How to deal with a ruptured perianal abscess?

Written by Chen Tian Jing
Colorectal Surgery
Updated on April 24, 2025
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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.

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Written by Chen Tian Jing
Colorectal Surgery
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Can a perianal abscess heal by itself?

During the acute phase of a perianal abscess, there is significant local redness, swelling, heat, and pain around the anus. Generally, this condition is caused by an infection of the anal crypts, and the possibility of self-healing is very low, so the main treatment for a perianal abscess is surgery. The surgical approach usually involves incision and drainage of the perianal abscess, combined with a one-time curative surgery. If the abscess ruptures and forms an anal fistula, surgical treatment is also required. During the outbreak of a perianal abscess, due to the severe local pain, it is advisable to undergo surgery as soon as possible to prevent further spread of the abscess. Simple topical medications can only relieve the symptoms of local inflammatory infection and cannot achieve a cure.

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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 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
57sec home-news-image

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.

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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.