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Anal abscess

Anal abscess

WHAT IS AN ANAL ABSCESS?

An anal abscess represents the acute phase of an infection that originates in microscopic glands located within the anal canal which have the task of secreting mucus to facilitate the passage of faeces. The abscess is a circumscribed collection of pus located superficially near the anus (called perianal abscess) or deeper (for example the ischiorectal abscess and the pelvirectal abscess).
 

ANAL ABSCESS CAUSES: WHERE AND WHEN THE INFECTION IS BORN

The infection that leads the anal abscess is produced by the penetration of bacteria or foreign material inside very small glands that we can imagine as small bottles with the neck facing the anal canal. This obstruction causes slowing of secretions, stagnation, subsequent infection and abscess formation. The pathologies, factors and conditions that can lead to the development of an anal abscess are many:

  • local trauma;
  • alteration of the faeces consistency;
  • rectocolitis and proctitis;
  • chronic inflammatory bowel diseases (e.g., Crohn’s disease);
  • surgical complications;
  • sexually transmitted diseases;
  • reduced immune defences.

 

THE SYMPTOMS THAT ACCOMPANY THE ANAL ABSCESS

The symptoms may differ depending on the type of abscess. While deep abscesses are less painful and can create generalised malaise, fatigue, febrile states and abdominal pain, in the case of a perianal abscess the symptoms are characterised by:

  • intense and pulsating burning and pain in the anal region;
  • swelling in the vicinity of the anus;
  • redness of the patient’s skin.

The swelling is usually not immediately felt, as the collection of pus and consequent swelling are the final stage of the pathological process. The pain, on the other hand, tends to increase progressively and can become continuous throughout the day, intensifying especially during defecation.
 

DIAGNOSIS AND THERAPY: HOW TO CURE ANAL ABSCESS

When you experience symptoms that may make you suspect the formation of a perianal abscess, it is always advisable to consult a specialised proctologist in order to assess its extent and to implement the most suitable therapy. Diagnosis is made from the objective examination and, when necessary, from the image diagnostics. When no redness or external oedema occurs, the proctologist may formulate an anorectal abscess by diagnosis through digital exploration followed by anoscopy. Other tools that help the proctologist to have a clearer vision are the transrectal ultrasound and the CT scan, especially in case of suspicion of a deep abscess.

The anal abscess is treated by a rapid surgical incision followed by adequate drainage, without waiting for the abscess to open spontaneously. Many abscesses can be drained in outpatient conditions, under local anaesthesia; deeper abscesses may require drainage in the operating room, with spinal or general anaesthesia. The specialist doctor may also prescribe antibiotics to patients that are immunosuppressed, diabetic or that already have an infection.

It frequently happens that the anal abscess opens naturally to the outside through the skin, in this case it is necessary to undergo a proctological medical examination in order to ensure correct cleaning and healing. Even with appropriate treatment, the abscess can, in about half the subjects, lead to the formation of an abnormal channel which starts from the anus or rectum and flows externally onto the skin or into an internal cavity, thus forming a fistula.
 

POST-OPERATIVE TREATMENT AND HEALING

After surgery, it will be necessary to follow a post-operative course: dressings, painkillers, control visits, until full recovery. In the period following the operation, it is normal to experience:

  • irritation, pain, burning and itching;
  • slight red-yellowish blood loss;
  • fever;
  • difficulty in containing gas.

It is normally recommended not to sit for long periods and to always use a therapeutic cushion, to properly and gently wash the treated area and prefer a high-fibre diet. Spicy foods, alcohol, coffee, chocolate and all those foods that can create inflammation are not recommended.

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