Perianal Abscess

Dr Calvin Ong

MBBS M.MED (SURGERY) MRCS FRCS

What is a Perianal Abscess?

A perianal abscess is an infection characterised by pus accumulation in the perianal area, often due to blocked anal glands or bacterial infection.

It can occur spontaneously or be secondary to conditions such as anal fissures, trauma, or recent surgery. If untreated, an abscess may lead to complications such as fistulas, which are abnormal channels that connect the infected gland to the skin surface.

Causes and Risk Factors of Perianal Abscess

Perianal abscesses develop from infections in the anal glands. Factors that increase the risk include:

Blocked or Infected Anal Glands

Anal glands can become blocked by stool or skin debris, creating an environment for bacteria such as Staphylococcus aureus and Escherichia coli to multiply, forming an abscess.

Inflammatory Bowel Disease (IBD)

Chronic conditions such as Crohn’s disease and ulcerative colitis cause chronic inflammation in the digestive tract, which can weaken the surrounding tissue surrounding the rectum, increasing the likelihood of abscess formation.

Trauma and Surgery

Anal fissures, trauma, or recent surgical procedures can introduce bacteria, increasing the risk of infection and abscess development.

Weakened Immune System

People with conditions such as diabetes or those on immunosuppressive medications are at increased risk of infection, and they may present with more severe symptoms.

Age and Gender

Men are more prone to perianal abscesses, and the risk increases with age due to reduced tissue integrity and weaker immune function.

Diagnosis of Perianal Abscess

Diagnosing a perianal abscess typically involves several steps to confirm the infection and guide treatment. Early detection is necessary for effective management and to prevent complications.

Physical Examination

The doctor will visually inspect the area around the anus for swelling, redness, warmth, and signs of drainage, which indicate infection.

Digital Rectal Exam

This may be done to determine the depth and size of the abscess, allowing the doctor to assess the severity of the infection and any abnormalities in the tissue near the rectum.

Imaging Tests

Ultrasound or MRI can provide a clearer view if the abscess is located deeper or if a fistula is suspected. These tests are done when necessary, as most superficial abscesses can be diagnosed through physical examination.

Blood Tests

Blood tests help detect signs of infection, such as an elevated white blood cell count, which indicates an active infection. These results allow the doctor to assess the severity of the infection and plan appropriate treatment.

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Treatment Options for Perianal Abscess

Non-Surgical Treatment

Non-surgical options can relieve symptoms, particularly for smaller abscesses.

Antibiotics

Antibiotics may be prescribed to control mild infections, especially for patients with conditions like diabetes or weakened immune systems. However, antibiotics alone are usually insufficient, as most abscesses require drainage to prevent complications.

Medication for Pain and Inflammation

Pain relievers, such as acetaminophen or ibuprofen, can help reduce pain and swelling. These medications manage symptoms but do not treat the underlying cause of the abscess.

Surgical Treatment

Surgery is typically required for most perianal abscesses to ensure effective drainage, relieve symptoms, and prevent complications.

Incision and Drainage

This standard procedure involves a small incision near the abscess, allowing the pus to drain and relieving pressure and pain. Local anaesthesia is used for smaller abscesses, while general anaesthesia may be required for larger or deeper abscesses. Incision and drainage offer immediate relief and promote healing.

Fistulotomy

If a fistula develops, a fistulotomy may be performed to remove the infected tract and prevent recurrence. In some cases, a seton (a thread-like drain) may be temporarily placed to allow controlled drainage before surgery.

Preventing Perianal Abscess

Preventing a perianal abscess involves maintaining hygiene by regularly cleaning the anal area to reduce bacterial buildup. Managing inflammatory bowel disease (IBD) with proper treatment, along with controlling constipation and diarrhoea, helps prevent anal trauma and infection. Supporting immune health through a balanced diet, sleep, and exercise further lowers infection risk.

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Dr Calvin Ong Jianming

MBBS (S’pore)|

M.Med (Surgery)|

MRCS (Ireland)|

FRCS (Edin)|

王健名医生

Dr. Calvin Ong is a Senior Consultant with more than 15 years of surgical experience. He specializes in colorectal and general surgery, performing minimally invasive as well as advanced robotic surgeries for benign and malignant colorectal conditions, including inflammatory bowel disease, pelvic floor disorders, colorectal cancer, and hernia repair. He is dedicated to providing high-quality, personalised care for his patients.

Dr. Ong graduated with a Bachelor’s degree in medicine and surgery from the National University of Singapore in 2008 and completed his Masters of Medicine (Surgery) at the same institute. He finished his advanced specialist training in 2016 and became a fellow of the Royal College of Surgeons of Edinburgh.

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    Frequently Asked Questions

    Can a perianal abscess heal without treatment?

    In rare cases, a small abscess may drain on its own, providing temporary relief. However, the underlying infection often remains, making medical treatment necessary to prevent complications like fistulas or recurrent infections.

    Is there a high chance of recurrence after an abscess is treated?

    While treatment reduces the risk of recurrence, some individuals, especially those with Crohn’s disease or other inflammatory conditions, may experience repeated abscesses. Proper wound care and managing underlying health conditions are key to reducing recurrence risks.

    How long does recovery take after surgical drainage?

    Recovery times depend on the size and depth of the abscess, as well as the individual’s healing rate. Most patients experience significant relief within a few days, but complete healing can take 2-4 weeks with consistent wound care and follow-up monitoring to prevent complications.

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