Perianal Abscess

Overview

What is a perianal abscess?

A perianal abscess is a boil-like lump filled with pus found near your anus, rectum or perineal area (the space between your genitals and anus). It happens when one of the glands in your anus becomes clogged and infected. Pus and fluid collect in the anal gland, and the result is an extremely painful abscess around your anus (the hole in your buttocks).

Your anus is the last part of your digestive system. It’s a 2-inch long canal consisting of your pelvic floor muscles and two anal sphincters (internal and external). Your sphincters are muscles that open and close to allow stool (poop) to pass through. There are many mucus-secreting glands in your anus. When one of these gets clogged, it can lead to infection and the formation of an abscess.

Perianal abscesses are also called anal abscesses or anorectal abscesses.

Who gets perianal abscesses?

Perianal abscesses are most common in men or people assigned male at birth (AMAB). It’s more likely to occur between the ages of 20 and 60. Certain factors can increase your risk.

Who is at risk for a perianal abscess?

You may be at higher risk for developing an abscess in your perineal area if you have any of these conditions:

Other risk factors include:

  • You’re pregnant.
  • You smoke cigarettes.
  • You take prednisone, drugs used to treat cancer or drugs that suppress your immune system.
  • You have frequent diarrhea or constipation.
  • Placing objects in your rectum (like during sex).

Symptoms and Causes

What are the symptoms of a perianal abscess?

The most common symptom of a perianal abscess is a swollen and tender boil (similar to a large pimple) near the edge of your anus. It may be red, extremely painful or constantly throbbing. Sitting down, coughing and pooping may make it hurt worse.

Other signs and symptoms of an anal abscess include:

  • Pus-like discharge from the anus.
  • Pain in your anus or rectum.
  • Lump or nodule that’s red, swollen and painful.
  • Constipation or painful bowel movements.
  • Irritation of the tissue around your anus.
  • Rectal bleeding.
  • Pain in the lower part of your abdomen.

Abscesses can also cause fever, chills and other flu-like symptoms.

What causes perianal abscesses?

Most perianal abscesses form when a gland is blocked or clogged inside of your anus. There are many glands in your anus. An abscess forms when bacteria or stool (poop) gets trapped inside one of these glands and gets infected.

Other causes of perianal abscess are:

  • An infected anal fissure (tear in the lining of your anus).
  • Trauma to the area (like during anal sex).
  • STIs.
  • Medical conditions that affect the bowels or intestines.
  • An infected epidermoid (sebaceous) cyst in your perianal area. Compared with the classic perianal abscess, an infected cyst is usually less painful and less likely to cause fever and other general symptoms.
  • Hidradenitis suppurativa. This chronic disease involves special skin glands found in certain areas, such as your armpits, groin, perianal, perineal and under your breasts. Perianal hidradenitis can cause abscesses around your anus.

Diagnosis and Tests

How is it diagnosed?

Your healthcare provider diagnoses perianal abscesses with a rectal exam. They insert a gloved, lubricated finger into your rectum and feel around for irregularities. A speculum (a device that helps open hollow body parts) may help your healthcare provider view your entire rectum. They may be able to see external abscesses without using any tools. However, some abscesses aren’t on your skin’s surface or are located deeper in your skin.

Your healthcare provider may also perform a proctosigmoidoscopy. They’ll insert a narrow tube into your anus. The tube has a tiny camera and light on the top. You may also have a CT scan, MRI or ultrasound test. This is especially helpful if the abscess is deep in your rectum.

Your healthcare provider may want to rule out other conditions like rectal cancer or other more serious diseases.

Management and Treatment

How do you treat a perianal abscess?

Treatment involves your healthcare provider opening and draining the pus from the abscess. Don’t attempt to drain an anal abscess on your own. Most people feel immense pain relief once the abscess is drained.

Your healthcare provider can drain an abscess at their office using a numbing agent and a small scalpel or needle. Your healthcare provider makes an incision in the abscess to allow the pus and fluid to drain out. In the case of a large or deep abscess, general anesthesia may be needed, and the procedure takes place at a hospital.

Depending on the location and severity of the abscess, your healthcare provider may place a catheter in the area for continuous drainage. In most cases, you won’t need stitches and a bandage is placed over the area.

Your healthcare provider may recommend the following after surgery:

  • Sitting in a warm sitz bath several times a day. A sitz bath is when you submerge your anus and genital region in a tub of warm water. It helps soothe pain and swelling and promotes healing.
  • Prescription antibiotics to stop the infection or for people with a weakened immune system.
  • Laxatives or stool softeners to prevent painful bowel movements.
  • Over-the-counter pain medication or, in some cases, prescription pain medicine.

How can I take care of a perianal abscess at home?

Some perianal abscesses can be treated at home using warm compresses and sitz baths. It’s always a good idea to see your healthcare provider first to ensure they don’t want to drain the abscess. Some healthcare providers may permit an abscess to drain on its own without surgical drainage. Because this depends on several factors, visiting your healthcare provider is recommended. If the abscess breaks open on its own, you run the risk of spreading the infection.

How long does it take for a perianal abscess to heal?

It takes three or four weeks for a drained abscess to heal completely. According to the American Society of Colon and Rectal Surgeons, about half of people who have an anal abscess will develop an anal fistula (an infected tunnel between their skin and anus).

Should you pop a perianal abscess?

No, you shouldn’t pop a perianal abscess. This can spread infection or make the abscess worse.

What do I do if a perineal abscess bursts?

If a perineal abscess bursts, try your best to keep the area clean. Wash the area with soap and water, then cover it with a bandage. It can still be infected or cause infection, so keep an eye on it for several days to make sure it’s healing.

Prevention

How can I prevent a perianal abscess from returning?

You can reduce your chances for recurrent abscesses by:

  • Managing any medical conditions you have that increase your risk for anal abscesses like diabetes or IBD (inflammatory bowel disease).
  • Practicing good hygiene in your anal and genital area.
  • Using condoms during anal sex to prevent STIs and the transfer of bacteria.

Certain health conditions that increase your risk for abscesses might be impossible to avoid. Getting treatment for these conditions and being aware of how they may increase your chances of anal abscesses is important.

Outlook / Prognosis

Is a perianal abscess serious?

Perianal abscesses generally aren’t serious and highly treatable. However, call your healthcare provider if your symptoms worsen or don’t improve after treatment.

What are some complications of a perianal abscess?

Treatment for anal abscesses is usually successful. If complications occur, they could include:

  • Anal fistula.
  • Recurring abscesses (keeps coming back).
  • Infection or sepsis (a life-threatening complication of infection).
  • Fourniers gangrene (a serious bacterial infection of your perineum).

Living With

When should I see my healthcare provider?

An anal abscess can cause complications if it’s left untreated. You should call your healthcare provider if you experience:

  • Severe pain and discomfort.
  • Rectal bleeding.
  • Fever and chills.
  • Swelling in your rectal area.

Frequently Asked Questions

What’s the difference between hemorrhoids and an abscess?

Hemorrhoids are hard lumps that form inside of your rectum or outside of your anus. They can be uncomfortable and cause bleeding. Unlike abscesses, hemorrhoids aren’t an infection. Hemorrhoids are swollen veins that often go away on their own with over-the-counter creams. Abscesses tend to be more painful and larger than a hemorrhoid. Hemorrhoids are more firm, while abscesses are warm and tender to the touch. An abscess can cause complications and lead to fever, chills and other symptoms if left untreated. A hemorrhoid is usually more of a nuisance.

A note from Cleveland Clinic

A perineal abscess is an annoying and painful condition caused by a clogged anal gland. Luckily, abscesses are highly treatable and don’t usually lead to complications. Certain health conditions can increase your risk of developing perineal abscesses. It’s important to monitor any bumps or nodules in your rectal area and let your healthcare provider know if you experience signs of infection like fever and chills. In most cases, surgically draining the abscess at your healthcare provider’s office provides relief.

Last reviewed by a Cleveland Clinic medical professional on 06/17/2022.

References

  • American Society of Colon and Rectal Surgeons. Abscess and Fistula Expanded Information. (https://fascrs.org/patients/diseases-and-conditions/a-z/abscess-and-fistula-expanded-information) Accessed 6/17/2022.
  • Colon & Rectal Surgery Associates. Anal Abscess/Fistula. (http://www.colonrectal.org/services.cfm/sid:6602/Anal_Abscess/Fistula/) Accessed 6/17/2022.
  • Lu D, Lu L, Cao B, et al. Relationship Between Body Mass Index and Recurrence/Anal Fistula Formation Following Initial Operation for Anorectal Abscess. (https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6822332/) Med Sci Monit. 2019;25:7942-7950. Accessed 6/17/2022.
  • Merck Manual. Anorectal Abscess. (https://www.merckmanuals.com/professional/gastrointestinal-disorders/anorectal-disorders/anorectal-abscess) Accessed 6/17/2022.
  • Sigmon DF, Emmanuel B, Tuma F. Perianal Abscess. (https://www.ncbi.nlm.nih.gov/books/NBK459167/) 2021 Jun 29. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing; 2022 Jan-. Accessed 6/17/2022.

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