Anal Abscess

ANAL ABSCESS pain

Last Updated June 3rd, 2019

Overview

Since the anus is one of the orifices of the body communicating directly with the external environment, it is particularly vulnerable to infection. The glands, ducts, and lining of the anal canal are the usual sites of infection. An anal abscess usually develops when the anal glands get blocked or plugged with fecal matter, bacteria or foreign material which then collects in a cavity-causing irritation and inflammation.

These can easily appear in infants and young children if sufficient care is not taken to maintain hygiene during diaper changes. Among adults, sexually transmitted infections are also, at times, responsible for this often painful condition. Anal abscesses are not uncommon but since they are often spontaneously resolved, not all patients seek medical intervention.

 

Definition

Anal abcess dischargeAn anal abscess is a pus-filled cavity that is caused by infection of the cryptoglandular tissue of the anal canal. Externally, these manifest as tender, often painful reddish boils or lumps located around the rim of the anus. Less often, these are situated deeper in the tissue and do not present externally except in the form of fever.

The infectious agents usually implicated in this condition are a variety of common bacterial flora found in the gut and on the skin. Abscesses initially arise in the intersphincteric space of the anal canal and then spread outward from there, the infection spilling into one or more of the spaces surrounding the anal canal. They may drain spontaneously. Otherwise surgical incision and drainage is the preferred mode of treatment.

 

Causes

The primary cause of the anal abscess is an infection which may be contracted in a number of different ways including sexual intercourse or postoperative infection. Common aerobic and anaerobic bacteria such as Escherichia coli, Clostridium, Bacteroides fragilis, Staphylococcus aureus, and Streptococcus are usually responsible.

  • Blockage of anal glands can lead to infection and abscess formation.
  • Sexually transmitted infection.
  • Anal fissures are breaks in the skin surrounding the anus. These can be infiltrated by bacteria and become infected, developing into abscesses.
  • In rare instances, appendicitis can lead to supralevator abscesses. There are also certain risk factors that can increase the likelihood of an individual developing anal abscess:
  • Taking certain immunosuppressant medications.
  • Chemotherapy.
  • Constipation, since it can result in anal fissures.
  • Anal intercourse which can lead to anal fissures and infections if adequate protection is not used.
  • Inflammatory bowel disorders such as Crohn’s disease or ulcerative colitis.
  • Weakened immunity due to diseases such as HIV or AIDS.
  • Pregnancy.
  • Diarrhea.
  • Obesity.
  • Tuberculosis.
  • Anorectal or blood cancers.
  • Diverticulitis.

 

Symptoms

The telltale externally noticeable boils are usually easy to identify. However, when an abscess is located deeper within the tissues, as in the case of the supralevator variety, fever may be the only sign. The general symptoms of this condition are as follows:

  • Painful, reddish swelling in the area adjacent to the anus. This may be warm to the touch.
  • Rectal discharge that may be accompanied by bleeding.
  • Persistent throbbing pain in the anal region. The pain may be exacerbated by movement or by sitting.
  • Fever and chills.
  • Fatigue.
  • The difficulty with bowel movements or urination.
  • Sciatica and acute lower back pain may present in some cases of the supralevator abscess.
  • Infants may show signs of discomfort and irritability.

 

Types of Anal Abscess

ANAL ABSCESS painDepending on its specific location within the anal region, an abscess can be of four main types. Those that are located more superficially, such as the perianal kind, are by far more common. The ischiorectal variety is the next most common, followed by the intersphincteric and supralevator varieties.

  • Perianal: This accounts for nearly 60% of anal abscesses and results from the spread of infection to the area directly below the surface of the skin surrounding the anus. Tender, reddish lumps are externally noticeable and may be accompanied by some itching.
  • Ischiorectal: Infection spreads into the ischiorectal space of the anal region, with minimal external indications apart from some reddening of the skin surface and hardening of the underlying tissue. Symptoms such as fever, chills and severe pain are more common.
  • Intersphincteric: Infection remains confined to the intersphincteric space.
  • Supralevator: These account for only about 3-4% of the incidence of the anal abscess. They may be caused by the spreading of infection from intersphincteric or ischiorectal abscesses. They may even occur as a result of Crohn’s disease or diverticular disease.
  • Submucosal: 1% of all diagnosed cases are of this variety. Sometimes the abscess spreads in such a way as to partially encircle the area around the anus and this form is known as a horseshoe abscess.

 

Clinical Complications

Nearly half of all cases of anal abscess are found to progress into a chronic condition known as an anal fistula. A fistula is an abnormal tunnel connecting the abscess itself with the skin surrounding the anus. In the event of incomplete drainage of infected material during surgical treatment, the abscess can reappear soon afterward. Recurrent abscess formation commonly leads to the development of an anal fistula.If untreated or inadequately treated, infection from the abscess can spread to other locations and cause a systemic infection.

 

Diagnosis

A physical examination usually reveals the presence of the painful lump or boil characteristic of a perianal abscess. When they are more internally located, abscesses may be difficult to detect solely by means of physical examination. Anesthesia administered prior to examination aids the process by minimizing the patient’s pain and discomfort.

Digital rectal examination helps identify ischiorectal abscesses although intersphincteric and the rarer supralevator varieties generally only become apparent through diagnostic imaging. A computerised tomography (CT), magnetic resonance imaging (MRI) and anal ultrasonography help locate the abscess. associated fistulae if any and possible adverse effects on the anal sphincters or other internal structures. Screening for sexually transmitted diseases, inflammatory bowel diseases or other conditions such as cancer might be required to establish whether there is a causative relationship.

 

Treatment and prevention

Treatment – if it is a minor case if abscess, a local aesthesia can be given; and the abscess drained. In severe cases, a more intensive form of treatment may be needed –

  • Surgical drainage of the abscess and repair of the fistula.
  • Antibiotic treatment.
  • Placement of steton if continuous drainage is needed.

Preventions 

  • Manage diabetes.
  • Use a condom if you are partaking in anal sex.
  • In the cases of inflammatory bowel diseases such as Crohn’s, medication is usually provided to prevent abscess.

Facts

  • In the United States, the estimate incidence rate is between 68,000-96,000 cases per year.
  • Perianal suppuration affects 1-2:10,000 per year and represents about 5% of all proctology consultations.

Facts

  • Men are affected more compared to women with a 2:1 ratio.
  • Frequently, this is a benign condition in infants.

Facts

  • If the site of the abscess has not healed within 2-3 months a fistula should strongly be suspected and necessary steps must be taken.

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Dos and Don'ts

Dos
  • Sit in an 8-10 centimeter sitz bath 3 times a day and after a bowel movement. This helps with the pain and itching.
  • If you are prescribed with antibiotics, take them as directed.
  • Follow the doctors’ instructions if you are sent home with a drain or a package of the abscess.
Don'ts
  • Consume high-fiber foods; increase your fiber intake slowly.
  • Partake in any strenuous activity.
  • Skip your pain medications. If they do not work ask your doctor for different ones.

 

 

 

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Power up your gut: 8 proven steps on how to improve your digestion Did you know you have a colony of bacteria in your gut that help you in digesting food?…
Find all the instant ways to get rid of blackheads Blackheads - Not only are they aesthetically unappealing but if left untreated these can cause bacterial overgrowth on…
Tattoo Aftercare: The best practices to follow once you get inked Planning getting permanently inked? Make sure you follow these critical tattoo aftercare techniques to avoid infectious agents attacking…
Oxalates: How healthy greens can sometimes be bad news for your kidneys Oxalates are compounds present in a majority of healthy foods. However, at times an overconsumption of these could…
Inversion Therapy: The anti-gravity way of healing chronic back pain Inversion therapy involves suspending a person upside dow using different types of equipment. This works by taking the…
Barium-enema
Barium Enema Barium enema is also known as colon x-ray. Here, the patient is asked to consume small amount of…
vdrl test syphilis
VDRL Test The VDRL test is a blood test that is used to diagnose sexually transmitted or venereal diseases, primarily…
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Anemia Profile Anemia Profile test (Basic) is a blood screening test that measures the levels of important components of the…
immunoglobulin M
Immunoglobulin M Test Immunoglobulin M is the largest and the first produced antibody which helps in the prevention or fighting of…
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Keep your shoulders pain-free with these shoulder exercises Shoulder exercises are important in order to prevent chronic back and neck pain. Learn more about how you…
sugar toxic health
Sugar: 7 new shocking truths revealed about the sweet poison Can drinking soda bring you closer to death? Is sugar slowly poisoning you and your family? You would…
avocado benefits
Avocado: 15 reasons why this fruit should be a staple in your diet Did you know that the word avocado literally means "testicles". Don't get grossed out as this power-packed fruit…
Beware of these common foods that cause high bodily inflammation! Maybe its the long list of inflammatory foods in your diet that is making you frequently sick. Find…
Coconut sugar: What is it and is it healthier than table sugar? In the long list of things that the wonderful coconut gives us, coconut sugar is another remarkable addition.…
The complete “what to eat” guide for gluten intolerance Does eating breads and pastas often makes you nauseous? Gluten intolerance is a common reason why you might…
Hibiscus: Nourish your beauty and health with these vibrant blooms Hibiscus is a trumpet shaped flower found abundantly in tropical countries. It has been historically used for its…
How to correctly perform nasal irrigation using a Neti Pot? Neti pot has been a part of Ayurveda since centuries. This ancient tool is extremely effective in treating…
Pescatarian Diet 101: What are the inherent health advantages of this diet? People opt to become a pescatarian in order to enrich their bodies with the essential health benefits that…
Erythritol: A healthy sugar substitute or yet another marketing ploy? Erythritol is a popular choice of a healthy alternative sweetening agent in foods. But how healthy can a…
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What does hypoglycemia look like when you don’t have diabetes? Hypoglycemia is not just a disease that co-occurs with diabetes. Non-diabetics could also become hypoglycemic. Hypoglycemia can be…
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Beware: Ignoring these tell-tale signs of stroke could cost a life The signs and symptoms of a stroke differ depending on which part of the brain has been affected.…
Bubble Tea: Bubbling with nutrition or a hidden sugar mine? The tapioca pearls present in the tea looks like bubbles and hence the name bubble tea became popular.…
GGt test
GGT – Gamma-Glutamyl Transferase Test GGT or gammaglutamyl transferase test is a liver function test that is used to detect the extent of…
EEG
Electroencephalogram – EEG EEG or electroencephalogram is a diagnostic tool used to access the functioning of neurons and brain activity to…
Tachycardia heart
Cardiac Profile Cardiac profile is panel of blood tests performed to check cholesterol level and other heart disease markers to…