Anorectal boils or abscesses are pus-filled cavities that form within the grooves of the anal canal (called the anal sinuses). Depending on where it occurs, it may also be called an anal abscess, rectal abscess, perianal abscess, or perirectal abscess.
Anorectal abscesses are most often caused by the accumulation of bacteria in weak or damaged tissue. Although abscesses can form spontaneously, they are commonly associated with inflammatory bowel disease or conditions that affect the immune system, such as HIV. It usually needs to be drained by your health care provider.
This article describes anal and rectal abscesses, also known as boils. We will also discuss its causes and its treatment.
Berrywell / Laura Porter
Symptoms of anorectal abscess
Anorectal abscesses are usually first recognized by a dull, throbbing pain in the anus or rectum, often accompanied by sharp pain during bowel movements.
Perianal abscesses (“perianal” meaning around) are the most common type and are usually visible because they occur in the upper layers of tissue. The lump is usually soft, red, and warm to the touch.
In contrast, perirectal abscesses tend to form in deeper tissues and are more often felt than seen. Of the two types, perirectal infections tend to be more severe.
Once the pus begins to solidify and form a palpable lump, other symptoms of an anorectal abscess appear, including:
- heat
- Malaise
- constipation
- Rectal discharge and bleeding
- I feel like going to the toilet even though I don’t want to.
- Pain increases, often persists, and worsens when moving or sitting
If you experience any of these symptoms, it is important to consult your health care provider and undergo a thorough examination.
complications
If an abscess is left untreated, it can develop an anal fistula, an abnormal tunnel connection between the skin around the anus and the rectum or anal canal, through which stool and pus can drain. This may require intensive surgery and a long recovery.
If you develop a high fever (100.4 degrees or higher), shaking chills, persistent vomiting, inability to defecate, or extreme anal or rectal pain (with or without defecating), go to the emergency room without delay. These may indicate a systemic infection that has spread from the abscess site to the bloodstream.
Without proper treatment, this type of systemic infection can lead to sepsis, toxic shock, and even death.
anal abscess and hemorrhoids
Anal abscesses and hemorrhoids are both swellings that occur in the rectum or anus. Abscesses are usually much larger and more painful than hemorrhoids. Because abscesses are caused by infection, they are hot and painful to the touch. The pain from an abscess tends to get worse over time. You may also experience systemic symptoms of infection that are not normally experienced with hemorrhoids, such as fever and nighttime chills.
Hemorrhoids are dilated veins that form in the rectum or on the anus. Hemorrhoids feel harder than abscesses and are not caused by infection, although they can become infected.
cause
Anorectal abscesses can occur on their own and are often caused by an overgrowth of common bacteria in the gastrointestinal tract, such as: Escherichia coli (Escherichia coli).
However, in recent years, cases of drug-resistant bacteria such as methicillin-resistant bacteria have been increasing. Staphylococcus aureus (MRSA).
Anyone can get an anorectal abscess, young or old, but there are several medical conditions that can increase your risk. They include:
- Inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis
- HIV and other forms of immunosuppression
- Diabetes
- anal sex
- Chronic or severe constipation or diarrhea
- Use of steroid drugs, including prednisone
- chemical treatment
- sexually transmitted infections of the anus or rectum
- Hidradenitis suppurativa, a rare skin disease
- Infected fissure or epidermoid cyst
diagnosis
Most anorectal abscesses are diagnosed based on medical history and physical examination. If the abscess has invaded the anal canal, your health care provider may want to perform an anoscopy using a flexible anoscope to get a closer look inside.
Less commonly, if the abscess is particularly deep, imaging tests such as a computed tomography (CT) scan or transrectal ultrasound (TRUS) may be used.
During a physical exam, your health care provider will want to determine whether the mass is an abscess or a hemorrhoid. The two conditions can usually be distinguished by the presentation of symptoms. Abscesses do not respond to standard hemorrhoid treatments.
If IBD, HIV, or diabetes is suspected, other tests may be ordered, such as blood tests or a colonoscopy.
process
Anorectal abscesses rarely heal on their own or with antibiotic treatment alone. In most cases, a healthcare provider will need to drain the abscess. This is a relatively simple in-office procedure that uses local anesthetic, a scalpel, and forceps.
If the abscess is particularly deep or located high in the rectum, surgery may need to be performed in a hospital under general anesthesia. The surgery usually takes about 30 minutes. Some of the extracted pus may be sent to a laboratory to identify the causative bacteria.
Once the procedure is complete, antibiotics will be prescribed for about a week to treat the infection and prevent further spread. Here are some home remedies that can help you during your recovery.
- Take a sitz bath (a shallow basin used to soak and clean the anal area)
- Taking painkillers such as Tylenol (acetaminophen)
- Use stool softeners to reduce abrasion and promote healing of drained abscesses.
- keep the area clean
After defecating, pat yourself dry with toilet paper and rinse with a squirt bottle filled with lukewarm water. Wash lightly with soap, but avoid alcohol or hydrogen peroxide, which can slow healing. Pad the wound with gauze or maxi pads if necessary.
You can also ask your health care provider about the short-term use of over-the-counter topical creams or gels to help soothe the anal tissues.
Draining the abscess provides almost immediate symptom relief. You may feel some pain after the procedure, but it is usually relatively mild. However, if you experience excessive rectal bleeding, fever, chills, or vomiting after returning home from the procedure, contact your health care provider right away.
Can I drain the boil myself?
Do not try to drain the boil yourself. What looks like a small boil or abscess may be a deeper, more widespread infection.
When heat is applied, the boil may open up naturally, making it easier for water to drain. However, it is best to have a health care professional drain the abscess in the office to ensure the area is kept sterile. Your health care provider will usually prescribe antibiotics and may also test for pus to determine the type of infection.
Can an abscess come back?
Anal abscesses may recur. In fact, up to 44% of anorectal abscesses recur within 1 year after surgery. You can reduce the chance of this problem occurring by:
- Ensure that any conditions that increase the risk of developing an abscess are properly managed
- Practice safe sex to reduce your risk of contracting sexually transmitted diseases
Recurrent abscesses around the anus may be related to anal fistulas. Your health care provider will need to surgically drain and fix the fistula and prescribe antibiotics to remove the infection and prevent recurrence.
summary
An anal abscess is a pus-filled lump that forms on or around the anus. It is caused by a bacterial infection. In addition to the painful lump, symptoms such as fever, constipation, discharge, and bleeding may occur.
Abscesses usually do not go away on their own and require a medical professional to drain the pus. If an abscess is not treated, an anal fistula may develop, and repair may be necessary.