If you have been following our posts you have heard the term rectal or perirectal abcess. The term refers to an abcess/infection occurring around or near the anal opening or on the buttock. They represent one of the 3 causes of anorectal pain. Anyone who has had an abcess anywhere on the body is aware of how painful they are. This is especially true in the anorectal area which is very sensitive to pain! They are the result of an infection which begins in one of the small mucous glands which lie within the external anal canal. The infection can then spread out into skin and subcutaneous tissue surrounding the anal opening…resulting in an abcess, which is a loculated area of pus. The symptoms consist over severe pain and swelling with redness and localized temperature increase. Generalized symptoms of infection are rare and seen only with severe infections. Although many people have never heard of a perirectal abcess: as Colorectal surgeons we see them often. The most important aspect of treatment is early incision and drainage! This cannot be emphasized enough, and is true of any abcess. There is no role for antibiotics except in patients with severe infections or those who are immuno-compromised: and then only after incision and drainage! A common mistake made by clinicians is to send a patient home on antibiotics with the expectation that the abcess will resolve. The infection is resolved only when drained by a surgeon or after many hours/days of pain when it ruptures on it”s own. As noted, the most important treatment is incision and drainage. This can be done by any clinician or surgeon who has the experience to perform the procedure. It is done under sedation or anesthesia with the use of a local anesthetic as well. Patients get immediate relief of their pain despite the incision!
All patients should see a Colorectal Surgeon for follow up if their initial drainage was not done by someone familiar with anorectal anatomy. This is because of the possibility of developing a fistula after drainage of the abcess. A fistula is a small subcutaneous tunnel from the drainage site on the skin to the opening of the mucous gland within the anal canal. This happens in approximately half of the cases. Though it is not serious, it can result in chronic drainage and recurrent infections. Treatment requires a detailed knowledge of the anatomy of the anal canal and rectum. Colorectal Surgeons are board certified in the diagnosis and treatment of complex colorectal problems such as fistulas. The treatment of a fistula requires performance of a fistulotomy, or in some cases more complex procedures to close the fistula. In fact, many Colorectal surgeons will do the fistula surgery at the same time as their initial incision and drainage; saving the patient a second surgery. As noted, patients get immediate relief of pain after drainage. The wound is left open without sutures. Post op care consists of warm soaks ( sitz baths ), mild analgesics, cotton or gauze pads for drainage, and return to normal activities as soon as comfortable. Many patients resume normal activities within a week or so. If you have anorectal pain for any reason…see a Colorectal Surgeon. Call us at 812-301-8110