perianal abscess

Make sure you care of your tushy as well!

Perianal abscess is a superficial infection that appears as a tender red lump under the skin near the anus. The infection occurs when bacteria gets trapped in the crypt glands that line the anal canal. The bacteria and fluid (pus) build up and becomes a lump that is red and painful (like a “pimple”). It may drain pus on its own and then heal and disappear. 

Perianal abscess is diagnosed on physical examination. No other imaging study is necessary. The abscess may be firm, red, and tender to the touch. If left untreated, the infection can spread locally to the buttock area. The location of the abscess can be not determined by physical examination and requires additional X-ray study, either CT scan or MRI of the pelvis.

Perianal abscess can sometimes be treated at home with Sitz baths or warm water soaks with each bowel movement or at least 2-3 times a day. The abscess can drain pus on its own and then heal without needing any other treatment. When the infection has spread locally to the surrounding buttock area, antibiotics are prescribed to treat the skin infection. In addition, an abscess that does not drain by itself may need to be drained in the office by the pediatric surgeon. This may be all that is needed to treat the abscess and allow the skin to heal permanently. Perianal abscess may return and require repeated warm water soaks or drainage.

For those who have repeat infections, there may be a fistula that has formed and is causing bacteria contamination and abscess development. You surgeon will discuss the option of fistulotomy. This an operation that is done in the operating room under general anesthesia. The operation is an outpatient procedure, and you will go home the same day. During the operation, the surgeon identifies the opening in the anal canal that connects to the opening in the skin. The tube-like connection is cut opened. The incision that is made during the fistulotomy is left open and not closed with stitches. This open wound will heal and close by itself in one to two weeks. While the area is healing, no infection will occur in the wound, even with bowel movements. You can help keep the area clean by having a warm bath after every bowel movement. This will clean and soothe the area while it is healing. Antibiotic is not needed at this time. Prescription pain medication is not routinely required after this operation. Patients usually only need acetaminophen or ibuprofen once they are at home.