Since a perianal abscess is an acute symptom of a local skin infection around the anus, during the acute phase of a perianal abscess, an abscess cavity and pus formation generally occur within about a week. As the disease worsens and progresses, the perianal abscess will rupture about a week later.

If the perianal abscess ruptures, it may have already formed an anal fistula. A perianal abscess and an anal fistula represent two different stages of the disease, and both require surgical treatment. The main surgical treatment for anal fistulas is fistulotomy with seton placement, and care must be taken to drain and disinfect the local wound post-surgery to prevent pseudohealing of the wound.