ANORECTAL ABSCESS
An anal, or rectal abscess is an infected cavity filled with pus found near the anus or rectum. If an anal abscess does not heal, it can cause a lot of pain and may require surgery.
What is an anorectal abscess?
An anorectal abscess is an acute infection that accumulates pus around the anus – rectum. Most anorectal abscesses are a result of infection from small anal glands.
A rectal abscess is a buildup of pus in the deep tissues surrounding the anus. In contrast, an anal abscess is a shallow accumulation of pus under the skin around the anus. However, both are sometimes described as an anal abscess.
Both types of abscesses need immediate medical attention. However, a perirectal abscess is usually a more severe infection.
Delay in treatment can worsen the disease and cause unnecessary complications.
What are the symptoms of an anorectal abscess?
Signs and symptoms of an anal abscess include the following symptoms:
Superficial anal abscesses
Pain, which is usually constant, throbbing, and worse when sitting down
Swelling around the anus
Red and warm skin around the anus.
Fever and chills
Deeper anal abscesses:
Pain may be alleviated but may have symptoms of toxicity such as fever, chills, and fatigue.
Pain in the rectal wall or discharge from the rectum may be observed.
Pelvicorectal abscesses can cause lower abdominal pain and fever without rectal symptoms. Sometimes fever is the only symptom.
How about the frequency of disease?
Approximately 30% of patients with rectal abscesses have a previous history of similar abscesses.
The incidence of abscess formation appears to be higher in spring and summer.
The disease is common in middle-aged people, and adult males are twice as likely as females to develop anorectal abscesses.
What are the causes of an anorectal abscess?
Common causes of an anorectal abscess include:
Blocked glands in the anal area
Infection of an anal fissure
Sexually transmitted infections of the anus or rectum
Deep rectal abscesses may be caused by intestinal disorders, such as Crohn's disease or diverticulitis.
What is the risk of an anorectal abscess?
The following factors increase the risk for the development of an anorectal abscess:
Having anal sex
Chemotherapy drugs
Diabetes
Inflammatory bowel diseases (IBD) such as Crohn's disease and ulcerative colitis (UC)
Inflammatory colitis such as IBS
Colon diverticulum
Pelvic inflammatory disease
Use of corticosteroid drugs
Immune system impairment (such as HIV / AIDS), tuberculosis
Anal rectal cancer
How is an anorectal abscess diagnosed?
Diagnosing an anorectal abscess is not difficult through examining the anal area. The doctor may incorporate additional anal ultrasound, CT scan, or MRI to get an accurate diagnosis in more complicated cases.
Their location classifies anorectal abscesses in relation to the structures comprising and surrounding the anus and rectum: perianal, ischioanal, intersphincteric and supralevator
How to treat it?
The problem rarely goes away on its own. Antibiotics alone usually cannot treat an abscess.
Treatment includes surgery to open and drain the abscess, combined with pain relief and antibiotics.
Purulent removal incision can take about 30 minutes.
For small abscesses located near the skin, doctors can numb the place to incise abscess purulent discharge.
In cases of large or deep abscesses, doctors will use spinal anesthesia to provide good pain relief for surgery.
What are the complications after surgery?
Possible complications after surgery:
Infection
Anal fissure
Recurrent abscesses
Pain is constant
Scarring
When can you be discharged from the hospital?
If your doctor uses local anesthesia, you can leave the hospital the same day after surgery, and he will give you antibiotics and pain relief at home.
If you have to use spinal anesthesia, you need to stay in the hospital about 1-2 days after surgery.
When can you return to work?
After surgery, you may still have pain for about 3-5 days, during which time the doctor will give you pain medications. However, you need to rest and clean the operating area, so going to work at this time is not recommended. After seven days, you can return to work, but you should not sit for long.
How to take care after surgery?
After surgery, you need to change the dressing twice a day, and a specialist nurse should do this. It may be painful to change the dressing, but this is necessary as the wound needs to be washed to heal. You can take the pain reliever half an hour before the bandage change.
You can take pain relievers and antibiotics for a few days depending on your medical condition.
How to prevent an anorectal abscess?
Not much is known about preventing an anorectal abscess, but there are a few ways you can do it.
Protection against sexually transmitted diseases (STIs) and prompt treatment is crucial for any infection. Condom use, especially during anal sex, is key in preventing STIs that can cause anal abscesses.
Good hygiene and cleanliness of the anal area are essential to protect both children and adults.
How about the prognosis of the disease?
In general, the mortality rate from anorectal abscesses is relatively low.
Abscess recurs in about 10% of patients, with anal fistula occurring in more than 50%.
Feb 2, 2021
TRUNG V. HUYNH, MD
HUNG M. DO, MD, Ph.D