Anal Fistula and Abscess – Managing Perianal Infections
Q: I am a 16 year old girl. I was recently put on antibiotics by my doctor for a lump under the skin, next to my anus. It started small and it was incredibly itchy, so I thought it was a mosquito bite, but it quickly grew to the size of a strawberry. It was round in shape and under the skin; only a faint redness was visible. It was incredibly painful, and I found it difficult to sit, lie down and walk. I had two more similar lumps before this one, one on my right elbow and one on my left hip, though these were not as big or painful as the one near my anus. All three of these had to be squeezed and huge amount of pus came from them, but they’re now gone.
I was taking antibiotics for a week for the most painful of the lumps. As soon as I finished the antibiotics, four more lumps came up, only small, but all of them around my anus. One is particularly painful. I am worried about how painful it could become having four in the same place. I’m also worried about scars they could leave. Is there something that can stop these lumps from appearing in the first place?
Let’s discuss in detail. Painful pus containing lump around the anus is called an anal abscess.
An anal abscess is basically an infected cavity filled with pus found near the anus or rectum. There are small glands just underneath the skin of the anus. Sometimes, they get infected by some bacteria, foreign matter or clogging of their small ducts. This leads to the development of an abscess.
Abscess is always treated by draining it. Usually no additional treatment it required.
If fistula-in-ano are recurrent, they need to be investigated. There are certain conditions which make these infections more likely. They are:
- Colitis or other inflammatory conditions of the intestine
- Physical trauma such as a hard stool or foreign body
- Injury such as a crack (fissure) in the anal tissue
- Crohn’s disease or ulcerative colitis
- An immune system that is not functioning well (immunocompromised condition)
- Pelvic infections such as diverticulitis or appendicitis
- Being the receptive partner in anal sex
- Use of medications such as prednisone
- Any genitourinary infection
- An anal fistula
Presence of an anal fistula is the commonest cause of having recurrent perirectal or perianal abscesses in the anal region.
What is an Anal Fistula?
Bowel fistula is the result of a previous abscess. It is a small tunnel that forms under the skin and connects a previously infected anal gland to the skin on the buttocks outside the anus. After an abscess has been drained, the drainage tunnel may persist connecting the anal gland from which the abscess arose to the skin. Persistent drainage from the outside opening may indicate the persistence of this tunnel. If the outside opening of the tunnel heals, recurrent abscess
All abscesses do not become fistula-in-ano. There is no way to predict if this will occur.
Get the abscess treated first. Antibiotics are a poor alternative as treatment, because they do not completely penetrate the fluid within an abscess. Proper treatment is always draining the abscess surgically.
An opening is made in the skin near the anus to drain the pus from the infected cavity and thereby relieve the pressure. Often, this can be done in the doctor’s office using a local anesthetic.
Then you need to get investigated for the recurrence of these abscesses.
Presence of any anal fistulas is the first cause to be ruled out.
What About Treatment for a Fistula?
Surgery is done. Although fistula surgery is usually relatively straightforward, the potential for complication exists. So it is preferably performed by a specialist in colon and rectal surgery. It may be performed at the same time as the abscess surgery, although fistulas often develop four to six weeks after an abscess is drained, sometimes even months or years later.
This surgery involves opening up the fistula tunnel. This may require cutting a small portion of the anal sphincter, the muscle that helps to control bowel movements. The external and internal openings of the tunnel are joined. Healing begins from the inside out. Most of the time, fistula surgery can be performed on an outpatient basis, unless it is a deep or extensive fistula.
Treatment of an abscess or fistula is followed by a period of time at home, when soaking the affected area in warm water (sitz bath) is recommended three or four times a day. Stool softeners or a bulk fiber laxative may also be recommended. It may be necessary to wear a gauze pad or mini-pad to prevent the drainage from soiling clothes. Bowel movements will not affect healing.
Measures to Prevent Anal Abscess and Fistula
- Using stool softeners if constipated. Very hard stools traumatize the anal opening leading to abscess formation.
- Adding fiber to your diet
- Drinking plenty of water, up to eight-ounce glasses a day
- Using clean, moist pads to wipe the area around the anus, to remove any irritating particle or fluid
- For adults, using condoms during sexual intercourse, including anal intercourse, can help prevent anal abscesses.
Guidelines to keep the lower gastrointestinal tract healthy, hence preventing the occurrence of abscesses:
- Eat food high in fiber.
- Drink plenty of water each day (up to 8-ounce glasses).
- Have regular physical exams to look for underlying diseases of
- Have an active lifestyle, with exercises.