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Perianal abscess
How to treat perianal abscess?
Perianal abscesses generally have two treatment options. Initially, if the abscess is not very large and the swelling and pain are not particularly severe, conservative treatment with antibiotics can be used temporarily. If conservative treatment is ineffective and the swelling worsens, surgical treatment may be necessary. In cases of severe abscesses, incision and drainage can be considered first, followed by antibiotic treatment. Surgical definitive treatment can then be performed 3-5 days later.
Symptoms of perianal abscess
Perianal abscess is a common acute infectious disease in proctology. When a perianal abscess occurs, the patient generally experiences severe pain in the anal area accompanied by local skin redness, increased skin temperature, and even systemic fever and fatigue symptoms due to the local abscess. During an outbreak of a perianal abscess, the abscess cavity or pus encapsulation can generally be clearly seen under perianal color ultrasound, and it is necessary to promptly carry out perianal abscess incision and drainage surgery, as well as further one-time radical surgery for the perianal abscess. If not treated actively, a perianal abscess might rupture and likely form an anal fistula, the treatment of which is also primarily surgical.
The difference between perianal abscess and anal fistula
Perianal abscesses and anal fistulas both belong to local infectious diseases of the anus. A perianal abscess represents the acute phase of infection, characterized by significant localized subcutaneous swelling, heat, pain, and the formation of pus and abscesses. Once the pus breaks through the skin and discharges, it naturally forms an anal fistula. Anal fistulas represent the later stages or dormant phases of local infections. Both perianal abscesses and anal fistulas require surgical treatment. The surgical method for perianal abscesses mainly involves a one-time radical surgery for the abscess, while the surgical approach for anal fistulas primarily involves fistulotomy with seton placement, followed by regular wound cleaning and dressing changes post-surgery.
What should I do if there is pus draining from a perianal abscess?
When a perianal abscess occurs, there is typically pus or an enclosed abscess under the skin. If the perianal abscess ruptures and drains pus, it may have developed into an anal fistula. Once a perianal abscess forms an anal fistula, surgical treatment should be carried out as soon as possible. The surgical methods for treating perianal abscesses and anal fistulas mainly include incision drainage debridement surgery and incision with seton placement. After the surgery, due to substantial secretion from the local wound, it is essential to disinfect and change dressings regularly and to monitor the wound daily. It is crucial to prevent excessive granulation or pseudohealing at the local site, which could encapsulate the infection and prevent complete recovery, potentially leading to recurrence in the future.
Can a perianal abscess be completely cured?
The primary cause of perianal abscesses is the repeated inflammatory stimulation near the dentate line of the anus, leading to infection. As the infection worsens, localized foci of infection form, resulting in the formation of pus and abscesses. Once a perianal abscess has formed, the patient will experience severe pain and will require prompt surgical treatment. If a definitive one-time surgery for the perianal abscess is chosen, it can be completely treated. Post-surgery, simply changing the dressing on the local wound will suffice, and the wound is expected to fully heal and recover. However, if an incision and drainage surgery was performed for the perianal abscess, a fistula may have already formed, requiring a second surgery for cutting and threading the fistula.
Can a perianal abscess heal by itself?
During the acute phase of a perianal abscess, there is significant local redness, swelling, heat, and pain around the anus. Generally, this condition is caused by an infection of the anal crypts, and the possibility of self-healing is very low, so the main treatment for a perianal abscess is surgery. The surgical approach usually involves incision and drainage of the perianal abscess, combined with a one-time curative surgery. If the abscess ruptures and forms an anal fistula, surgical treatment is also required. During the outbreak of a perianal abscess, due to the severe local pain, it is advisable to undergo surgery as soon as possible to prevent further spread of the abscess. Simple topical medications can only relieve the symptoms of local inflammatory infection and cannot achieve a cure.
Can an anal abscess be cured by taking medicine?
An anal abscess is formed due to repeated infections within the anal crypts, resulting in localized pus or an encapsulated abscess. During an episode, the patient experiences severe pain, strong positive tenderness, and notable swelling, heat, and pain around the anal area. In severe cases, it can affect normal sitting and even walking activities. When an anal abscess occurs, it generally requires prompt surgical incision and drainage followed by definitive surgery. Relying solely on oral or topical medications cannot completely cure an anal abscess and only serves to alleviate symptoms. Post-surgery for an anal abscess usually involves local dressing changes to prevent pseudohealing and maintain proper drainage of the wound.
Causes of perianal abscess formation in babies
In pediatric outpatient surgery, perianal abscesses are not uncommon, and many parents visit the hospital daily for this issue. They wait, register, and change dressings. Once the wound heals, it often recurs after a while, leading to repeated incisions and drainage, persisting for several months. Eventually, the doctors say a fistula has formed and surgery is required. What exactly causes such troublesome perianal abscesses? The cause of perianal abscesses is not completely clear, but many affected children have been found to have deeper anal crypts than normal, so it's speculated that it may be related to this abnormality. In children under two years old, perianal abscesses mostly occur in boys. Some studies suggest that testosterone levels are higher in boys aged 1-3 months, coinciding with a peak period for perianal abscess incidences, leading to speculation that it may be related to the child’s hormone levels. In children over two years old, there is less gender bias in the incidence of perianal abscesses, and some cases are secondary to Crohn’s disease.
How to find the internal opening of a perianal abscess?
The internal opening of a perianal abscess is mainly identified through digital rectal examination and with the aid of a probe and perianal ultrasonography. Typically, during the onset of a perianal abscess, there is noticeable redness, swelling, heat, and pain around the anus. Inside the anal canal, digital rectal examination and anoscopy reveal swollen mucosa at the anal crypt, accompanied by the discharge of pus. Using a probe for exploration can clearly identify the presence of the internal opening locally. Once the internal opening of a perianal abscess is located, prompt surgical treatment is necessary. Surgery for perianal abscesses generally involves a one-time radical procedure complemented by incision and drainage. If an internal opening exists and involves the sphincter, further surgery involving incision, drainage, and seton placement may be required.