Anal Abscess: When Is Surgery Necessary?

Anal abscess

Hello, Dr.
Ke! I would like to ask you about my anal abscess, which has been present for about 8 days.
I have seen a doctor at the hospital (I have had three follow-up visits), and the area around my anus is still swollen.
The doctor prescribed antibiotics, and I have been taking them for 6 days, but my condition remains the same.
I have also received antibiotic injections, and today I received an injection for pain relief, but there hasn't been any improvement.
Is surgery necessary for an abscess, or is it not always required?

Chen Chen, 20~29 year old female. Ask Date: 2016/05/07

Dr. Ke Fangxu reply Surgery

Anal abscesses are generally recommended to be treated surgically.
If the symptoms are mild, the procedure can be performed under local anesthesia in an outpatient setting.
In more severe cases, hospitalization may be required.
If surgery is not performed, even if recovery occurs, there is a high risk of developing anal fistula as a complication.
However, if the symptoms have persisted for more than a week, it may be beyond the optimal time for incision and drainage.
It is advisable to consult a colorectal surgeon for specialized medical advice.

Reply Date: 2016/05/07

More Info

When it comes to anal abscesses, the decision to proceed with surgery often depends on several factors, including the size of the abscess, the presence of systemic symptoms, and the response to conservative treatment. Based on your description, it seems that you have been experiencing persistent swelling and discomfort around the anal area for about eight days, despite being on antibiotics and receiving pain relief injections.
Anal abscesses typically occur when a gland in the anal region becomes blocked, leading to an accumulation of pus. The standard treatment for an anal abscess is surgical drainage, especially if the abscess is large or if there are signs of systemic infection such as fever or significant pain. Antibiotics alone may not be sufficient to resolve the infection, as they do not address the underlying issue of the pus accumulation.

In your case, since you have been on antibiotics for six days without significant improvement, it may be an indication that surgical intervention is necessary. The persistent swelling and lack of improvement suggest that the abscess may not be resolving on its own. Surgery is usually performed under local or general anesthesia, depending on the size and location of the abscess, and involves making an incision to drain the pus. This procedure not only alleviates pain but also helps to prevent the infection from spreading.

It is also important to consider that if an abscess is left untreated, it can lead to more serious complications, such as the formation of a fistula, which is an abnormal connection between the anal canal and the skin. This can lead to recurrent infections and may require more extensive surgical intervention in the future.

In summary, while not all anal abscesses require surgery, your ongoing symptoms and lack of improvement with conservative treatment suggest that surgical drainage may be the best course of action. It is crucial to discuss this with your healthcare provider, who can evaluate your specific situation and recommend the most appropriate treatment plan. If you are still experiencing significant pain and swelling, it would be advisable to seek further medical evaluation, as timely intervention can lead to better outcomes and prevent complications.

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