Anal abscess

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Anal abscess
ICD-10	K61.0
ICD-9	566
DiseasesDB	32048

Synonyms and keywords: Anorectal abscess; perianal abscess; rectal abscess

Risk Factors

The following factors increase your risk for an anorectal abscess:

• Anal sex
• Diabetes
• Inflammatory bowel disease (Crohn's disease and ulcerative colitis)
• Weakened immune system

The condition may occur in infants and toddlers who are still in diapers and who have a history of anal fissures.

Natural History, Complications and Prognosis

Complications

In severe or recurrent abscesses, a fistula may develop, connecting the rectum to the skin. This requires more intensive surgery. Furthermore, any untreated abscess may (and most likely will) continue to expand, eventually becoming a serious systemic infection.

History and Symptoms

Symptoms

The following are all symptoms of an anal abscess

• Constipation (may occur)
• Discharge of pus from the rectum
• Fever
• Lump or nodule, swollen, red, tender at edge of anus
• Pain associated with bowel movements

In infants, the abscess often appears as a swollen, red, tender lump at the edge of the anus. The infant may be fussy from discomfort, but there are generally no other symptoms.

Treatment

Anal abscesses, unfortunately, cannot be treated by a simple course of antibiotics or other medications. Even small abscesses will need the attention of a surgeon immediately. Treatment is possible in an emergency room under local anesthesia, but it is highly preferred to be formally admitted to a hospital and to have the surgery performed in an operating room under general anesthesia.

Generally speaking, a fairly small but deep incision is performed close to the root of the abscess. The surgeon will allow the abscess to drain its exudate and attempt to discover any other related lesions in the area. This is one of the most basic types of surgery, and is usually performed in less than thirty minutes by the surgical team. Generally, a portion of the exudate is sent for microbiological analysis to determine the type of infecting bacteria. The incision is not closed (stitched), as the damaged tissues must heal from the inside toward the skin over a period of time.

The patient is often sent home within twenty-four hours of the surgery, and is instructed to perform several 'sitz baths' per day, whereby a small basin (which usually fits over a toilet) is filled with warm water (and possibly, salts) and the affected area is soaked for a period of time. During the week following the surgery, many patients will have some form of antibiotic therapy, along with some form of pain management therapy, consistent with the nature of the abscess.

The patient usually experiences an almost complete relief of the severe pain associated to his/her abscess upon waking from anethesia; the pain associated with the opening and draining incision during the post-operative period is often mild in comparison. In many cases, the patient is completely healed with no discomfort whatsoever within just one or two weeks of the surgery.

Prevention

Prevention or prompt treatment sexually transmitted diseases may prevent this cause of anal abscesses. Use condoms during intercourse, including anal sex, to prevent such infections.

Frequent diaper changes and proper cleaning during diaper changes will help prevent both anal fissures and perianal abscesses in infants and toddlers. Template:Gastroenterology

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