Does a recurrent perianal abscess occur in the same location?

Written by Yu Xu Chao
Colorectal Surgery
Updated on March 01, 2025
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The recurrence of a perianal abscess may not necessarily be in the same location, but it is possible. If the internal opening was not completely cleared during the first perianal abscess surgery, this could lead to reinfection of the anal glands and subsequently a recurrence of the perianal abscess.

In such cases, it is advisable to visit a hospital early for a perianal MRI to determine the position of the internal opening and the extent of the infected tissue. Then, a one-time radical surgery for the perianal abscess can be performed. After the surgery, it is crucial to consistently use medications like red oil gauze, anal wash, and golden ointment for dressing changes, to promote wound healing and avoid pseudo-healing.

Additionally, if a perianal abscess was completely cured once, poor diet, lack of sleep, or frequent alcohol consumption could potentially cause abscesses in other perianal areas later. This situation is quite common, so it is important for patients to maintain a light diet.

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Written by Chen Tian Jing
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.

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Written by Yu Xu Chao
Colorectal Surgery
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How long will it take for the perianal abscess anti-inflammatory medicine to work?

Once a perianal abscess is discovered in clinical practice, it's recommended to undergo surgical treatment as soon as possible, rather than using anti-inflammatory drugs for anti-infection treatment. This is because perianal abscesses are primarily caused by inflammation of the anal glands, leading to swelling and redness around the anus. Treating with only anti-inflammatory medications can temporarily control the condition, but the already infected tissues and the internal opening are not adequately treated. Improper diet or staying up late can lead to recurrence, or even lead to anal fistulas or necrotizing fasciitis. Therefore, for perianal abscesses, it is recommended to promptly undertake procedures such as incision and drainage of the perianal abscess, or a one-time radical surgery for perianal abscesses. However, for a minority of patients with perianal abscesses, such as subcutaneous perianal abscesses, if the area is relatively small, applying ichthammol ointment topically combined with oral administration of anti-inflammatory drugs or antibiotics can generally improve the condition within five to six days. (Please follow the doctor's advice regarding medications.)

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Written by Chen Tian Jing
Colorectal Surgery
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Can a perianal abscess heal by itself without rupturing?

Perianal abscesses that have not ruptured generally involve two scenarios. First, the application of topical or oral antibiotics may eliminate the local abscess, but some infection foci and swelling may persist, with a possibility of recurrence later. The second scenario occurs when the abscess does not rupture, but the pus chamber further expands, leading to an increase in the area of infection and thus worsening systemic infection symptoms. Once a perianal abscess is detected, it is necessary to treat it promptly. If an early-stage typical pus chamber has not formed, antibiotics can be used for symptomatic treatment to reduce local inflammation. If a clear pus chamber has formed and is accompanied by pus, it is advisable to promptly perform an incision and drainage of the abscess, followed by a definitive surgical debridement.

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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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Colorectal Surgery
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Is the recurrence rate of perianal abscess high?

Perianal abscess is an acute infectious disease localized around the anus. If a perianal abscess acutely erupts, it requires prompt surgical treatment. Without surgery, there is a possibility of recurrent episodes of perianal abscesses or the formation of anal fistulas due to the rupture of the abscess. After surgery for a perianal abscess, it is also important to pay attention to a light diet and regular bowel movements. It is crucial not to allow the stool to become too dry, nor to experience diarrhea. Recurrent diarrhea can lead to infection of the anal crypts, thereby causing perianal abscesses and local infections. Therefore, the care of a perianal abscess is very important; maintaining good dietary and bowel habits is essential to prevent recurrence of the abscess.