highly unlikely that you would develop a recurrence at this stage. Most recurrences occur within the first five years after treatment; therefore, I am no longer concerned about this, and neither should you be.

I do not think sciatica can cause enlargement of this lymph node. If you are concerned about the lymph node, you may take photographs of it and upload them so that I can review them.

The size you mentioned previously does not appear pathological, meaning it does not seem diseased. As mentioned earlier, groin lymph nodes are commonly palpable in humans. A slightly palpable or even tender lymph node does not necessarily indicate a serious underlying disorder.

Infections are by far the most common cause of mildly enlarged and tender lymph nodes. I also believe that a small perianal abscess could be a potential cause in your case. Since you are already on antibiotics, I expect both the lymph node and the abscess to further reduce in size.

I hope you find this information helpful.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Yes, I agree with your thoughts. This is not something that can be easily captured in a photo. Most of these tiny abscesses, or more accurately, inflamed hair follicles, usually resolve on their own after discharging a small amount of pus, and that seems to be the case for you.

I am here to assist you anytime you need. It is, after all, my pleasure to offer you support.

Thanks and Regards.

Hi,

Welcome back to icliniq.com.

I understand your concerns and can also understand the reason for your anxiety. The rule of thumb is that any lymph node that is more than 0.3 inches in size is a concern for everybody.

Any lymph node less than this size, with some exceptions, is not an alarming thing. The exceptions are when they are multiple and scattered across the whole body, or matted, or present in the vicinity of a mass which is supposed to be a cancer.

Now, I probably have communicated to you earlier that inguinal lymph nodes of that small size are usually present in humans without an underlying serious condition. Plus, they can enlarge in case of infection in the locoregional area. The small abscess/folliculitis was most likely the explanation for that enlarged inguinal lymph node as well.

Well, out of curiosity and concern, a doctor’s choice of giving an antibiotic and getting a CT scan was not a bad idea. Now, to answer your concerns:

1. A CT (computed tomography) scan is a good investigation to detect any pathological enlargement of the lymph node or a locoregional pathology such as cancer. So, if the CT scan is normal, then it is completely normal over there.
2. No. Neither nerve pain nor sciatica can cause this. However, a gluteal abscess, which is an accumulation of pus between two layers of gluteal muscle, can cause lymph node enlargement. But if this were present, then the CT would have picked that. Secondly, severe pain and fever are hallmark symptoms, which you do not have.
3. Yes, I still believe this.
4. Attachments and consistency are things we look for when the size of the lymph node is more than 0.3 inches. Those small lymph nodes actually don’t draw our attention.
5. For the reason I explained in point 1, they are a completely ignorable thing. With that small size, there is no meaning of hardness. The lymph node is otherwise hard in consistency because it is made of hard tissue. They are soft, rubbery, and painful in conditions of infection because that makes them tender, inflamed, and sometimes they accumulate pus.
6. Do not worry. There is nothing serious with you, and the nurse has already broken the good news to you. Collect the CT scan report and share it with your physician there. I am sure you do not have anything to worry about.

I hope this helps.

Please feel free to reach out in case of further queries.

Thank you.

Hi,

Welcome back to icliniq.com.

I understand your concern.

Well, you probably remember, I was never in favor of going for surgery for that tiny peri-anal abscess. Since you attempted to drain it yourself, which was successful, and this was followed by the use of some antibiotics, it essentially obsoletes any need for surgery whatsoever.

Yes, an incisional hernia can occur near the previous scar. Up to now, I had the impression that it was simply a swollen lymph node.

Given the size of the lymph node you described, it does not seem to be an alarming thing, since small lymph nodes of that size (with some degree of tenderness if they are infected) are common in humans.

An incisional hernia even has a benign course, meaning it is not cancerous, and it will not progress to cause you problems. Close examination of the swelling is the best guide to proceed. Since only examining the lump would clarify its origin, whether an incisional hernia, a lymph node, or an inguinal hernia, it would not necessarily be of the incisional type.

Why don’t you share a picture of this swelling now? Take multiple photos from the front and side, in a bright room. I would be able to guide you more specifically on this.

I hope I have clarified your query.

Thank you.

Hi,

Welcome back to icliniq.com.

I have seen the pictures you attached (attachment removed to protect the patient's identity). I can see the scar from the previous surgery, which is above the lump you are feeling. On the gross look, it does not seem like a swelling at all.

Swelling, if present, often appears as a significant bulge, which you do not have. I am sure it will only be palpable to you when examining with your hands. To me, this does not seem to be a problem.

They may be tiny lymph nodes, which are often palpable in many men. I do not suggest you should have any more CT (computed tomography) or MRI (magnetic resonance imaging). Your GP (general practitioner) is not doing it properly; otherwise, they would have clarified this earlier.

A small bulge appearing in the vicinity of the previous scar commonly appears when you cough or lift a heavy weight; this suggests a hernia.

See if this bulge becomes prominent when you strain, cough, or lift a heavy weight. This is called a cough impulse and suggests a hernia. Again, a hernia is a benign condition, and you should not be worried about it.

I hope you find this helpful.

Thank you.