Anorectal abscess: what it is, symptoms, causes and treatment

An anorectal, anal or perianal abscess is the formation of a cavity filled with pus in the skin around the anus, which can cause symptoms such as pain, especially when evacuating or sitting; the appearance of a painful lump in the anal region; bleeding or the elimination of a yellowish secretion.

Generally, an abscess results from the clogging of glands in the anus region followed by the development of bacteria, which leads to the formation of this cavity and pus. However, some diseases such as cancer and inflammatory bowel disease may also be involved, facilitating the formation of an anorectal abscess.

If you have symptoms of an anorectal abscess, especially if they are associated with immune problems or signs of infection such as fever and swelling with redness, it is important to consult a general practitioner or a coloproctologist.

Main symptoms

The main symptoms of anorectal abscess include:

  • Pain in or near the anus, especially when defecating or sitting;
  • Lump in the anal region;
  • Redness of the skin;
  • Heat on site;
  • Swelling;
  • Increased sensitivity at the site;
  • Fever;
  • Bleeding;
  • Pus discharge.

When the abscess ruptures and the pus drains out, symptoms may be relieved, especially pain. However, if symptoms persist, return, or pus is released frequently, it may indicate the presence of other diseases or that the abscess is not improving. In these cases, it is recommended to consult a doctor. Check out the main causes of pain when defecating .

How to confirm the diagnosis

The diagnosis is usually made by the doctor through an evaluation of the symptoms and analysis of the anal region.

However, in some cases, tests such as anoscopy, ultrasound, CT scan or MRI may still be necessary. Blood tests, such as a complete blood count, can also help assess the severity of the infection.

Possible causes

A perianal abscess is caused by a bacterial infection, usually due to blockage of the glands that produce mucus in the anal region.

However, there are some conditions that increase the risk of an abscess forming, such as:

  • Inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis;
  • Hidradenitis suppurativa;
  • Rectal infections, such as amoebiasis, lymphogranuloma venereum, tuberculosis or rectal schistosomiasis;
  • Anal fissure;
  • Anorectal cancer;
  • Trauma;
  • Presence of a foreign body in the region;
  • Compromised immunity;
  • Sequelae of chemotherapy treatment;
  • Having undergone surgery in the anorectal region, such as hemorrhoidectomy, episiotomy or prostatectomy, for example.

These conditions cause inflammation in the tissue of the rectum and anus, facilitating the accumulation of bacteria and the formation of pus. Learn more about the causes, symptoms and treatment of proctitis .

How is the treatment done?

Depending on the depth of the abscess, its size, the severity of the infection and the risk of widespread infection, treatment may involve:

1. Drainage by surgery

The main form of treatment for an anal abscess is drainage of the pus, which should be done as soon as possible to reduce the risk of a more serious infection.

This procedure can be performed by a general practitioner, under local anesthesia and without the need for hospitalization, in cases of more superficial and smaller abscesses. However, more complicated cases require hospitalization so that drainage can be performed in the surgical center by a general surgeon or coloproctologist.

After drainage, your doctor may recommend rest, painkillers and warm sitz baths, due to their anti-inflammatory effects. It is important that your doctor monitors your recovery to ensure that the abscess has improved and that there are no complications.

2. Use of antibiotics

The use of antibiotics should always be guided by a doctor, and is generally indicated in addition to drainage when the abscess is large, has an extensive area of ​​redness and heat, or if there is a risk of generalized infection, as in the case of diabetes, compromised immunity or obesity, for example.

3. Treatment of associated changes

Sometimes, there may be a fistula related to the abscess. This fistula is a channel that can appear after the pus has drained out, or due to other diseases, and can hinder the improvement of the infection. In these cases, treatment of the abscess must also include treatment of the fistula, which can be done through surgery or by placing a material inside the fistula to encourage its closure. Learn more about what an anal fistula is and how to treat it .

What to do if the abscess doesn’t get better

If the abscess does not improve, it is recommended to consult a doctor, because after draining an anorectal abscess there may be a failure in healing and formation of a fistula, which may be responsible for the persistence or return of symptoms such as perianal swelling and discharge of secretion.

Additionally, in some cases the abscess may return, which is most common during the first year after initial treatment.

Possible complications

In some cases, the abscess can give rise to an anal fistula, which can run from the anus to the vagina, uterus, urinary tract or other parts of the intestine, for example.

Other complications that an anal abscess can cause are the compromise of the anal sphincter, causing fecal incontinence, or a necrotizing infection, which is when bacteria reach neighboring tissues, such as skin, muscles and fat.

Furthermore, if treatment is not carried out correctly, it is possible for the bacteria to reach the bloodstream and cause a generalized infection, which can even lead to death.


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