Perianal Abscess: Causes, Symptoms and Treatment

The majority of anorectal disorders comprise perianal abscesses and fistulas. A perianal abscess is an infection on the surface of the anus. It often appears like a bump filled with pus and can cause serious pain and discomfort.

A perianal abscess may also be referred to as an anal (rectal) abscess. If left untreated, the infection can spread and cause complications. Keep reading to know more about the perianal abscess, its symptoms, causes, diagnosis, treatment and more.

Disease Name	Perianal Abscess
Alternative Name	Anal (rectal) Abscess, Perineal Abscess, Anorectal Abscess
Symptoms	Swollen and inflamed bump, Throbbing pain, Pus-like discharge, Bleeding, Painful bowel movement
Causes	Infected anal fissure, Sexually transmitted infections
Diagnosis	Digital rectal examination, Proctosigmoidoscopy, Colonoscopy, Anoscopy, Imaging scans (CT or MRI Pelvis)
Treated by	General Surgeon (Proctologist)
Treatment options	Incision and drainage

Perianal abscess is a condition of the anorectal region, meaning it generally occurs around the space between the anus and genitals. This condition develops due to an infection of the anal glands which leads to the accumulation of pus in that area.

In some cases, perianal abscesses can become extremely painful and may cause serious trouble if they persist long. A variety of causes can trigger an abscess in the perianal area to form. Learn more about this condition in subsequent sections.

The most common and visible symptom of a perianal abscess is a pimple-like boil near the anal opening. It may be accompanied by inflammation and swelling in the affected region.

The symptoms may worsen due to activities such as sitting down, coughing and passing stool as these can put a strain on the affected area. Some of the other signs and symptoms of perianal abscess include:

1. Swollen and Inflamed Bump: A pimple-like bump or lump near the anus along with redness and swelling. It is generally a very painful condition.
2. Throbbing Pain and Irritation: In the perianal abscess, throbbing and constant pain is another noticeable symptom. This pain can increase while passing stools.
3. Pus-like Discharge: A yellowish discharge can be observed that can denote pus coming out of the abscess or rectum.
4. Bleeding: In rare scenarios, patients may spot some bleeding from the anus.
5. Painful Bowel Movement: Perineal abscess may cause difficulty in passing stools or painful bowel movements.

Some other symptoms may include pain in the lower abdominal area, difficulty while urinating, fatigue, fever, and chills.

Our body lining, majorly skin, comprises a collection of glands. The most common cause behind the development of perianal abscesses is blocked or clogged glands inside the anus.

If you do not clean the anal region properly, the stool or bacteria can get stuck inside the skin pores. This may cause the bacteria to stay there for longer, causing a buildup of infection and eventually the formation of perianal abscesses.

Apart from the aforementioned, there can also be other causes for perianal abscess. These include:

1. Infected Anal Fissure: An anal fissure refers to a small tear in the anal canal’s tissue lining. If an infection occurs in the fissure, it may lead to perianal abscess.
2. Sexually Transmitted Infections (STIs): Carrying out unsafe sex, meaning without using condoms can elevate the possibility of catching bacterial infections. The infection can spread to form perianal abscesses.

Perianal Abscess Risk Factors

There are certain conditions that can elevate the chances of developing an anorectal abscess. The risk factors can be divided into modifiable and non-modifiable. This includes the following:

Modifiable Risk Factors

1. Persistent Constipation or Diarrhoea: In constipation, the stool hardens due to the infrequent bowel movements. This causes difficulty in stool passing and a patient may develop anal fissures. The fissure can become infected to cause a perianal abscess.
   
   Frequent and watery stools in diarrhoea can lead to irritation and inflammation of the anal lining. It can further trigger the formation of perianal abscesses.
2. Traumatic Injury: Anal sex can put excess pressure on the anus and lead to a fissure. The bacteria can affect those areas and can eventually cause anal abscesses.
   
   Placing objects like sex toys in the anus can also increase the risk of an infection like an abscess.
3. Sebaceous Cyst: Cysts that form when the sebaceous (sweat glands) get clogged are called sebaceous cysts. Such cysts can further form into a perianal abscess but may be less painful and less infective.
4. Diabetes: In people with diabetes, the wound-healing process slows down. So, it increases the chances of the infection spreading due to a perianal abscess.
5. Immunosuppressive Drugs: Such drugs suppress the immune system’s normal functioning. Perianal abscess is an infected condition and your body needs to fight off the infection to get rid of it. A weakened immunity will restrict the proper healing of this condition.

Non-Modifiable Risk Factors

1. Male Gender: Men are more likely to develop this condition as compared to females of the same age. It commonly occurs between the ages of 20 and 60.
2. Fissure History in Kids: Toddlers and children that have a history of anal fissures are likely to develop perianal abscesses later in life. This is generally because of chronic constipation.
   
   A perianal abscess can also occur in infants due to diaper usage. If not cleaned properly, it can make the stool stay there longer.
3. Inflammatory Bowel Disease (IBD): IBD conditions such as Ulcerative Colitis or Crohn’s Disease are inflammatory conditions that can occur anywhere in the gastrointestinal tract.
   
   Inflammation in or near the rectum can increase the risk of developing perianal abscesses.
4. Diverticulitis: In this condition, the digestive tract develops small pouches which can become inflamed and infected. This infection may spread further and increase the risk of an anal abscess.

A prompt treatment or even better taking preventive measures can save a person from painful anorectal conditions such as an abscess. You can try the following steps to prevent the development of this disease:

1. Maintain Good Hygiene: Maintain proper hygiene and cleanliness around the anal region to avoid any accumulation of bacteria.
2. Lifestyle Changes: Manage stress levels by incorporating yoga and meditation into the routine.Following a healthy balanced diet, and drinking enough water can also prevent conditions such as constipation, reducing the risk of developing an abscess in the perianal area.
3. Condoms During Anal Sex: One must use condoms as a safe practice during anal sex to prevent sexually transmitted diseases (STDs) and sexually transmitted infections (STIs).Condoms can help prevent the transfer of bacteria and the formation of fissures and anorectal abscesses.
4. Frequent Diaper Changes: It is crucial to clean the area properly while doing a diaper change and it should be frequent. This helps prevent anal abscesses.

If an individual is experiencing constant pain in or around the anal region, it is crucial to visit a doctor for a proper diagnosis of the condition. It may be an anal abscess or some other condition.

The doctor will check the patient’s anal area for redness, and swelling. However, in some cases, additional tests may also be recommended by the doctor to confirm the presence of a perianal abscess.

The following diagnostic procedures may be performed by a doctor:

Non-Clinical Diagnosis

1. Patient History: The doctor will ascertain the diagnosis of a perianal abscess by asking a few questions about the patient's medical history. This may include the symptoms they may be experiencing with the presence of a painful bump.
2. Physical Examination: The primary care doctor will generally be able to diagnose a perianal abscess by carefully examining the area between the buttocks. He might further insert a gloved, lubricated finger into the anus to deeply look for any irregularities and infection.A physical rectal examination helps rule out other causes of anal pain or discharge. With the help of this, the doctor can identify any signs of thickening or hardening of the skin around the perianal region.

Clinical Diagnosis

1. Proctosigmoidoscopy: It is a procedure that involves the insertion of a thin tube attached to a camera called a proctoscope. It also has a light source that also goes inside the rectum. It helps in the examination of the lower rectum and anus.
2. Colonoscopy: The process of colonoscopy is similar to that of proctosigmoidoscopy. This also involves the insertion of a long, flexible tube with a camera and light source (colonoscope) to examine the rectum and colon.A colonoscopy can help detect rectal abnormalities such as polyps, tumours, and inflammation.
3. Anoscopy: In this procedure, a device called an anoscope is inserted into the anal canal to get a detailed look at the tissues within the specific region.
4. Imaging Tests: MRI (Magnetic Resonance Imaging) and CT (Computed Tomography) scans may be used to produce detailed images of the body's internal structures. It can help in the detection of fissures and abscesses.

How to Prepare for a Doctor's Consultation?

You can always prepare yourself prior to a doctor’s appointment. Some of the things that can be kept in my or noted are as below:

1. List down the symptoms including ones that may seem unrelated to the condition.
2. The patient should also inform the doctor about the intake of regular diet, medications and supplements.
3. Some of the questions that can be asked from the doctor include:
   1. What’s the likely cause of the condition?
   2. Is this a temporary or a permanent condition?
   3. Can perianal abscess cause cancer? Does it cause any other complications?
   4. Do I need to undergo any tests?
   5. Can I undergo perianal abscess removal surgery? Why or why not?
   6. What's the procedure for the removal of the abscess? Are there risks?
   7. Is it likely to reoccur?
   8. Can I see some real perianal abscess pictures?
   9. Do you have any resources I can refer to for a better understanding of the perianal abscess?

Perianal abscess is a condition that does not generally go away on its own. It may require a doctor’s intervention to remove the abscess safely.

Based on the complexity of the case, the patient’s age and other relevant factors, the doctor may recommend one of the following treatment methods for perianal abscess.

Treatment of Perianal Abscess Without Surgery

Perianal Abscess Treatment at Home

A few lifestyle changes can help alleviate the discomforting symptoms of anal abscesses. Some of the changes a patient can incorporate in his/her daily routine to cope with the problem include:

1. Maintain Cleanliness: Since perianal abscesses occur due to microbial infection, it is extremely important to ensure keep the area clean and dry at all times.
2. Consuming a Balanced Diet: It is important to consume a well-balanced diet for good digestion and easy stool passage. Avoid spicy, salty and processed foods to avoid constipation and pain.
3. Drink Plenty of Water: Drinking an adequate amount of water i.e., 6 to 8 glasses of water in a day, can help improve digestion.
4. Sitz Bath: To take a sitz bath, fill a basin or bathtub with a few inches of warm water and sit in it for 15 to 20 minutes. This can keep the area clean and help reduce inflammation and pain.
5. Warm Compress: Soak a clean towel in warm water and apply it to the affected area for 10 to 15 minutes several times daily. Ensure washing your hands before and after applying the compress to avoid spreading infection.

Note: Do not forget to check with your doctor as some of these procedures may cause drainage from the abscess. Also, make sure to keep the temperature under control to prevent skin burns.

Medications for Perianal Abscess

In some initial cases, perianal abscess may be treatable using medicines. Medications that a doctor may prescribe include:

1. Antibiotics: Your doctor may prescribe you a couple of antibiotics to fight bacterial infections causing abscesses.
2. Over-the-Counter Medicines: Some over-the-counter medicines for perianal abscesses include:
   1. Pain Killers: An anal abscess can be extremely painful while passing stool. The doctor may prescribe you some painkillers to cope with pain.
   2. Laxatives: They help in easing the excretion of stool. Stool softeners may also be prescribed which help in softening the stool to prevent constipation.

It is crucial that the patient consults with a doctor for the best suitable treatment for their perianal abscess.

Ayurvedic Treatment for Perianal Abscess

Ayurvedic treatment methods for a boil near the anus hole may help it heal. Ayurveda does not generally cause side effects, however, it is important to ask your doctor about the same. Some of the ayurvedic treatments for perianal abscesses include:

1. Triphala Powder: Triphala is a blend of three fruits - Amla, Haritaki, and Bibhitaki. It is often consumed in powdered form mixed with water or as a capsule.Triphala helps in soothing pain, easing constipation and reducing inflammation as amla contains anti-inflammatory substances.
2. Guggul: One of the important anti-inflammatory herbs, guggul helps in reducing inflammation.
3. Neem Paste: Neem leaves have anti-bacterial properties, which help in fighting the infection in a perianal abscess. The leaves can be boiled and ground to form a paste. Applying the same to the affected region may help heal the infection.

Note: Before taking up any of the non-surgical treatments, one must consult with their doctor to know the possible side effects or complications.

Treatment of Perianal Abscess With Surgery

In majority of the cases, anal abscess rarely goes away without surgical treatment. The most commonly used method to treat a perianal abscess is through incision and drainage of the pus.

In this method, the doctor cleans the skin with an antiseptic solution. He may or may not use an anaesthetic to numb the affected area. The abscess is then incised using a scalpel (medical knife) and the pus begins to drain out.

In cases where the infection is deeper, a catheter may drain the remaining pus.

Cost of Perianal Abscess Treatment

The cost of perianal abscess treatment in India can vary depending upon multiple factors including the complexity of the condition and the age of the patient. Other factors include the type of hospital or clinic where the procedure is performed and its location.

Here is a table highlighting the cost of the treatment for perianal abscesses:

Surgery Name	Surgery Cost
Incision and Drainage	₹ 8,000 - ₹ 20,000

You can find more details on incision and drainage cost in India.

The surgery for the removal of the perianal abscess can relieve the discomfort due to the condition. However, some risks and complications of perianal abscess surgery may include:

1. Scarring: With every surgical procedure, the skin has normal scarring due to the cut or wound getting healed.
2. Sepsis: An infection may occur after treating a perianal abscess using surgery. It is a rare complication that may develop if the wound is not properly handled.
3. Recurrent Abscess Formation: Abscess can reoccur even after complete treatment through surgery. This is because an abscess is a bacterial infection that can occur anywhere in life.
4. Fistula Formation: A fistula (tunnel-like space) may form after the drainage of pus.
5. Faecal Incontinence: The anal Involuntary passage of stools.

If a perianal abscess is treated properly and prompt drainage is done, its recurrence rate will be less.

When to See a Doctor?

1. If one suffers from a perianal abscess, then he/she must seek immediate medical help. If you notice any unusual symptoms with pain in the anorectal region, consult your physician: 
2. High-grade fever with chills
3. Difficulty in passing stools
4. Painful bowel movement
5. Vomiting
6. Drainage of pus or blood from anorectal area
7. Foul smell from draining pus

An individual's diet plays a vital role in the development of any disease. A poor dietary habit may elevate the risk of developing perianal abscesses. Some of the measures that can be taken to reduce the risk of complications:

1. Fibre-Rich Foods: Foods with ample fibre content including fruits, vegetables, cereals, whole grains, legumes, etc. may help prevent constipation.
   
   This further reduces the recurrence of perianal abscesses. Adequate fibre intake may also help promote overall digestive health and reduce body inflammation.
2. Turmeric Milk: Turmeric has anti-inflammatory and anti-bacterial properties. Drinking a glass of turmeric milk or golden milk may help alleviate symptoms of perianal abscess such as pain, swelling and discomfort.
3. Protein-rich Foods: Such foods speed up the skin’s healing process as protein helps repair body tissues.
4. Nuts and Seeds: These foods consist of the basic vitamins and minerals your body needs to repair and rebuild tissues.

Note: Diet alone cannot treat or help manage the symptoms of a perianal abscess. It can only help prevent the recurrence and further spread of this condition. Therefore, it is crucial to discuss with your doctor on the same.

Perianal abscess is a common condition that can cause significant discomfort and pain. If left untreated, it can lead to complications such as fistula formation or systemic infection.

Timely diagnosis and treatment are essential to prevent complications and promote quick healing of  a perianal abscess. The treatment typically involves incision of the abscess and pus drainage.

You can contact the experts at HexaHealth for the best and smooth treatment process. Know the symptoms and take control with proper treatment and prevention. With the right knowledge and care at the right cost.