A Family Doctor's Tale - ANORECTAL ABSCESS

DOC I HAVE ANORECTAL ABSCESS

Recently I have an elderly patient who had a bad fall on his buttocks.

He developed an anal abscess which spread up to the rectum.

He was sent to the hospital and incision and drainage of the abscess was done.

He was sent home and daily dressing was done by a home visiting nurse.

However he developed a high fever and was sent to another hospital where the surgeon felt the surgery was too shallow and never reach the ischio rectal abscess.

A second surgery was done to reach the deeper abscess which was finally drained properly.

After 2 months the wound finally healed.

It is important to note that sometimes the abscess may be deeper than usual or another deeper abscess may be present.

So if the patient do not improve a MRI should be done to detect a deeper abscess.


Anorectal abscess is a pocket of pus in the anal  and rectal region.


Perianal abscess lies under the mucosa within the external anal sphincter.

Ischiorectal abscess is situated in deeper tissues above the anal sphincter and in the ischiorectal fossa.

People who are prone to anorectal abscess are:

1.Diabetic patients who are always prone to infections


2.AIDS or immunity compromised diseases

3.Cancer patients or other patients (SLE, rheumatoid arthritis, psoriasis ) who are on anti cancer drugs

4.Patients with Crohn's disease and ulcerative colitis are also prone to anorectal abscess


Anorectal abscess is caused by infection in the anal glands of the anal mucosa and becomes abscesses or pockets of pus.

1.Trauma or injury causes cell damage and infection

2.Small mucosal tears from hard feces(constipation) may lead to infection

3.Anal fissures, hemorrhoids can also lead to abscess

Most infections are E.coli infections which is common in the small and large intestine.

Less often the causative agent is  staphylococcus



Symptoms start off with:
1. throbbing pain around the anus


2. sitting, walking, defecation painful

3.Fever, chills, malaise

4.Abscess may be seen on inspection or rectal exam

Diagnosis of  Anorectal abscess is by:
1.Symptoms of
a.anal swelling and pain

b.proctoscopy of anus and rectum


c.swab & culture of any infected area

2.ESR raised very high sometimes > 30

3.moderate leucytosis

4.Trans-rectal Ultrasound and MRI will detect clearly the abscess and its extent




The complications are:
1.colitis - further infections of the lower colon


2. Anal fistula usually develop if the abscess is left untreated

3.Septicemia and rarely death


Treatment of Anorectal abscess is by:

1.Incision & drainage of the anorectal abscess under local anesthetic or general anesthesia is the treatment of choice as there is need to release the pus before the infection spread further.

Hospitalisation is therefore necessary as the wound is never stitched but left  open for the pus to drain out and healing to occur naturally


2.Antibiotics is needed after the causative agent is determined

3. Analgesics and pain killers is needed for pre and post-operative pain

4.The patient is advised to soak in a basin of warm water with small amount of salt


Prevention for Anorectal abscess is :


1.Avoiding constipation using stool softeners


2.Proper control of underlying diseases such as diabetes, immunity deficient diseases

Prognosis of Anorectal abscess is usually good with proper surgical treatment.

Early therapy with antibiotics may produce good results