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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What is the internal opening of a perianal abscess?

The internal opening of a perianal abscess primarily refers to the anal crypt. It forms an infection site due to prolonged, repeated inflammatory infections, generally characterized by distinct pus discharge from the internal opening. Therefore, perianal abscesses tend to form a local internal opening near the anus along with intermittent pus discharge. If the perianal abscess acutely flares up or the pus cavity spreads, it might also rupture, causing pus to exit from an external opening, thereby leading to the formation of a typical anal fistula. During the acute phase of a perianal abscess, if there is local internal opening pain or pus discharge, it is recommended to seek surgical treatment as soon as possible. The primary method of surgery is aimed at radical treatment in one session. The principle involves opening the local pus cavity to allow for the discharge of pus, followed by a thorough debridement and removal of the local infection site. However, it is necessary to preserve the function of the local anal sphincter. If needed, a seton procedure may also be performed.

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Written by Chen Tian Jing
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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Written by Chen Tian Jing
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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Written by Chen Tian Jing
Colorectal Surgery
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Can I eat eggs with a perianal abscess?

Patients with perianal abscess can eat eggs, but during the acute onset period of a perianal abscess, besides sticking to a light diet, it is more important to seek surgical treatment as soon as possible. A perianal abscess is an acute infectious disease near the anal sinuses. Typically, it presents with severe local pain in the anus. Once pus forms, it is encapsulated in the abscess cavity and needs to be surgically drained as soon as possible to remove the infection thoroughly. This helps to prevent further enlargement of the abscess cavity and worsening of the condition. Furthermore, in the early postoperative period, patients can consume liquid foods and eat eggs in moderation or other easily digestible foods. However, they should avoid spicy and irritating foods such as chili peppers and seafood.

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Written by Yu Xu Chao
Colorectal Surgery
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If pus is draining from a perianal abscess, does that mean it's getting better?

The discharge of pus from a perianal abscess does not indicate improvement. This situation is due to the spontaneous rupture of the perianal abscess, which can easily lead to the formation of an anal fistula. Since a perianal abscess is caused by an infection of the anal glands and can infect the surrounding tissues, the simple discharge of pus without clearing the internal opening and infected tissues will not resolve the problem. Furthermore, there is a risk of recurrent episodes that may even result in more severe swelling. Therefore, it is necessary to seek early treatment at a hospital's colorectal surgery department for a definitive one-time surgical resolution of the perianal abscess, removing the internal opening and infected tissues. Post-surgery, medications like anal washes and potassium permanganate solutions should be used for dressing changes. Additionally, medications like erythromycin ointment strips and mupirocin ointment can be used to promote healing of the local surgical site. Patients should also maintain perianal hygiene, ensure smooth bowel movements, and avoid dry, hard stools that may irritate and cause pain or bleeding at the wound site.