Perianal abscess: symptoms and surgical intervention

What is a perianal abscess?
A perianal abscess is the infection of a gland that secretes (secretes) mucus in the canal around the anus.
An abscess often causes another painful condition called an fistula.
This is a small canal that develops between the rectum and the skin near the anus.
In more severe cases, there may be an opening to the right and left of the anus, in this case the horseshoe fistula is called.

The most common type of abscess occurs at the perianal level. It often appears like a swollen and painful pustule near the anus.
The perianal abscess can be red and hot when touched.
Deeper abscesses are less common and may be less visible.

After an abscess is drained, about 40% of patients develop a complication called a fistula.


What is a perianal fistula?

The perianal fistula is the result of a previous abscess.
An abscess is a pus-filled cavity that can form anywhere in the body, but occurs with greater frequency around the anus.
The reason for this is that the anus area is colonized by billions of bacteria that can multiply uncontrollably and cause infection under certain conditions, even if they are usually not pathogenic.

Causes of abscess

An abscess can have many different causes. Among them are:

  • Infection of an rhagade. An rhagade is a small superficial lesion of the canal skin;
  • ulcer (painful wound);
  • complication after surgical intervention;
  • clogged glands.

Risk factors for an abscess include:

  • Irritable bowel syndrome;
  • Ulcerative colitis;
  • Crohn’s disease;
  • Diabetes;
  • Diverticulitis;
  • pelvic inflammatory disease;
  • passive sexual intercourse;
  • rectal cancer;
  • Tuberculosis;
  • Chlamydia;
  • Syphilis.

Symptoms of perianal abscess

The superficial abscess can cause the following symptoms:

  • pain in the area, which is usually constant, tapping and stronger when sitting;
  • Skin irritation around the anus, which occurs together with:
    • Swelling
    • Reddening
    • painfulness;
  • discharge of pus;
  • Constipation and pain during defecation.

The deeper abscess can also cause symptoms such as:

  1. Fever;
  2. Ague;
  3. Indisposition.

Sometimes fever is the only symptom of a deep abscess.

Differential diagnosis

The following should be excluded from the doctor:

  • Inflammatory bowel disease;
  • Haemorrhoids;
  • cancer;
  • Colorectal cancer (colorectal carcinoma).

Tests and examinations for perianalabscess

As a rule, an examination of the rectum with the finger is sufficient for diagnosis and therapy planning of the abscess.
The initial examination depends on the physical examination, the following options are possible:

  • Anoscopy can be performed to rule out other diseases.
  • ultrasound is another method to detect a perianal abscess and is performed by means of a special ultrasound probe without special preparation of the patient.
  • Laboratory tests to detect sexually transmitted diseases.

Nuclear magnetic resonance imaging (MRI) is rarely performed and allows the evaluation of:

  1. possible fistulas;
  2. position of the internal and external opening of the fistula;
  3. position of deep abscess;
  4. condition of the anorectal wall and perirectal spaces;
  5. Possible damage to the sphincter.

What is the therapy for perianal abscess?

Therapy for the abscess provides for a small operation to drain the pus from the infected abscess cavity.
Surgery is almost always required.
An incision is made in the skin above the abscess area near the anus.

This incision can be made:

  • in a medical practice using a local anesthetic for small abscesses,
  • under general anesthesia in an operating room for large or deep-seated abscesses.

Inpatient treatment may be required in patients prone to severe infections, such as diabetics or patients with immunodeficiency.

Antibiotics are used to combat surrounding infections (cellulitis). However, it should be remembered that these drugs alone can not cure an abscess, because they can not penetrate into the abscess cavity.
The proctologist often advises against medication because they can promote the formation of fibrosis, which may cause difficulties later in the event of surgery.
A significant number of perianal abscesses can recur within a year or two, especially if there are predisposing factors.

How long does a postoperative recovery take?

The symptoms after the operation of a fistulated abscess are mild to moderate in the first week and can be treated with painkillers.
Laxatives (laxatives) are also prescribed to prevent constipation and postoperative discomfort.
Normally, you only lose a few working days as a result.

Treatment of an abscess requires a limited stay at home.
The doctor may prescribe medication to soften the stool.
So that the drained liquid does not stain the clothing, a gauze insert may be required.
Initially, a nurse takes over the treatment of the affected areas.
Defecation (bowel movements) does not negatively affect the healing process.

What is the probability of a recurrence of the abscess or fistula?

If the patient is properly cured, an abscess usually no longer occurs. But it is important to follow the proctologist’s instructions to prevent recurrence. Even in the hands of an excellent surgeon, there are always some possibilities for the disease to develop again.

In up to 50% of abscesses that have been drained, a tunnel (fistula) may remain, connecting the infected gland to the outer skin. If the skin opening heals in the presence of a fistula, a recurrence of the abscess can form.
As long as the fistula is not eliminated, many patients suffer recurring pain, swelling and drainage alternating with apparent healing processes.

What do you need to know about the postoperative days?

Some pain is normal after a procedure, but it should subside quickly in the first few days.
If the pain decreases, the doctor may prescribe paracetamol. Aspirin should be avoided for the first two weeks as it could increase bleeding because it is an anticoagulant.
In addition to medication, pain is also reduced by sitting baths in a tub of warm water. From the day after the operation, bathing is allowed.

One should take a sitz bath at least twice a day until the abscess is emptied.
Alternatively, it is recommended to apply a gauze strip to the painful area.

Many people are worried when they go to the toilet for the first time. The best way to avoid painful defecation is to avoid constipation and a soft and regular bowel movement.
The easiest way to do this is to change your diet.
The most important thing is bowel movements within 1-3 days after surgery.
Do not need to go to the toilet after the day of surgery, the doctor may recommend taking 2 tablespoons (30 grams or 30 ml) of magnesium milk before bedtime.

Prevention of perianal abscess

In order to prevent rhagades and perianal abscesses in infants and children, diapers should be changed frequently, observing appropriate hygiene.

Diet and nutrition for perianal abscess

According to natural medicine and hygienism, infection-causing bacteria and organisms only multiply if they find the appropriate breeding ground.
Bacteria feed on dead or decomposing tissue, so a healthy body free of toxins does not allow these harmful microorganisms (saprophytes) to survive.
Infections can be avoided and treated by:

  • Consumption of natural and raw foods
  • Compliance with correct food combinations

The metabolism of cooked foods leads to the formation of acidic residues, so it is recommended to limit cooked food.
Many people are of the opinion that they do not digest raw vegetables, especially:

  • Cauliflower
  • Courgette
  • Spinach
  • Swiss chard, etc.

In reality, the cooking process destroys the vitamins and digestive enzymes contained in food, so eating raw vegetables and fruits is much better.

Prognosis and healing times for patients with perianal abscess

The results are good if the abscess is treated on time.
However, about half of patients with operated abscess develop chronic fistula. The number of recurrences requiring surgery can be significantly reduced by an initial fistula split.
Newborns and infants usually get a cure quickly.
If no fistula forms after the operation, healing takes place in about 2-3 weeks.

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