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A Pain in My Ass

Back in late October, I started getting some serious painage down in the valley and I had no idea what was going on. I felt swelling, tenderness, and much much pain. From there I decided to see a doctor. I just went to a normal family practice place. The kind with about 50 doctors–all of whom could really care less about you and your problems. After explaining my symptoms to the doctor and a quick exam, he determined I had a hemorrhoid. So he prescribed me some very expensive cream and sent me on my merry way. About a month later, in early December, I still was feeling the symptoms I originally felt. Only this time, they were accentuated to the extreme. One night, I just could not handle the…

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 Perianal Abscess: A Painful Problem for Your Butt

99% of the time, the term “pain in the ass” is a metaphor for a mild inconvenience. But if you’re reading this, chances are your pain in the ass is way too literal. One of the more common culprits of butt pain is a perianal abscess, which is basically a pimple on steroids that camps out near your b-hole. These things are filled with pus, hurt like hell, and turn everyday activities like sitting, coughing, and pooping into a living nightmare.

Articles of Interest

Why Does My Perianal Abscess Keep Coming Back?

A recurring perianal abscess is often an indicator of an anal fistula, so out first recommendation is to treat the anal fistula through surgical drainage of the fluid. Although that can sound scary, this is actually a routine surgery that’s very minimally-invasive! Patients typically require the use of a local anesthetic, and the surgery can be performed in an outpatient setting.

Biomaterials in the Treatment of Anal Fistula: Hope or Hype?

Treatment of AF is challenging. Options abound with variable results. Biologic alternatives typically should be considered low-risk options with variable success rates. While they do provide hope as we develop newer material, initial results are not necessarily associated with significant long-term advantages over traditional surgical treatment. The

Do you have an anal abscess?

An anal abscess is a condition that occurs when there is a buildup of pus near the anus. They can be quite painful. The most common cause of anal abscesses is an infection that develops in the anal glands. The most common type of anal abscess is a perianal abscess, which looks like a swollen boil near the anus.

Perianal Abscess/Fistula Disease

Fistula management is much more complicated. It requires striking a balance between rates of healing and potential alteration of fecal continence. This, therefore, requires much more finesse. Many techniques are now available in the armamentarium of the surgeon who treats fistula-in-ano.

Perianal/Perirectal abscess

Perianal abscesses begin with infection of anal crypt gland, usually polymicrobial. A perianal abscess occurs when that infection tracts down to the perianal skin, manifesting as a superficial, tender mass near the anus. When the infection tracts to any other space- intersphincteric, ischiorectal, or supralevator- a perirectal abscess results. This is one of the few remaining situations where a digital rectal exam (DRE) is critical, as a intersphincteric or supralevator abscess may have little to no external findings but be palpable on DRE. Isolated perianal abscess is the only type of abscess that can be adequately treated in ED. Surgical referral is important due to frequent formation of fistulas. In fact, it is recommended to make the incision as close to the anus as possible so that if a fistula forms, it will be as short as possible. Perirectal abscesses should be drained by surgeons in the OR.

The Low Down on Ano-Rectal Disorders

Emergency physicians are often uncertain about when and how to drain perianal abscesses. We worry about abscesses being too deep and beyond our scope of practice. Although there are many complex terms and designations for abscesses in the various potential spaces of the ano-rectal region, a simple rectal examination can usually determine if an abscess requires surgical referral for drainage. Severe pain or fluctuance ascending proximally along the ano-rectal canal should alert the clinician to the presence of a deeper (perirectal) abscess. Perirectal abscesses are best drained in the operating room under general anesthesia. In some instances, these also involve other abnormalities, such as fistulae, which also require surgical repair.

The Silent Enemy: Understanding the Hidden Dangers of Perianal Abscess 


While some health conditions are more widely recognized, others remain silent enemies that can cause discomfort and serious complications if left untreated. Perianal abscess is one such condition that often goes unnoticed until symptoms become severe.

What You Need to Know About Perianal Abscess and How to Deal with It in an Emergency Case?

All ages, including infants, kids, and adults, are susceptible to developing perianal abscesses. They could be brought on by a number of things...

Resources

American Society of Colon and Rectal Surgeons

An anal abscess is an infected cavity filled with pus found near the anus or rectum. Ninety percent of abscesses are the result of an acute infection in the internal glands of the anus. Occasionally, bacteria, fecal material or foreign matter can clog an anal gland and tunnel into the tissue around the anus or rectum, where it may then collect in a cavity called an abscess. An anal fistula (also commonly called fistula-in-ano) is frequently the result of a previous or current anal abscess. This occurs in up to 50% of patients with abscesses.

JETem

Perianal abscess typically presents as severe pain in the anorectal area that is constant and unrelated to bowel movement. Physical exam signs include perianal erythema with an associated palpable, often fluctuant, mass. However, physical examination may not adequately differentiate between a perianal abscess and perirectal abscess.

Patient

The outcome is good if the abscess is treated promptly. One study found that 31% of patients who had incision and drainage of perianal abscess developed a fistula. Patients aged under 40 years and patients without diabetes seemed to be at higher risk.

StatPearls

Perianal abscesses are the most common type of anorectal abscesses. These abscesses can cause significant discomfort for patients. They are located at the anal verge and if left untreated, can extend into the ischioanal space or intersphincteric space since these areas are continuous with the perianal space. They can also cause systemic infection if left untreated.