This month we take a brief look at perianal abscess. These conditions are often linked across a spectrum whereby an abscess may develop into a fistula over time. An abscess usually starts as an infection of the anal oil glands within the anal sphincter complex. As the infection enlarges, it begins to become uncomfortable with symptoms noticed in the anal region. These may start as a vague discomfort but worsen as the infection, now called an abscess, increases in size. The natural progression of the infection is to find a point of weakness and burst through – this can be in the direction of the rectum/anal canal internally, or towards the skin near the anus externally. 

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The next stage is discharge of the abscess which can often relieve the initial discomfort. At this point, many abscesses will begin to subside and a simple course of antibiotics may allow complete resolution of the symptoms. However, a formal drainage procedure may be required and this is undertaken in hospital. 

This may be the end of this episode for many patients. In some cases, however, there may be residual infection which leads to recurrent abscesses or the infection may cause a tunnel between the rectum/anal canal and the skin, traversing the initial site of infection. This is called a fistula. 

In most cases, there is no underlying cause of developing an abscess. Risk factors include disease states where the immune system is compromised such as taking steroids or chemotherapy; diabetes; inflammatory conditions of the bowel such as Crohn’s disease.

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If you are concerned you may have experienced such symptoms or are concerned an abscess may be developing into recurrent disease or a fistula, please do get in contact.

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Take care,

Manish Chand

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