Initial symptoms of perianal abscess

Written by Chen Tian Jing
Colorectal Surgery
Updated on May 25, 2025
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The primary cause of perianal abscesses is recurrent infections at the anal crypts, also known as repeated episodes of cryptitis. Generally, when cryptitis recurs and forms a local infection foci, early symptoms of a perianal abscess include pain in the anus and anal canal, accompanied by pus discharge from the anal canal. When the condition progresses to a certain extent, there will be hard pus pockets or pus formation. Once the infection within the pus pocket completely turns into pus, the patient will experience intense pain, manifesting as throbbing pain. Therefore, to alleviate the pain, it is necessary to promptly incise and drain the pus and further remove the local infection foci completely.

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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 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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How many days is the hospital stay for perianal abscess surgery?

After surgery for a perianal abscess, due to the presence of a local wound and the significant discharge from the wound in the early postoperative period, combined with the potential fall of ligatures or elastic bands at the area, a hospital stay of approximately two weeks is required. For severe cases or those with deeper abscess cavities, a hospital stay of three weeks or even a month might be necessary. The main purpose of the hospital stay post-surgery is to monitor for any major bleeding from the wound, and to facilitate dressing changes. Postoperative dressing changes for a perianal abscess wound are crucial for recovery, as only thorough daily disinfection and dressing changes can ensure uniform granulation and growth of local tissues, prevent the enclosure of pus within the local cavity leading to pseudohealing or reinfection, and thus affect the treatment outcome of the surgery. Approximately one month after surgery, regular follow-up visits are required to monitor the healing of the local wound.

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Written by Yu Xu Chao
Colorectal Surgery
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Does a recurrent perianal abscess occur in the same location?

The recurrence of a perianal abscess may not necessarily be in the same location, but it is possible. If the internal opening was not completely cleared during the first perianal abscess surgery, this could lead to reinfection of the anal glands and subsequently a recurrence of the perianal abscess. In such cases, it is advisable to visit a hospital early for a perianal MRI to determine the position of the internal opening and the extent of the infected tissue. Then, a one-time radical surgery for the perianal abscess can be performed. After the surgery, it is crucial to consistently use medications like red oil gauze, anal wash, and golden ointment for dressing changes, to promote wound healing and avoid pseudo-healing. Additionally, if a perianal abscess was completely cured once, poor diet, lack of sleep, or frequent alcohol consumption could potentially cause abscesses in other perianal areas later. This situation is quite common, so it is important for patients to maintain a light diet.

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Written by Chen Tian Jing
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.