Can conservative treatment be effective for perianal abscesses?

Written by Chen Tian Jing
Colorectal Surgery
Updated on September 19, 2024
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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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Written by Chen Tian Jing
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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Written by Xiao Zhi Guo
Colorectal Surgery Department
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How to treat perianal abscess?

Perianal abscesses generally have two treatment options. Initially, if the abscess is not very large and the swelling and pain are not particularly severe, conservative treatment with antibiotics can be used temporarily. If conservative treatment is ineffective and the swelling worsens, surgical treatment may be necessary. In cases of severe abscesses, incision and drainage can be considered first, followed by antibiotic treatment. Surgical definitive treatment can then be performed 3-5 days later.

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Written by Chen Tian Jing
Colorectal Surgery
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What is the best medicine to take for a perianal abscess?

Perianal abscess is a type of acute infectious disease localized around the anus, and oral medication is not necessarily the best treatment method for perianal abscesses. Rather, the best treatment for perianal abscesses is surgery. Surgical methods generally include incision and drainage procedures, as well as further definitive surgeries, because perianal abscesses are associated with infections in the anal crypts. Thus, medication alone can only relieve symptoms and cannot completely clear the infection. If treatment is solely through medication or if it is incomplete, there is a high likelihood of recurrent infections, which may even lead to the formation of anal fistulas. Once an anal fistula forms, it can only be cured through surgical procedures that involve cutting and threading.

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Written by Yu Xu Chao
Colorectal Surgery
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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.

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Written by Chen Tian Jing
Colorectal Surgery
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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.