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Perianal Abscess
Perianal abscess refers to an abscess which occurs along the margin of the anus. The anus is a muscular orifice which permits the regulation of bowel function. A bacterial infection in the skin, usually a plugged skin gland, gives rise to this common problem. This problem is seen more often in patients with a history of Crohn's disease. Common symptoms and findings include: marked swelling and tenderness to an area on the margin of the anal opening. Pain with defecation, a pus-like discharge, and constipation are common. Some patients may have a fever and appear more systemically ill depending on the size of the abscess. Evaluation is by history and physical examination. Digital rectal examination, although painful, will allow the physician to make the important determination of whether or not the infection extends further into the rectum (last portion of the colon). Blood tests may be done to determine blood counts (CBC). Cultures of discharge (pus) may be performed allowing the physician to positively identify the bacteria responsible. Treatment is with incision and drainage of the well localized perianal abscess. A local anesthetic will be used. Often a "drain", or piece of gauze, is left packed in the abscess cavity to encourage drainage. The gauze is commonly removed within 24-48 hours, after which the patient begins warm soapy tub soaks (several times a day). The abscess cavity heals and will completely close by itself. Antibiotics may be indicated in some cases. More advanced infections that extend further into the rectum may require surgical drainage in the operating room under general anesthesia. This problem can be treated by the Emergency Physician in the majority of cases. More serious infections which extend into the rectum will require General Surgery referral.
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