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Perianal abscess
What are the early symptoms of perianal abscess?
The early symptoms of a perianal abscess mainly manifest as a red and swollen lump around the anus, which is noticeably painful to touch, and feels warm. As the lump grows and purulence develops, a fluctuation sensation can be felt upon touching. In severe cases, patients may even experience systemic symptoms such as fever and night sweats. For a perianal abscess, it is recommended that patients visit the proctology department of a hospital as soon as possible to undergo procedures like incision and drainage of the abscess, or a radical surgery for perianal abscess. Relying solely on medication can delay treatment and cause the abscess to spread further, potentially leading to necrotizing fasciitis or anal fistula. A perianal abscess is typically caused by an infection of the anal glands, which spreads from inside the anal canal to the surrounding areas. Simple medication treatment cannot eradicate the infection source; therefore, it is advisable to opt for surgical treatment as soon as a perianal abscess is detected.
The difference between perianal abscess and hemorrhoids
Perianal abscess and hemorrhoids are two different types of common anorectal diseases. When a perianal abscess occurs, the onset is generally sudden and there is severe pain in the anal area. Under the skin of the anal area or inside the anal canal, a submucosal abscess forms, encapsulating pus. Surgical treatment is required as soon as possible to prevent further spread of the abscess cavity. Hemorrhoids, on the other hand, are caused by the long-term and repeated accumulation of local tissues in the anal area, leading to the formation of blood clots or varicose vein masses. These generally occur near or around the dentate line, and may also be accompanied by skin tags of external hemorrhoids.
Does a second surgery for a perianal abscess hurt?
When it comes to a second surgery for a perianal abscess, it is generally recommended to proceed directly with spinal anesthesia. Simple local anesthesia might be more painful for the patient, as spinal anesthesia does not cause pain sensations. If there is pain after the surgery, one can opt for oral painkillers or a combination of pain relief pump treatments. Alternatively, pain relief gel can be applied to the wound to alleviate pain before each dressing change. Therefore, after the onset of a perianal abscess, whether it is the first or second surgery, it is essential to operate as soon as possible, and to disinfect and change dressings postoperatively to prevent pseudo-healing or secondary recurrent infections. To relieve pain, painkillers can be chosen. Before or after each bowel movement, one may use clean water for local cleansing to soothe the sphincter and prevent fecal residue.
How to deal with a ruptured perianal abscess?
Perianal abscesses that recur or occur acutely may locally form an abscess or pus pocket. If the abscess or pus ruptures, secretions will flow out of the abscess cavity around the anus, further leading to the formation of an anal fistula. After the perianal abscess ruptures, it is necessary to promptly perform local debridement, mainly to thoroughly remove the pus from the abscess cavity and to further disinfect the area. After a typical anal fistula forms, surgical treatment involving a fistulotomy with seton placement is required. The principle of the surgery is to completely remove the local infection while preserving the function of the anal sphincter muscles. Subsequent dressing changes and application of ointments or growth factor gels are necessary to promote normal growth of the granulation tissue.
Why does a perianal abscess recur?
Perianal abscess is an infectious disease of the local skin and tissues around the anus caused by an infection in the anal crypts. If a perianal abscess is not treated with a definitive one-time surgical intervention, it is very likely to recur, or after rupture of the abscess, to form an anal fistula with long-term intermittent discharge of pus from an external opening. Therefore, during the acute phase of a perianal abscess, once a distinct abscess cavity and pus formation occurs, it is necessary to promptly perform a one-time definitive surgical treatment of the perianal abscess, rather than choosing conservative medication treatment or simple incision and drainage. The above treatments only temporarily alleviate symptoms of a perianal abscess; only a one-time definitive surgery that completely cleans the local wound can result in the complete healing of the perianal abscess.
What anti-inflammatory medication should be taken for a perianal abscess?
If the perianal abscess is in the acute phase, one can opt for oral medication that clears heat, cools the blood, reduces swelling, and relieves pain, specifically designed for hemorrhoids, and it can be combined with oral antibiotics for anti-inflammatory treatment. However, treating a perianal abscess with oral medication alone can only alleviate symptoms or prevent the pus cavity from spreading too quickly, and does not provide a radical cure. The definitive treatment for a perianal abscess primarily involves surgery. The surgical method generally used is a one-time radical surgery for perianal abscesses, as the abscess forms a pus cavity and pus under the skin around the anus. Therefore, the surgery initially requires draining of the local pus, followed by thorough debridement of the walls of the pus cavity to allow fresh granulation tissue to regrow, filling the wound and facilitating the recovery of the local wound. (Note: This answer is for reference only. Please consult a doctor and follow the guidance of a professional physician before using any medication. Do not self-medicate.)
What is the internal opening of a perianal abscess?
The internal opening of a perianal abscess primarily refers to the anal crypt. It forms an infection site due to prolonged, repeated inflammatory infections, generally characterized by distinct pus discharge from the internal opening. Therefore, perianal abscesses tend to form a local internal opening near the anus along with intermittent pus discharge. If the perianal abscess acutely flares up or the pus cavity spreads, it might also rupture, causing pus to exit from an external opening, thereby leading to the formation of a typical anal fistula. During the acute phase of a perianal abscess, if there is local internal opening pain or pus discharge, it is recommended to seek surgical treatment as soon as possible. The primary method of surgery is aimed at radical treatment in one session. The principle involves opening the local pus cavity to allow for the discharge of pus, followed by a thorough debridement and removal of the local infection site. However, it is necessary to preserve the function of the local anal sphincter. If needed, a seton procedure may also be performed.
How many days of antibiotic injections are needed to treat a perianal abscess?
During the acute phase of a perianal abscess, the main focus is on the nature of the local abscess. If it is a hard swelling without pus formation, anti-inflammatory injections or antibiotics can be used for symptomatic treatment. Generally, a five to seven-day course of antibiotic and anti-inflammatory treatment can reduce the local swelling, but it cannot guarantee a 100% chance of non-recurrence in the future. If a local pus cavity or swelling has already formed, and there is pus formation, simply using anti-inflammatory injections for symptomatic treatment will not be curative. Surgery is also required, mainly involving opening the local pus cavity, cleaning out the pus thoroughly, and removing local infection foci to promote normal growth of fresh granulation tissue, which could then lead to the healing of the local wound.
Can I eat eggs with a perianal abscess?
Patients with perianal abscess can eat eggs, but during the acute onset period of a perianal abscess, besides sticking to a light diet, it is more important to seek surgical treatment as soon as possible. A perianal abscess is an acute infectious disease near the anal sinuses. Typically, it presents with severe local pain in the anus. Once pus forms, it is encapsulated in the abscess cavity and needs to be surgically drained as soon as possible to remove the infection thoroughly. This helps to prevent further enlargement of the abscess cavity and worsening of the condition. Furthermore, in the early postoperative period, patients can consume liquid foods and eat eggs in moderation or other easily digestible foods. However, they should avoid spicy and irritating foods such as chili peppers and seafood.
What is causing the stabbing pain in the wound half a year after perianal abscess surgery?
Six months after surgery for a perianal abscess, if there is local pain at the wound site, it is first necessary to rule out the presence of local infection and recurrence. To differentiate between infection and recurrence, it is necessary to conduct a digital rectal examination and a perianal ultrasound to confirm the diagnosis. If infection and recurrence are ruled out, consider the possibility that the pain may be due to contraction and softening of the scar tissue at the site of the perianal abscess surgery, leading to painful stinging at the wound. Local application of anti-inflammatory ointments or gels can be used to treat the inflammation. If the pain or discomfort is severe, Chinese herbal washes or dilute salt water can be used for fumigation and hot compresses on the local scar.