How should a perianal abscess be treated effectively?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 29, 2024
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During the acute phase of a perianal abscess, there is generally severe pain in the anal area, accompanied by redness and throbbing of the skin, and there may be a pus cavity or pus encapsulation under the skin. The treatment of perianal abscess is mainly surgical. The surgical method is incision and drainage, combined with a one-time radical surgery. If the infection involves the local sphincter or has already formed a clear fistula, further incision and ligation surgery may be required. After surgery, it is necessary to thoroughly disinfect and change the dressings of the wound to prevent excessive granulation or the formation of false healing at the local wound. Postoperative diet should consist mainly of light, liquid foods, and spicy and irritating foods should be avoided.

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Colorectal Surgery
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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.

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Colorectal Surgery
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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.

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Colorectal Surgery
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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.)

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Colorectal Surgery
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Can conservative treatment be effective for perianal abscesses?

Conservative treatment of perianal abscesses can only relieve temporary inflammatory symptoms and cannot achieve a curative effect. There is also the potential for conservative treatment to delay the condition, leading to an increase in the size of the abscess cavity or the rapid expansion of pus, thereby exacerbating the condition. Once a perianal abscess is identified, surgical treatment should be carried out as soon as possible. First, the abscess cavity needs to be opened, and the enclosed pus drained completely, and then either a local incision with suture or debridement surgery chosen for treatment. Additionally, it is necessary to maintain the normal function of the anal sphincter. If only conservative medication is used for a perianal abscess, it can only temporarily relieve the current symptoms and does not benefit the healing of the disease or its long-term development at all.

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Colorectal Surgery
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How to operate on a perianal abscess

The surgical methods for perianal abscess vary depending on the location of the lesion. If it is a simple ischiorectal fossa subcutaneous abscess, a one-time incision and drainage surgery is generally used. The local wound is debrided and necrotic tissue is removed. After trimming the wound, it is important to maintain clear drainage of the local wound. Local application of gauze strips for compression and drainage treatment can be used. If the abscess is in the ischioanal fossa or the pelvirectal space, considering that the location of the lesion is deep, a one-time incision and seton drainage radical surgery may be required for the perianal abscess. Post-surgery, thorough disinfection and drainage of the local wound are also necessary.