Anal abscesses

 
Anal Abscess Illustration
Image from wikipedia {link to
https://en.wikipedia.org/wiki/Anorectal_abscess/}

Although both hemorrhoids and anal abscesses appear to be tissue lumps protruding from the rectum, they are two very different issues that are important to distinguish.

Hemorrhoids could be as painful as anal abscesses when thrombosis develops. Anal abscesses are an infection around the opening of the anus or deep in the rectum, where there is pus. An anal abscess is commonly mistaken for a hemorrhoid upon first notice; however it eventually becomes more painful and leads to a fever.

Hemorrhoids are usually a chronic condition, while anal abscess is an acute disease, which can cause serious complications that could result in death if left untreated. If you are experiencing any of these symptoms, medical attention should be found as soon as possible.

ANORECTAL ABSCESS?
Anorectal abscesses are the result of infection of anal glands in the lining of the anal canal near the opening of the anus. The anal glands secrete fluid into the anal canal, passing through a crevice known as the anal crypt. Most perirectal abscesses form from obstruction of the anal crypts (approx. 90% of cases). Normally the internal anal sphincter acts as a barrier between bacteria in the gut and the tissue surrounding the rectum, but it is possible for bacteria to pass this barrier through the anal crypt. Once bacteria passes through the crypt, it can easily move to the surrounding tissue. This results in the formation of an abscess of varying severity and depth depending on how deep the infection is and where it spreads.

Anal abscesses most commonly occur in the third and fourth decade of life, and are more common in men. Deaths due to anorectal abscesses are very rare.

Most abscess can be easily identified via physical examination and digital rectal examination. Deep rectal abscesses are more difficult to find and may require a CT scan, MRI scan, or ultrasonography to confirm.

Most of the time a perirectal abscess can be detected upon initial examination. Digital rectal examination involves the doctor putting the finger of their gloved hand into the rectum in order to feel out the presence of an abscess. Sometimes anesthetic is used in cases where pain from the abscess would limit the effectiveness of the examination.

Sometimes the formation of a fistula can accompany this infection (approx. 30-60%% of cases). 10% of patients suffer from recurring and chronic anal fistula. An anal fistula is an abnormal passage between the anal canal and the skin near the anus.

TREATMENT
The presence of an abscess warrants surgical incision and drainage as soon as possible. Just antibiotics would be ineffective at this stage in the infection. Delaying surgical intervention can result in tissue destruction, fibrosis (scar tissue formation), and impaired anal continence.

Drainage of perianal abscesses involve a small incision above the abscess made as close to the anus as possible. After 24 hours the gauze is removed. Postoperative care involves sitz baths three times a day and after bowel movements. Painkillers and stool softeners may be prescribed for pain and constipation. The patient will follow up with the doctor 2-3 weeks later. After the procedure, antibiotics are generally not necessary in healthy adults.

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