Will surgery still be performed if a perianal abscess has ruptured?

Written by Chen Tian Jing
Colorectal Surgery
Updated on May 05, 2025
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After a perianal abscess ruptures on its own, a fistula-in-ano has formed, which cannot be completely cured by conservative medication. The main treatment method is still surgery, so further surgical treatment is required after the rupture of the perianal abscess. The surgical approach for a perianal abscess or fistula mainly involves an incision and seton technique, preserving the function of the local sphincter as much as possible while thoroughly removing the infection foci to allow the growth of fresh granulation tissue. Post-operation care requires attention to dressing changes, especially during the early stages of the wound when there may be secretions. It is crucial to thoroughly remove these secretions and apply appropriate hemorrhoids ointment or growth-promoting agents to facilitate the healing and growth of the local mucosa.

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Written by Yu Xu Chao
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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Written by Chen Tian Jing
Colorectal Surgery
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Can a perianal abscess be treated with hot compresses?

Hot compress therapy for perianal abscesses is typically chosen after surgery. Prior to surgery, due to the formation of a typical pus cavity in the perianal abscess and the encapsulation of pus fluid, it is an acute infectious foci. Using hot compress therapy can easily lead to further aggravation of the local infection or spread of the pus cavity, which may worsen the condition. Therefore, hot compresses are not recommended before surgery. After promptly conducting surgery on a perianal abscess, since the local wound contains infectious material, it is suitable to fumigate and apply hot compresses postoperatively to disinfect the local wound further, and to manage residual fecal matter to prevent infection. Additionally, changing dressings is necessary to promote the fresh growth of normal granulation tissue, thus leading to the proper healing of the wound rather than pseudohealing or infection.

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Written by Chen Tian Jing
Colorectal Surgery
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Why does a perianal abscess recur?

Perianal abscess is an infectious disease of the local skin and tissues around the anus caused by an infection in the anal crypts. If a perianal abscess is not treated with a definitive one-time surgical intervention, it is very likely to recur, or after rupture of the abscess, to form an anal fistula with long-term intermittent discharge of pus from an external opening. Therefore, during the acute phase of a perianal abscess, once a distinct abscess cavity and pus formation occurs, it is necessary to promptly perform a one-time definitive surgical treatment of the perianal abscess, rather than choosing conservative medication treatment or simple incision and drainage. The above treatments only temporarily alleviate symptoms of a perianal abscess; only a one-time definitive surgery that completely cleans the local wound can result in the complete healing of the perianal abscess.

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Written by Chen Tian Jing
Colorectal Surgery
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Which is more serious, perianal abscess or hemorrhoids?

Perianal abscesses and hemorrhoids are two different types of anorectal diseases. During the acute phase of a perianal abscess, the urgency of the condition is greater than that of hemorrhoids. If active surgical intervention and incisional drainage and debridement are not carried out for a perianal abscess, it can lead to further enlargement of the pus cavity, increasing the size of the infected wound and the focus of infection, causing more severe pain and symptoms of systemic infection in the patient. Hemorrhoids, on the other hand, can be managed with conservative medication to alleviate symptoms. Surgical treatment is considered only when there are recurrent flare-ups, severe pain, significant prolapse, and worsening bleeding.

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Written by Chen Tian Jing
Colorectal Surgery
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How to treat recurrent perianal abscess?

If a perianal abscess has already been treated surgically, it is necessary to develop good dietary and bowel habits postoperatively to reduce the likelihood of recurrence. However, recurrence may still occur due to poor diet and bowel habits of the patient. If there is pain or discomfort at the site of the local wound of the perianal abscess, it is advisable to go to the hospital as soon as possible for an anal examination and perianal ultrasound to confirm if it has recurred. If it is confirmed to have recurred, early surgical treatment is necessary to prevent further expansion of the local infection focus or aggravation of the infection, which would increase the difficulty of treatment later.