The difference between perianal abscess and hemorrhoids

Written by Chen Tian Jing
Colorectal Surgery
Updated on April 28, 2025
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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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What should I do if the perianal abscess bursts?

Since a perianal abscess is an acute symptom of a local skin infection around the anus, during the acute phase of a perianal abscess, an abscess cavity and pus formation generally occur within about a week. As the disease worsens and progresses, the perianal abscess will rupture about a week later. If the perianal abscess ruptures, it may have already formed an anal fistula. A perianal abscess and an anal fistula represent two different stages of the disease, and both require surgical treatment. The main surgical treatment for anal fistulas is fistulotomy with seton placement, and care must be taken to drain and disinfect the local wound post-surgery to prevent pseudohealing of the wound.

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Written by Yu Xu Chao
Colorectal Surgery
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Can a perianal abscess that is draining pus heal by itself?

Perianal abscesses cannot heal on their own after they spontaneously rupture and discharge pus, which can lead to the development of anal fistulas. This is mainly due to infection of the anal glands that initially causes swelling and lumps around the anus. Once these rupture and release pus, they can form channels that develop into anal fistulas, causing repeated perianal swelling, pain, and the discharge of pus and blood. In this case, it is advised to visit the proctology department of a hospital as soon as possible for a perianal MRI scan to determine the location of the infection and the direction of the fistula tract, followed by determining the surgical method. After the rupture and discharge of a perianal abscess, a definitive one-time surgical procedure is required to treat the abscess to prevent the potential development of a fistula or a complex, high fistula, which could cause significant damage to the patient and increase the complexity of later surgeries.

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Colorectal Surgery
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Precautions for Perianal Abscess

The precautions for perianal abscess mainly include those during an acute episode and post-surgical measures. If it is clearly an acute onset of a perianal abscess, it is important to seek treatment promptly. Treatment methods, besides incision and drainage, further include debridement to achieve a complete cure through surgery. Generally, simple incision and drainage only alleviate temporary pain symptoms. If not followed by definitive surgery, there is a high likelihood of developing anal fistulas, necessitating a second surgery. Post-surgical precautions for a perianal abscess primarily involve maintaining cleanliness of the local wound, changing dressings, and ensuring that the drainage from the wound remains unobstructed to prevent false healing.

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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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Colorectal Surgery
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Symptoms of perianal abscess

Perianal abscess is a common acute infectious disease in proctology. When a perianal abscess occurs, the patient generally experiences severe pain in the anal area accompanied by local skin redness, increased skin temperature, and even systemic fever and fatigue symptoms due to the local abscess. During an outbreak of a perianal abscess, the abscess cavity or pus encapsulation can generally be clearly seen under perianal color ultrasound, and it is necessary to promptly carry out perianal abscess incision and drainage surgery, as well as further one-time radical surgery for the perianal abscess. If not treated actively, a perianal abscess might rupture and likely form an anal fistula, the treatment of which is also primarily surgical.