Can an anal abscess be left untreated without surgery?

Written by Chen Tian Jing
Colorectal Surgery
Updated on November 30, 2024
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Surgical treatment is required during the acute phase of a perianal abscess. If surgery is not performed, it could lead to an expansion of the abscess cavity or worsening of the infection. Severe cases may lead to a local cellulitis around the anus, forming an inflammation of the cellular tissue. The surgical approach for a perianal abscess primarily involves incision and drainage, complemented by a one-time radical cure. The surgical principle mainly involves excising the infected local lesions altogether, thoroughly disinfecting and dressing the area, accelerating the shedding of the local infection, and ensuring normal growth of granulation tissue. Postoperative dressing changes are also crucial for the recovery from a perianal abscess.

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Written by Chen Tian Jing
Colorectal Surgery
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Can a perianal abscess heal by itself without rupturing?

Perianal abscesses that have not ruptured generally involve two scenarios. First, the application of topical or oral antibiotics may eliminate the local abscess, but some infection foci and swelling may persist, with a possibility of recurrence later. The second scenario occurs when the abscess does not rupture, but the pus chamber further expands, leading to an increase in the area of infection and thus worsening systemic infection symptoms. Once a perianal abscess is detected, it is necessary to treat it promptly. If an early-stage typical pus chamber has not formed, antibiotics can be used for symptomatic treatment to reduce local inflammation. If a clear pus chamber has formed and is accompanied by pus, it is advisable to promptly perform an incision and drainage of the abscess, followed by a definitive surgical debridement.

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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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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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Colorectal Surgery
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Can you eat fish with a perianal abscess?

Patients with perianal abscesses should avoid eating seafood or consuming excessive amounts of seafood products. Because fish and seafood are considered to provoke symptoms in traditional beliefs, their overconsumption can lead to congestion and swelling of the local mucosa. Along with an acute infection of a perianal abscess, food may exacerbate the infection. Therefore, the diet of patients with a perianal abscess should primarily be bland. Additionally, once a perianal abscess is detected, it is necessary to perform an incision and drainage procedure for the abscess promptly, as well as a one-time debridement and radical surgery to prevent the further expansion of the abscess cavity or recurrent infection leading to the formation of anal fistulas.

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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.