Can an anal abscess be treated without surgery?

Written by Chen Tian Jing
Colorectal Surgery
Updated on June 22, 2025
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Perianal abscess is a local infectious disease of the anus, typically occurring acutely with severe pain. The nature of the pain mostly involves jumping pain or peck-like pain. Patients also experience redness and swelling of the skin around the anus, as well as an increase in overall body temperature. Chronic recurrent attacks can lead to fatigue and further spreading of the abscess, causing enlargement of the local abscess cavity and even triggering a systemic infection. Therefore, it is essential to undergo surgical treatment as soon as possible during the acute phase of a perianal abscess. The main surgical methods are incision and drainage of the perianal abscess or a one-time radical surgery around the anus. Postoperative wound disinfection and dressing changes should be carefully attended to.

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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 Li Jiao Yan
Neonatology
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Causes of perianal abscess formation in babies

In pediatric outpatient surgery, perianal abscesses are not uncommon, and many parents visit the hospital daily for this issue. They wait, register, and change dressings. Once the wound heals, it often recurs after a while, leading to repeated incisions and drainage, persisting for several months. Eventually, the doctors say a fistula has formed and surgery is required. What exactly causes such troublesome perianal abscesses? The cause of perianal abscesses is not completely clear, but many affected children have been found to have deeper anal crypts than normal, so it's speculated that it may be related to this abnormality. In children under two years old, perianal abscesses mostly occur in boys. Some studies suggest that testosterone levels are higher in boys aged 1-3 months, coinciding with a peak period for perianal abscess incidences, leading to speculation that it may be related to the child’s hormone levels. In children over two years old, there is less gender bias in the incidence of perianal abscesses, and some cases are secondary to Crohn’s disease.

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Written by Chen Tian Jing
Colorectal Surgery
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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.

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Written by Chen Tian Jing
Colorectal Surgery
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Which department should I go to for perianal abscess?

During the acute phase of a perianal abscess, patients experience significant local redness, swelling, heat, and pain around the anus. The pain is severe and in some cases, patients are unable to sit or walk normally due to the discomfort. During this acute phase, the swelling of the skin around the anus can easily be confused with skin carbuncles, leading patients to mistakenly visit a dermatologist. However, a perianal abscess is a local anal disease that requires registration with a colorectal surgery department, as it is not merely a skin carbuncle but an infection caused by an infection at the anal crypts inside the anal canal. This necessitates prompt surgical incision and drainage, and, if a fistula has formed, a fistulotomy may also be necessary.

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Written by Chen Tian Jing
Colorectal Surgery
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Can a perianal abscess be treated with hot compresses?

Hot compress therapy for perianal abscesses is typically chosen after surgery. Prior to surgery, due to the formation of a typical pus cavity in the perianal abscess and the encapsulation of pus fluid, it is an acute infectious foci. Using hot compress therapy can easily lead to further aggravation of the local infection or spread of the pus cavity, which may worsen the condition. Therefore, hot compresses are not recommended before surgery. After promptly conducting surgery on a perianal abscess, since the local wound contains infectious material, it is suitable to fumigate and apply hot compresses postoperatively to disinfect the local wound further, and to manage residual fecal matter to prevent infection. Additionally, changing dressings is necessary to promote the fresh growth of normal granulation tissue, thus leading to the proper healing of the wound rather than pseudohealing or infection.