Can a perianal abscess be completely cured?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 07, 2024
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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.

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Written by Chen Tian Jing
Colorectal Surgery
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What will happen if a perianal abscess is not treated?

Perianal abscesses are localized abscess formations that occur due to repeated infections in the anal crypts. Typically, under perianal ultrasonography, clear pus chambers and related structures can be observed. If perianal abscesses are not treated promptly, there is a high likelihood of expansion of the local pus chambers and dispersion of the pus, leading to an increase in the size of local anal abscesses, which might involve the sacrococcygeal area or the intersphincteric space. The primary treatment for perianal abscesses is surgical, mainly through incision and drainage to evacuate the pus, followed by thorough debridement of the local wound. Additionally, if there are changes in the local sphincter, thread-lifting therapy may also be performed.

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Written by Chen Tian Jing
Colorectal Surgery
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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.

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Written by Yu Xu Chao
Colorectal Surgery
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Can an anal abscess without pus be treated without surgery?

Perianal abscesses require surgical treatment even if there is no pus present, as early-stage perianal abscesses are primarily characterized by pain and noticeable lumps near the anus, with the lumps typically being hard. This condition is mainly considered to be an infection and inflammation of the anal glands, which then infects the surrounding tissue, leading to the development of lumps. Surgical treatment should be undertaken as soon as possible even in the absence of pus, because as the infection worsens over time, it may lead to the formation of pus. Early treatment can be advantageous as the infected area is not very extensive, thus resulting in a smaller surgical wound. For early-stage perianal abscesses, a one-time radical surgery may be chosen to remove the internal opening and the infected tissue thoroughly, followed by postoperative care using medicated substances such as erythromycin ointment gauze, anal washes, or mupirocin ointment to promote healing of the surgical wound.

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Colorectal Surgery
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How many days is the hospital stay for perianal abscess surgery?

After surgery for a perianal abscess, due to the presence of a local wound and the significant discharge from the wound in the early postoperative period, combined with the potential fall of ligatures or elastic bands at the area, a hospital stay of approximately two weeks is required. For severe cases or those with deeper abscess cavities, a hospital stay of three weeks or even a month might be necessary. The main purpose of the hospital stay post-surgery is to monitor for any major bleeding from the wound, and to facilitate dressing changes. Postoperative dressing changes for a perianal abscess wound are crucial for recovery, as only thorough daily disinfection and dressing changes can ensure uniform granulation and growth of local tissues, prevent the enclosure of pus within the local cavity leading to pseudohealing or reinfection, and thus affect the treatment outcome of the surgery. Approximately one month after surgery, regular follow-up visits are required to monitor the healing of the local wound.

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Colorectal Surgery
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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.