Which is more serious, perianal abscess or hemorrhoids?

Written by Chen Tian Jing
Colorectal Surgery
Updated on March 09, 2025
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Perianal abscesses and hemorrhoids are two different types of anorectal diseases. During the acute phase of a perianal abscess, the urgency of the condition is greater than that of hemorrhoids. If active surgical intervention and incisional drainage and debridement are not carried out for a perianal abscess, it can lead to further enlargement of the pus cavity, increasing the size of the infected wound and the focus of infection, causing more severe pain and symptoms of systemic infection in the patient. Hemorrhoids, on the other hand, can be managed with conservative medication to alleviate symptoms. Surgical treatment is considered only when there are recurrent flare-ups, severe pain, significant prolapse, and worsening bleeding.

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Written by Chen Tian Jing
Colorectal Surgery
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Can an anal abscess be treated without surgery?

Perianal abscess is a local infectious disease of the anus, typically occurring acutely with severe pain. The nature of the pain mostly involves jumping pain or peck-like pain. Patients also experience redness and swelling of the skin around the anus, as well as an increase in overall body temperature. Chronic recurrent attacks can lead to fatigue and further spreading of the abscess, causing enlargement of the local abscess cavity and even triggering a systemic infection. Therefore, it is essential to undergo surgical treatment as soon as possible during the acute phase of a perianal abscess. The main surgical methods are incision and drainage of the perianal abscess or a one-time radical surgery around the anus. Postoperative wound disinfection and dressing changes should be carefully attended to.

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Written by Chen Tian Jing
Colorectal Surgery
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Postoperative Precautions for Perianal Abscess Surgery

After surgery for a perianal abscess, it is important to focus on the diet, primarily a liquid diet, since normal defecation is not advised in the early postoperative period or if the stool is too dry to avoid irritating the wound with feces, causing pain or even symptoms of infection. Therefore, the postoperative diet should primarily consist of a light, liquid diet. Postoperatively, since there will be local sutures and ligatures tied at the wound site, it is not recommended to engage in excessive exercise and activity within two weeks. The recovery of the local wound after surgery requires proper dressing changes. Postoperative dressing changes involve daily cleaning and disinfection of the local wound, ensuring smooth drainage, and using gauze packing to pressurize and drain the wound.

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Written by Yu Xu Chao
Colorectal Surgery
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Differences between minimally invasive surgery and traditional surgery for perianal abscess

In clinical practice, perianal abscesses are primarily due to infection and inflammation of the anal glands, which then leads to the formation of red and swollen masses around the anus, causing pain and swelling near the anus. If not treated surgically in a timely manner, it can lead to necrotizing fasciitis or anal fistulas. Minimally invasive surgery for perianal abscesses mainly aims to minimize damage to the anal sphincter during the procedure. Techniques such as loop drainage can be employed to preserve it, whereas traditional surgery generally involves larger incisions, but provides better drainage and has a lower recurrence rate post-operatively. However, leakage or moisture in the anal area can occur after traditional surgery. For minimally invasive surgery for perianal abscesses, there is a relatively higher recurrence rate since the drainage may not be as effective. However, the integrity of the anus post-surgery is better preserved and incidents of leakage are less frequent. The choice of surgical method should still be based on the severity of the perianal abscess.

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Written by Chen Tian Jing
Colorectal Surgery
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Why is a perianal abscess so painful?

During the acute phase of a perianal abscess, the intense pain is mainly due to the formation of an abscess and pus pockets in the subcutaneous area around the anus. The pus within these cavities cannot rupture, causing localized skin nerves to experience pecking-like or jumping pain. The pain from a perianal abscess is generally unbearable for patients, necessitating prompt surgical treatment. The surgical approach for a perianal abscess primarily involves incision and drainage, followed by debridement of the abscess cavity. It is important to note that postoperative disinfection and dressing changes of the local wound are crucial to prevent false healing of the wound.

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Colorectal Surgery
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What should I do if the perianal abscess bursts?

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.